Sao Tome and Principe to address maternal deaths and business impact on child rights

Sao Tome and Principe presented its consolidated 2^nd to 4^th periodic reports on the situation of the implementation of the Convention on the Rights of the Child in the country. The 5^th and 6^th periodic reports are expected by June 2018.

IBFAN did not present any alternative report.

Discussion on infant and young child feeding

The Committee did not address issues related to breastfeeding. However, it tackled the question of maternal mortality in relation to HIV/AIDS infections. The delegation of Sao Tome and Principe explained that it is currently taking steps to eradicate these infections by 2015. Counseling centers for sexual health have been established in schools and awareness-raising activities are being organized for young persons.

Concluding Observations

No recommendation specifically refers to breastfeeding in the Concluding Observations. The CRC Committee instead mentioned the importance of a good health care system. It drew attention to its General Comment no. 15 (2013) on the right of the child to enjoy the highest attainable standard of health. It therefore recommended Sao Tome and Principe to: “(a) allocate adequate human, technical and financial resources to improve the quality of health care and provide quality training for the health care personnel, particularly at local levels; (b) Undertake surveys and studies on the extent and root causes of maternal mortality throughout the country and apply the findings therein for formulating and implementing comprehensive programmes for addressing maternal deaths: and, (c) Seek financial and technical assistance from UNICEF and the World Health Organization (WHO), among others, in this regard” (para 48-49).

The CRC Committee also insisted on improving the access to safe drinking water. It recommended the State party to: “(a) intensify its efforts to improve access to safe drinking water and sanitation, and in doing so pay particular attention to rural and outlying areas” (Para 54-55).

Another paragraph was dedicated to HIV/AIDS. The Committee recognized the efforts of Sao Tome and Principe to decrease the mother-to-child transmission of HIV/AIDS rate by spreading HIV/AIDS testing for pregnant women. However, the Committee noticed that regular follow-up on infected mothers and children remain inadequate and that the access to antiretroviral treatment limited. Therefore, the CRC Committee recommends Sao Tome and Principe to: “(a) Sustain the measures in place to prevent the Mother-to-Child transmission of HIV/AIDS and develop a roadmap to ensure the implementation of effective preventive measures; (b) Improve follow-up treatment for HIV/AIDS-infected mothers and their exposed infants[...] and (d) Improve access and coverage of Antiretroviral Therapy and Antiretroviral prophylaxis for HIV infected pregnant women. In doing so, the Committee recommends that the State party seek technical assistance from, inter alia, the United Nations Joint Programme on HIV/AIDS (UNAIDS) and UNICEF” (para 52-53).

Finally, the CRC Committee drew Sao Tome and Principe’s attention to the General Comment No. 16 (2013) on State obligations regarding the impact of the business sector on children’s rights and recommended Sao Tome and Principe to have a clear regulatory framework and effective implementation and monitoring mechanisms to ensure that business activities do not negatively affect the rights of the child. Concerning that issue, the Committee recommended in particular Sao Tome and Principe to: “(b) Ensure effective implementation by companies, especially those of the extractive industries, of international and national environment and health standards, effective monitoring of implementation of these standards and appropriately sanctioning and providing remedies when violations occur, as well as ensure that appropriate international certification is sought; (c) Require companies to undertake assessments, consultations, and full public disclosure of the environmental, health-related and human rights impacts of their business activities and their plans to address such impacts; and, (d) Be guided by the United Nations “Protect, Respect and Remedy” Framework, accepted unanimously in 2008 by the Human Rights Council, while implementing these recommendations” (para 23- 24).

63rd CRC Committee: Recommendations on breastfeeding to Armenia, Guinea-Bissau, Israel, Rwanda, Slovenia and Uzbekistan

The 63rd session of the Committee on the Rights of the Child (CRC Committee) took place in Geneva from 27 May to 14 June 2013. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 6 countries: Armenia, Guinea-Bissau, Israel, Rwanda, Slovenia and Uzbekistan.

IBFAN submitted alternative reports on the situation of infant and young child feeding for all the countries under review. Some of the reports were written in collaboration with IBFAN groups and contacts in the countries and the regional offices.

