Ethiopia at the CRC: Very Low Rate of Skilled Attendance at Birth Compromises Neonatal and Maternal Health as well as Early Initiation of Breastfeeding

On May 22th, 2015, the Committee on the Rights of the Child considered the combined third to fifth periodic report of Ethiopia on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Ethiopia was led by H.E. Mrs. Zenebu Tadesse Woldetsadik, Head of delegation and Ministry of the Minister of Women, Children and Youth Affairs and H.E.Mr. Almaw Mengist Ambaye, State Minister of the Ministry of the Women, Children and Youth Affairs.   

On this occasion, IBFAN presented an alternative report to inform the CRC Committee on the situation of infant and young child feeding in Ethiopia.

General overview of breastfeeding in Ethiopia

Ethiopia presents high maternal and infant mortality rates and very low rates of skilled attendance at birth (10%). In such a context, IBFAN is particularly concerned about the low rates of exclusive breastfeeding within one hour after birth (51%). In addition, data show that exclusive breastfeeding is interrupted much too early (median duration of exclusive breastfeeding: 2.3 months).

IBFAN is also worried by the lack of systematic monitoring of breastfeeding indicators and the absence of information available on the results of the national policies and strategies related to infant and young child feeding, such as the National Nutrition Programme2013-2015 and the National Strategy for Child Survival.

In Ethiopia, only few provisions of the International Code of Marketing of Breastmilk Substitutes have been implemented and there is no information available on the National Breastfeeding Committee and on its activities. Besides, the Baby-Friendly Hospital Initiative is poorly implemented throughout the country, while the maternity leave is too short to enable working mothers to breastfeed exclusively up to 6 months. In addition, nursing mothers are not entitled to breastfeeding breaks.

 Finally, it is of concern that the 2013 Policy and Strategy on Disaster Risk Management does include measures to protect and support breastfeeding in emergencies, despite the fact that this topic is addressed in the 2004 National Nutrition Strategy for Infant and Young Child Feeding.

Discussion on infant and young child feeding

The CRC Committee highlighted that the breastfeeding rates are low in the country and pointed out the short median duration of breastfeeding. In addition, the Committee expressed concern about the partial implementation of the International Code and the lack of medical assistance during childbirth.

The Ethiopian delegation stated that the reduction of child mortality it is a top priority for the government and that new programmes focused on newborn health have been recently developed. The delegation also affirmed that increased financial support has been allocated to child health and that 30,000 health care workers have received specific training on newborn care.

In relation to nutrition, the delegation explained that the National Malnutrion Task Force is working in collaboration with the Breastfeeding Committee to coordinate all measures related to the 2004 National Nutrition Strategy for Infant and Young Child Feeding. The measures taken have led a reduction of the rates of stunting, underweight and child mortality under 5 years.

Regarding breastfeeding, the delegation highlighted that 52% of infants are exclusively breastfed until 6 months of age, while 98% are ever breastfed. The delegation explained that there are cultural beliefs that compromise the practice of exclusive breastfeeding (e.g. the belief that infants need to receive water). Therefore, the government implemented campaigns and activities to promote breastfeeding among mothers. Finally, the delegation noted that information on the International Code is delivered to health professionals during their pre- and in-service training.

Concluding observations

In its Concluding Observations, the Committee referred indirectly and directly to infant and young child feeding. 

After having welcomed the reduction of maternal, infant and under-five mortality rates, and the extension of immunization coverage and breastfeeding, the Committee expressed concerns about the very low per capita spending on basic health. It also deeply regretted the persistence of regional disparities in the provision of health services, and that malnutrition, infant, under-five and maternal mortality rates remain high (§55). Therefore, the Committee recommended Ethiopia to increase the annual expenditure per capita on health and eliminate disparities in the provision of health services as well as prenatal and postnatal care and immunization coverage (§56a). Moreover, Ethiopia was urged to implement the OHCHR Technical Guidance on child mortality (A/HRC/27/31), paying particular attention to rural and remote areas (§56b). Finally the Committee stressed the need to develop and implement policies to improve health infrastructures, and intensify training programmes for all health professionals, including the pastoralist health extension workers (§56d). 

With regard to the HIV/AIDS pandemic, the Committee urged Ethiopia to consider taking measures in order to eliminate geographical disparities regarding HIV and access to treatment, by enhancing free access to neonatal care and prevention of mother-to-child transmission (§58a). It also called for the improvement of the access to quality, age-appropriate HIV/AIDS, sexual and reproductive health services (§58d).

The Committee also made direct reference to breastfeeding, calling on Ethiopia to effectively address malnutrition in terms of stunting, wasting and low weight, particularly in rural and remote areas and develop public awareness programmes on food diversity consumption of nutritious food and on the benefits of breastfeeding in collaboration with the WHO and the UNICEF (§56c).