Timor-Leste at the CRC: Low Coverage of Skilled Attendance at Birth and High Prevalence of Acute Malnutrition

On September 25, the Committee on the Rights of the Child considered the combined 2^nd to 3^rd periodic report of Timor-Leste on the situation of the implementation of the Convention on the Rights of the Child in the country.

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

General overview of breastfeeding in Timor-Leste

Timor-Leste is characterized by high rates of child stunting (50%), underweight (about 38%) and moderate or severe malnutrition (about 11%), associated with low delivery care coverage and evidences of inappropriate feeding practices. Almost 30% of babies are born without the assistance of a skilled attendant, while only 22% of mothers give birth at health facilities. Additionally, the median duration of breastfeeding had decreased from 17.7 months in 2003 to 17.5 months in 2009/10 and less than 20% of children aged 6-23 months receive timely and appropriate complementary feeding.

IBFAN further noted the absence of a National Breastfeeding Committee and the lack of national guidelines for Infant and Young Child Feeding (IYCF). Breastfeeding indicators are not regularly and systematically monitored and the new legislation implementing the International Code of Marketing of Breast-milk Substitutes (hereafter: the Code) has not yet been endorsed by the Ministry of Health and is thus not enforced.  

The lack of appropriate pre- and in-service training programmes on infant and young child feeding is also of concern, as well as the lack of standards and guidelines for mother-friendly childbirth.

The report also flagged the low number of hospitals that are certified as “Baby Friendly” (2 out of 6 hospitals, i.e. 33.3%).

IBFAN further stressed the insufficient duration of the maternity leave (12 weeks) and the absence of legal provision allocating breastfeeding breaks. Finally, it noted that no specific programmes on IYCF and HIV/AIDS have been developed.

Discussion on infant and young child feeding

In its preliminary statement, the delegation began by mentioning the implementation of the integrated community health services through the SISCa programme. The programme is implemented in 13 districts, 65 Sub-Districts, and 442 villages. The delegation also mentioned the health promotion programmes aimed at pregnant women and granting them prenatal care and counseling. Finally, the delegation underlined the launch of the National Commission on Child rights in 2014, which is mandated to promote, defend and monitor children’s enjoyment of their rights.

The CRC Committee highlighted the most important problems in the country, such as the high rates of poverty, hunger, child malnutrition, stunting and wasting as well as the huge differences between rural and urban areas in terms of enjoyment of equal services and possibilities. It noted with concern the inconsistent data collection, as ministers do not use similar indicators, and the lack of regulation to control business sector activities that could affect children and their families. More specifically, the Committee noted that about 7 out of 10 children are not breastfeed until 2 years of age and asked what is done to encourage mothers to breastfeed. It also pointed out the insufficient duration of the maternity leave as well as the absence of provision allowing working women to take breastfeeding breaks.

The delegation of Timor-Leste recognized that malnutrition constitutes a major challenge for the country. Consequently, some programmes and measures have been put in place to remedy the situation, such as the promotion of appropriate infant feeding practices (exclusive breastfeeding under 6 months, adequate introduction of complementary food for children between 6-23 months, continued breastfeeding until 2 years or beyond, appropriate feeding for infants born from HIV-infected mothers). Regarding maternity protection, the delegation explained that working women are entitled to 90 days of maternity leave and once they return to their workplace, they are allowed to take 3 hours per day to breastfeed.

In its follow-up questions, the Committee emphasized breastfeeding as being the best nutrition for infants and asked whether the Ministry of Health was planning to ratify the law implementing the International Code of Marketing of Breastmilk Substitutes. The Committee also stressed the low number of hospitals certified as “Baby-Friendly” and asked how many hospitals have currently complied with the Ten Steps to Successful Breastfeeding.

The delegation referred to the 2013 Demographic Health Survey whereby the following results were established: early initiation of breastfeeding=93%, exclusive breastfeeding at 3 months=63%, breastfeeding between 12-15 months=75% and  continued breastfeeding 20-23 months=39%. Moreover, the delegation explained that 5 hospitals and 65 different health centers were complying with the Baby-Friendly Hospital Initiative.  The delegation added that the Prime Minister decided until November 28, 2016, all families should be visited by healthcare professionals. A programme of medical training has been set up in partnership with the Cuban government in order to increase the number of doctors. In the future, each of the 200 villages should be attributed 1 doctor and 2 nurses.