In its concluding observations, the CRC Committee referred specifically to breastfeeding in 5 out of the 6 countries. With the exception of Israel, all the other countries received concluding observations on infant and child nutrition, and breastfeeding in particular.

The Committee recommended states to promote adequate infant and young child feeding practices including exclusive breastfeeding of children up to the age of 6 months (Armenia, Guinea-Bissau, Rwanda and Uzbekistan), to support exclusive breastfeeding and ensure that parents and communities are informed about it and its advantages (Guinea-Bissau and Uzbekistan). The Committee has stressed the need to collect data on breastfeeding (Slovenia) and to adopt international definitions for data collection in order to, inter alia, identify intervention for infant mortality reduction including BFHi and breastfeeding information (Uzbekistan). Adopting a national law or policy on breastfeeding is another recommended action (Armenia and Guinea-Bissau).

All countries that received direct recommendations on breastfeeding issues are urged to revitalize or start to implement the Baby Friendly Hospital Initiative.

Emphasis is put on the importance of controlling marketing practices of breastmilk substitutes. Some countries are recommended to monitor, or strengthen the monitoring of, existing marketing regulations and to take action against violations (Armenia and Slovenia), while others are urged to adopt and enforce the International Code of Marketing of Breastmilk Substitutes (Guinea-Bissau, Rwanda and Uzbekistan), with Uzbekistan specifically recommended to adopt it as national law. In the case of Slovenia the recommendations on the Code are quite elaborated, with mention to regulation of also bottles and teats and to safeguarding against marketing in Maternity Care Institutions.

Regarding maternity protection at work, Uzbekistan is recommended to extend the post-birth period of the maternity leave in order to facilitate exclusive breastfeeding for 6 months, while Guinea-Bissau is advised to ratify the ILO Convention concerning the revision of the Maternity Protection Convention (Revised), 1952 (No.183).

On health more generally, the CRC Committee focused on the need to ensure equal access to health care services, with regard to both urban-rural differences and ethnic differences (Armenia, Israel, Rwanda and Slovenia). Access should also not impeded by the practice of informal fees, that should be eliminated (Armenia and Uzbekistan). The Committee highlighted the importance of quality of health care services that should be pursued by allocating adequate human, financial and technical resources to the health sector (Armenia, Guinea-Bissau, Israel, Rwanda and Uzbekistan).

Combating and preventing childhood obesity (Armenia and Slovenia) and preventing mother-to-child transmission of HIV (Armenia, Guinea-Bissau, Uzbekistan) are other important issues addressed in the concluding observations.

For the full report read here

Children’s Rights in Guinea-Bissau at the CRC Committee

The situation of children’s rights in Guinea-Bissau has been reviewed by the Committee on the Rights of the Child (CRC Committee) at its 63^rd session, on June 7^th 2013.

IBFAN presented an alternative report on the country situation vis-à-vis infant and young child feeding. The report shows how, although improving, breastfeeding rates are still insufficient: only 38% of infants were exclusively breastfed for 6 months in 2010, and in 2012 72% of babies were initiated to breast within one hour from birth, while the introduction of complementary food is not timely for more than half of infants.

Inadequate breastfeeding practices contribute to the high child and maternal mortality rates in Guinea-Bissau, where 9% of children die before their first year of life. Breastfeeding promotion activities took place in the country thanks to international cooperation partners, however projects are expiring this year and the country does not have the means to maintain them on its own.

Maternity protection at work is another challenge for Guinea-Bissau, where maternity leave is as short as 2 months and the relative benefits are paid by the employer, situation which carries the risk of generating a discriminatory effect against women, as employers may want to avoid paying such benefits.

During the interactive dialogue between the CRC Committee and the country delegation, the issue of breastfeeding has not been addressed in detail but only briefly mentioned in the context of health care. On this point, the country delegation assured the Committee that the national health system extends to all national territory, including rural and remote areas. The country is engaged in developing health plans, including a strategic plan on HIV/AIDS, on water and sanitation, and a financial strategic plan to reach the millennium development goals that will cover breastfeeding promotion and maternal mortality reduction programs. Regarding reproductive health services, the country delegation noted that prenatal consultation is free and includes counselling to pregnant mothers.

