The Issue of Breastfeeding in Armenia (CESCR)

On the 7^th of May 2014, the Committee on Economic, Social and Cultural Rights considered the combined second to third periodic report of Armenia on how the country is implementing the provisions of the International Covenant on Economic, Social and Cultural Rights.

IBFAN presented an alternative report on the situation of infant and young child feeding in Armenia, prepared by Confidence Health NGO.

General overview of breastfeeding

The report showed in particular how the International Code on Marketing of Breastmilk Substitutes is violated in hospitals. It additionally reported on how NGOs registered violations of the International Code in some baby-friendly certified hospitals since the implementation and monitoring of the Baby-Friendly Hospital Initiative (BFHI) has been discontinued in 2008. The report also mentions the existence of a draft law on the marketing of breastmilk substitutes, its weaknesses and possible improvements. Nevertheless, after the report was written, there have been some positive developments that resulted in a strengthening of the draft law. Other than that, the report also states that the overall situation of breastfeeding in Armenia has improved over the last decades by the increasing breastfeeding rates. Yet, in the last couple of years the situation of breastfeeding has come to a stall and progress has stopped.

One of the key challenges that Armenia is currently facing relates to complementary feeding, which is often nutritionally inadequate, as a result of lack of knowledge. This has led to increasing rates of stunting, anaemia and overweight among children.

Discussion on infant and young child feeding

No specific questions on breastfeeding or infant and young child feeding have been formulated. However, regarding the issue of payment of informal fees to healthcare by patients,  raised by the experts, the delegation stated that it had made all primary health services free of charge.

CECSR Concluding Observations

In its Concluding Observations, the Committee recommends Armenia to monitor and assess the impact of measures taken to advance the economic, social and cultural rights (para 7). It further recommends Armenia to adopt measures to expedite the elimination of discrimination against women and girls (para 22). 

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

Armenia to Adopt the Draft Law on the International Code and Strengthen BFHI Monitoring

In view of the 63^rd session of the CRC Committee, IBFAN presented an alternative report on the situation of infant and young child feeding in Armenia, prepared by Confidence Health NGO in collaboration with GIFA. The report showed in particular how the International Code on Marketing of Breastmilk Substitutes is heavily violated in hospitals and how NGOs registered violations of the International Code also in some baby-friendly certified hospitals since the implementation and monitoring of the Baby-Friendly Hospital Initiative (BFHI) has been discontinued in 2008. In addition, the report mentions the existence of a draft law on the marketing of breastmilk substitutes, its weaknesses and possible improvements. However, after the report was written there have been some positive developments that resulted in a strengthening of the draft law.

The CRC Committee reviewed the situation of children’s rights in Armenia on Wednesday 29^th May. The issue of breastfeeding and infant and young child feeding were raised by the Committee, in particular in connection with the issues of the International Code and of BFHI. Questions were answered by the representative of the Ministry of Health (MOH).

The International Code of Marketing of Breastmilk Substitutes

The Committee inquired on the plans of the government to finalize the draft law on the marketing of breastmilk substitutes and to adopt it as law and monitor it.

On this point, the Armenian delegate noted that the Country is in the process of adopting a law[i] prohibiting advertising of artificial food, including infant formula, and providing for measures to punish health workers that cooperate with distributors of infant formula. The parliament has just had a hearing on this law, and the MOH representative expressed her persuasion that the law will go through, despite lobbying against it by companies, because legislators look very favourably at it.

Baby-Friendly Hospital Initiative

The Committee asked information on government’s plans to monitor practices in hospitals, where breastfeeding is not always properly encouraged and where infant formula can be provided to mothers.

MOH representative reported that 60% of babies are born in baby-friendly hospitals, where infant formula provision is not allowed, and explained that monitoring of baby-friendly hospitals is carried out by NGOs.

The CRC Committee expressed its disappointment on the lack of government initiative in monitoring of baby-friendly hospitals practices and on the lack of countrywide implementation of the initiative, and asked the government to justify it.

The MOH delegate explained that in all Armenian hospitals babies are kept with the mother; however she acknowledged that the supply of infant formula to mothers is indeed an actual practice. She also explained the lack of State monitoring of BFH with the fact that very active NGOs – especially IBFAN – are carrying it out and the State works hand in hand with them in this area. The delegate further acknowledged that sometimes medical personnel work with distributors of infant formula and may encourage mothers to use it. In this case she considers the State collaboration with NGOs a positive practice.

Undernourishment

More broadly on nutrition, the representative acknowledged that the Country faces a problem of undernourishment mostly related to lack of vitamins. In Armenia children are not going hungry but they are not developing fully: there is a problem of undergrowth that a strategy developed with the assistance of UNICEF tries to tackle. The government delegate reminded that it is not only a health problem, but also of poverty and education.

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[i] The draft law is named "Breastfeeding promotion and regulation of infant food marketing”