Concluding Observations

The Concluding Observations have not yet been released. This article will be updated following their publication.

Netherlands at the CRC: Inadequate Official Information on Breastfeeding and Absence of a National Programme

On May 27th, 2015, the Committee on the Rights of the Child considered the fourth periodic report of Netherlands on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Netherlands was led by Mrs. Angelique Berg, Director General for Public Health, Ministry of Health, Welfare and Sports (Netherlands), H.E. Mrs. R. Bourne-Gumbs, Minister of Education, Culture, Youth and Sports (Sint Maarten), H.E. Mrs. Rutmilda Larmonie Cecilia, Minister of Social Development, Labor and Welfare (Curaçao) and H.E. Mr. Pauldrick F.T. Croes, Minister of Social Affairs, Youth and Labor (Aruba).

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

General overview of breastfeeding in Netherlands

Generally, there is a lack of regular and systematic collection of data on infant and young child feeding practices in the country and the few data available do not monitor the official WHO/UNICEF indicators (e.g. the rate of early initiation of breastfeeding within one hour after birth is not monitored). Data reveal that some 20% of the newborns received infant formulae within 24 hours after birth, due to a lack of adequate guidance provided by birth attendants. Besides, the country does not organize specific capacity building courses on HIV/AIDS and infant feeding aimed at health professionals.

It is of concern that despite the WHO recommendation to introduce complementary foods from 6 months onwards, official institutions such as the Netherlands Nutrition Centre and the Dutch Youth Health Centre advice to introduce complementary foods at 4 months. Besides, there is currently no Breastfeeding Masterplan in place and the National Prevention Plan does not include breastfeeding. The monitoring role of the National Breastfeeding Council should also be clarified.

In addition, no breastfeeding promotion campaign is being conducted in the country and the International Code of Marketing of Breastmilk Substitutes is not fully implemented while one third of hospitals and maternities are not certified as “baby-friendly”.

The duration of paternity leave duration (2 days plus 3 unpaid) is also too short to ensure that fathers are able to support mothers in establishing exclusive breastfeeding. Finally, there are no specific guidelines or policies regarding breastfeeding support or protection in case of emergency.

Discussion on infant and young child feeding

Responding to the State report, the Committee expressed concern about the mention of breastfeeding being “women’s own choice” which seems to leave new mothers alone with the decision of breastfeeding their baby rather than providing them with adequate information and support in this regard.

The Committee also expressed concerned about the Dutch official recommendations to introduce complementary feeding at 4 months rather than at 6 months as recommended by the World Health Organization. It also pointed out the lack of implementation of theInternational Code of Marketing of Breastmilk Substitutes. It specifically asked for further explanations on the measures taken bto prevent undue marketing of breastmilk substitutes and to ensure exclusive breastfeeding until 6 months of age. The Committee also asked questions on the measures to address the epidemic of obesity in the country.

The delegation affirmed that in Netherlands, misleading marketing is prohibited by the Commodities Act. It also highlighted that some 80% of mothers start breastfeeding right after the birth, while 47% still breastfeed after 3 months and 38% exclusive breastfeed until 6 months. Regarding breastfeeding promotion, the government indicated that it provides mothers with full information on the importance of breastfeeding through the Netherlands Nutrition Centre.

The representative of Sint Maarten underlined that obesity constitutes a huge challenge in the island. Therefore, programmes are implemented in collaboration with the Ministry of Health and Education to promote physical education, weight monitoring and a healthy eating in public schools. In relation with breastfeeding, the delegation declared that promotion of optimal breastfeeding practices such as exclusive and continued breastfeeding is done through the dissemination of information brochures among mothers.

In addition, the delegation stated that in Aruba there is currently a national plan to protect and promote breastfeeding as well as the implementation of Baby-Friendly Hospital Initiative. The mission of the Pro Lechi Mama Aruba Foundation, created in 2002, is to empower women to breastfeed through educational activities and practical support. It also provides information on breastfeeding to health care providers. According to the delegation, these measures have positively influenced breastfeeding rates in the island (e.g. the rate of exclusive breastfeeding raised from 3.1% in 2002 to 13.4% in 2010).