Other issues debated at the session included a wide range of topics: child adoption, juvenile justice, birth registration, infanticide, paedophilia, violence against children, child labour, children in street situation, education, child marriage and children with disabilities.

The dialogue between Guinea-Bissau and the Committee has been very collaborative and the country delegation was well aware of Guinea-Bissau’s shortcoming in realizing children’s rights in the country; however it stressed that due to financial constraints many improvements are not achievable at the moment.

ISRAEL’S BREASTFEEDING PRACTICES ARE IMPROVING

On Monday 3^rd May 2013 the situation of children’s rights in Israel, including the Occupied Palestinian Territories, have been reviewed by the Committee on the Rights of the Child (CRC Committee) at its 23^rd session.

The International Baby Food Action Network (IBFAN) presented an alternative report on the situation of infant and young child feeding.

The issue of breastfeeding was tackled by the CRC Committee that asked about the absence of a database for the collection of data and of a law on marketing of breastmilk substitutes and about the situation of BFHI and of maternity protection at work.

In particular, one Committee mentioned the maternity protection law providing that a female employee who is prohibited from working at certain jobs by law because of her breastfeeding is entitled to be excused from work and this absence is tantamount to leave without pay and asked clarification on its interpretation in order to avoid discrimination of women that decide to breastfeed.

The delegation could not answer all the questions due to time restraints; however they reported improvements in breastfeeding rates as they already reached the goals set by the government for the year 2020. To further support breastfeeding, each government facility must provide space for breastfeeding or for expressing breastmilk.

The delegation also explained how the International Code of Marketing of Breastmilk Substitutes is enforced is some situations, for example vis-à-vis advertising companies. In addition, they mentioned the 2003 Remedia case concerning a bulk of imported infant formula that lead to some children dying and some other being irreversibly harmed due to lack of a fundamental vitamin, and as a result all imported formula is now carefully examined. It was also noted that HIV positive mothers are given free breastmilk substitutes.

Finally, the Committee was concerned by reports of delays at checkpoints also involving pregnant women that are seeking medical assistance.

The delegation informed that within the West Bank all roadblocks have been removed and therefore there are no restrictions on the freedom of movement. To enter Jerusalem there still are checkpoints and roadblocks but there are not recent reports of delays in passage of pregnant women and all the military personnel is specifically trained to let though medical cases as expeditiously as possible.

Breastfeeding situation in Slovenia

The situation of the implementation of the Convention on the Rights of the Child in Slovenia has been reviewed at the 63^rd session of the Committee on the Right of the Child (CRC Committee), on Wednesday 6^th June.

IBFAN presented its alternative report where it highlighted that Slovenia has only few provisions of law implementing the International Code of Marketing of Breastmilk Substitutes.

The issue of breastfeeding has been touched upon during the interactive dialogue between the CRC Committee and the country delegation.

Slovenian delegation reported that their country puts a special emphasis on breastfeeding, in laws, policies and guidelines (e.g. in the ‘Guidelines on Healthy Diet for Young Children’), where it has pledged to increase exclusive breastfeeding for the period 0-6 months of the baby’s life.

According to the delegation, breastfeeding rates are high in Slovenia, with 97% of breastfed babies up to 3 months and 2/3 exclusively breastfed in 2010.

Slovenia has also adopted a ban on marketing of breastmilk substitutes, while many maternity clinics are mother-friendly hospitals.

Breastfeeding is included in labour legislation according to which mothers have the right to breastfeed breaks until the baby is 18 months of age, without loss of payment.

The problem of high incidence of obesity in the country was also addressed by the delegation. In a US-EU countries ranking on obesity, Slovenia falls in the first third with the most obese population. Obesity is a complex issue and it is mentioned in several policies: on physical activity, on nutrition, etc. Vending machines have been abolished in schools and a policy on healthy diet in schools is subsidized by the State.

BREASTFEEDING IN UZBEKISTAN AT THE CRC COMMITTEE

At the 23^rd session of the Committee on the Rights of the Child (CRC Committee) the situation of children’s rights in Uzbekistan has been reviewed on Tuesday 4^th May. IBFAN presented its alternative report on the state of infant and young child feeding in the Country, noting the high infant and maternal mortality rates and the very low rate of exclusive breastfeeding at 6 months of age (only 26%).