Finally the delegation of Curacao explained that there is also a foundation in charge for promoting optimal breastfeeding practices on the island and that breastfeeding is promoted within free baby well clinics in which children are followed up until 5 years of age. The Curacao delegation added that mothers are allowed to breastfeed at their workplace and that incarcerated women are allowed to keep their child with them until they reach the age of 6 months.

Concluding observations

In its Concluding Observations, the Committee did not specifically address breastfeeding, but it made recommendations indirectly related to infant and young child feeding.

The Committee first noted the lack of a central system that regularly collects data; therefore, it recommended Netherlands to improve its data collection system, including qualitative and quantitative indicators in all areas of the Convention (§16-17). 

The Committee also made recommendations on the importance of respecting child rights in relation to the business sector, highlighting the importance of establishing and implementing regulations to ensure the compliance of the business sector with international and human rights, particularly with regard to children rights (§23). Thus, referring to its General Comment No 16 (2013) on State obligations regarding the impact of the business sector on children’s rights, the Committee recommended Netherlands to establish a clear and regulatory framework for the industries to ensure that their activities do not affect negatively children rights (§23a), ensure the effective monitoring of implementation of international and environmental and health standards and implement an appropriate sanctioning system and remedy mechanism (§23b). 

Regarding health, the Committee expressed concerns about the high rates of infant mortality (§42a) and the limited access to health care services for children with low economic or social status (§42c). Consequently, the Committee urged Netherlands to take measures to prevent infant mortality by providing effective and quality neonatal and other care services for infants in the whole country (§43a) and to ensure that all children have free access to basic health care services (§43c-d). 

Lastly, with regard to nutrition, the Committee noted the significant numbers of child obesity and overweight (§42b) and therefore recommended Netherlands to “provide access to nutrition education and sufficiently nutritious food to all children in the State party in order to promote healthy eating habits” (§43b).

Mexico at the CRC: Steep Decline of Breastfeeding Practices

On May 19 and 20, 2015, the Committee on the Rights of the Child considered the combined fourth and fifth periodic report of Mexico on the situation of the implementation of the Convention on the Rights of the Child in the country. 

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

General overview of breastfeeding in Mexico

In its alternative report, IBFAN insisted on the high rates of child overweight and obesity as well as on the lack of drinking water and the widespread sale of soft drinks in schools. In 2006, child obesity rose to 36.9% while deaths caused by diabetes progressively increased. 

The report also emphasized the high infant mortality rate (7 per 1, 000 live births for 2012-2013) that even reaches 23.89 per 1,000 live births in remote regions like Chiapas. 

In such a context, it is of concern that breastfeeding rates are low. The 2012 National Health and Nutrition Survey showed that the median duration of breastfeeding was of 10 months only. It also reveals a steep decline of exclusive breastfeeding rates between 2006 and 2012. Regarding the enforcement of the International Code of Marketing of Breastmilk Substitutes, IBFAN report flagged the lack of monitoring and sanctioning mechanism, leading to Code violations within the National Health System. 

IBFAN also denounced the adverse impacts of national nutrition programmes. For example, the programme “Prospera”, Mexico’s largest programme of food assistance, includes distribution of a ready-to-use food supplement, contravening the international recommendations on infant and young child feeding. The Programme Cruzada Contra el Hambre is led in partnership with corporations that violate the International Code and the distribution of Tarjetas Sin Hambre allows poor families to access to a list of 15 subsidized products that includes unhealthy foods such as instant sugar-added coffee (Nescafé Dolca), instant oat cereal Powder milk (Nestlé’s Nido and others) and instant chocolate powder.

IBFAN also noted the Mexico did not ratify the ILO Convention 183 (2000) on Maternity Protection and needs to extend maternity protection to the growing number of women working in the informal sector. 

Finally, IBFAN stressed the need to adopt and implement the Operational Guidance on Infant and Young Child Feeding in Emergencies in order to protect breastfeeding during disasters.

Discussion on infant and young child feeding

The CRC Committee expressed concerns about the high rate of child mortality in indigenous areas. It also raised the issues of child obesity and teenage pregnancies. 