The CRC Committee asked information on measures to prevent infant and maternal mortality and on breastfeeding practices and the implementation of the International Code on Marketing of Breastmilksubstitutes.

The Uzbek delegation mentioned two programs designed and implemented in the Country in collaboration with UNICEF, namely the ‘Growth and development for young children’ program and the ‘Breastfeeding’ program to monitor the health of newborns. As a result of these efforts, over the last 10 years the proportion of breastfeeding has increased to 80%.

It is not clear if the data provided by the delegation concerns exclusive breastfeeding and if it reports a national average or it relates only to focus communities involved in UNICEF programs, therefore such data does not provide a clear picture of the situation of breastfeeding rates in Uzbekistan.

The question on marketing of breastmilk substitutes remained unanswered.

Concerning maternal and infant mortality, the Country delegation reported a 10% of maternal mortality in 2012 and a 4% of infant mortality in the same year. These data are much lower than those reported by UNICEF in 2010-2008 (30% of maternal mortality and 44% of infant mortality) and it might be due to discrepancies in data collection, a general problem acknowledged by the Uzbek delegation and being tackled at the national level.

Breastfeeding in Rwanda

On Thursday 30^th and Friday 31^st May the situation of children’s rights in Rwanda has been reviewed by the CRC Committee at its 63^rd session, where the question of breastfeeding has arisen.

IBFAN has submitted an alternative report on the situation of infant and young child feeding in Rwanda. The report notes that there are no baby-friendly hospitals; there is no legislative measure that implements the Code in Rwanda, only a draft measure; the policy on children’s health defines breastfeeding as a duty of mothers, putting the burden on women, and putting them in a vulnerable position and that the duration of maternity leave is short, only 12 weeks, and starting from the second 6 week mothers are entitled to receive only 20% of the salary. In addition, maternity benefits are paid for by the employer, which may result in employers discriminatory employment practices against women.

During the CRC session, the Rwandan delegation reported efforts to educate parents on breastfeeding and train pregnant women during the prenatal and postnatal period, in addition to campaigns on food production that is appropriate for young children.

It further explained that exclusive breastfeeding for 6 months is the practice followed in Rwanda. After a Committee member clarified that for the first 6 months of a baby’s life exclusive breastfeeding is the best feeding practice and that no other milk should be given, the Rwandan delegation added that soy milk is given as a complementary feeding after the first 6 months of age to combat child malnourishment.

The situation of BFHi has been briefly touched upon by a Committee member in the context of Rwanda’s Early Childhood Development Policy but the Country delegation did not elaborate on that.

More broadly on reduction of malnutrition, the delegation provided information on efforts to combat the problem through a national program for elimination of malnutrition. It also reported a 2009 screening program that reached each child in all villages where malnutrition is an issue. The screening program has been followed by an emergency program to accelerate the elimination of malnutrition. Other interventions include information on how to prepare local foods, economic empowerment of families, home gardens and kitchens for villages.

Other questions pertained to education, children with disabilities, leisure time and recreation, refugee law, mechanisms to tackle violence against children, discrimination of minorities, child labour, juvenile justice and adolescent reproductive health.

WHA Resolution Tackles Conflicts of Interest

The 65^th World Health Assembly (WHA) took place in Geneva in May and discussed an Implementation plan on infant and young child feeding. 

Proposed by Canada, UK, Swaziland and Mexico, the WHA adopted a new resolution WHA 65.6 on Maternal, infant and young child nutrition . 

It calls on governments to strengthen controls on the marketing of breastmilk substitutes and to establish “adequate mechanisms” to deal with conflicts of interest. 

The Resolution will be especially important in relation to the new partnerships and “multi-stakeholder” arrangements that are springing up to tackle poor nutrition - many of which are pushing fortified processed baby foods and fuelling the multi-billion “business of malnutrition”.

WHA 65.6 also mandates WHO "to provide clarification and guidance on the inappropriate promotion of foods for infants and young children".

More on this on IBFAN website