More specifically, the CRC Committee noted the decline of breastfeeding rates and the fact that many mothers receive promotional gifts from baby food companies within hospitals and maternities. It highlighted the lack of enforcement of regulations related to the marketing of breastmilk substitutes and asked which actions are by the government in this regard

The Mexican delegation answered that the mortality rate is currently following a downward trend in Mexico, and that many policies and programmes have been implemented in this regard. The government also mentioned their programmes “Prospera” and “Cruzada Contra el Hambre”, noting that they cover large portions of indigenous regions. For example, some 25% of the beneficiaries of the Prospera programme are from indigenous communities. In addition, the delegation noted that more than 700,000 families have beneficied of the programme “Tarjetas Sin Hambre”. 

In relation with infant and young child feeding, the delegation responded that as part of a national strategy for breastfeeding a new programme on breastfeeding promotion has been launched. It also affirmed that the Ten Steps to Successful Breastfeeding of the Baby-Friendly Initiative are being implemented throughout the country and that several human milk banks have been set up. 

Regarding obesity, the delegation mentioned the national comprehensive strategy for tackling overweight and obesity, which is based on 3 pillars: 1) taxes 2) legal reform and 3) promotion of physical activity. Likewise, a special tax on sugary drink has been implemented as part of this strategy. In relation with the legal reform, the delegation mentioned the integration of a constitutional article prohibiting the sale of sugary drinks in schools, as well as federal legal provisions limiting the advertisement of unhealthy foods on TV during programmes aimed at children and in cinemas. It affirmed that the government carries out awareness-raising activities such as campaigns to measuring waist and promote physical activity and it made reference to the national council on NCDs. The delegation also mentioned the implementation of water fountain in every school as part of the legal undertaken.

Finally, regarding maternal mortality, the delegation noted that several campaigns aiming at tackling teenage pregnancies have been launched. As a result, a drop of 15% of such pregnancies is expected. It also affirmed that teenage mothers are allowed to deliver in any health service of the country.

Concluding observations 

In its Concluding Observations, the Committee issued both indirect and direct recommendations related to infant and young child feeding to Mexico. 

Addressing specifically infant and young child feeding, the Committee expressed concerns the decline of exclusive breastfeeding (§47d) and recommended Mexico to strengthen the efforts to “promote breastfeeding through educational campaigns and training to professionals” and “adequately implement the International Code of Marketing of Breast-Milk Substitutes and the Child-Friendly Hospital Initiative”(§48d).

Highlighting the persistent child chronic malnutrition in rural and indigenous areas (§47c) and the increasing of overweight and obesity among children (§47e), the Committee also recommended Mexico to draft a national strategy on nutrition that would ensure food security, especially in rural and indigenous areas (§48c), as well as to continue raising awareness on the impact of processed food including and strengthen the regulations restricting the advertising and marketing of junk, salty, sugary and fatty foods and their availability for children (§48e).

Regarding, health services, the Committee stressed the need to ensure the availability and accessibility of quality health services, in particular rural and indigenous children, including by allocation adequate resources (§48a). 

The Committee also expressed concerns over the high child and maternal mortality rates (§47b), recommending the State party to strengthen and reduce maternal and child mortality, including by implementing the OHCHR Technical Guidance on child mortality (A/HRC/27/31).

Finally, regarding environmental health, the Committee expressed concern about the insufficient measures taken by Mexico to address air, water, soil and electromagnetic pollution, which gravely impact on children and maternal health. It thus recommended the State party to assess theses impacts on children and maternal health as a basis to design a well-resourced strategy to remedy the situation, prohibit the import and use of pesticides or chemicals that are banned or restricted for use in exporting countries and examine and adapt its legislative framework to ensure the legal accountability of business enterprises involved in activities having a negative impact on the environment in the light of its General Comment No 16 (2013) on State obligations regarding the impact of the business sector on children’s rights (§51-52a-c).

[Note: Click here to access to a discussion paper prepared by IBFAN Mexico which provides an interpretation of what should be an "adequate" implementation of the International Code of Marketing of Breast-milk Substitutes.]

Iraq at the CRC: High Prevalence of Infections and Chronic Undernutrition among Children

On January 21^th, 2015, the Committee on the Rights of the Child considered the combined second to fourth periodic report of Iraq on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Iraq was led by H.E. Mohammed Mahdi Ameen Al-Bayati, Minister of Human Rights.

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

General overview of breastfeeding in Iraq

The rate of early initiation of breastfeeding passed from 25.1% in 2006 to 43% in 2011. While representing a significant increase, this means that almost 6 children out of 10 are still not receiving any breastmilk during their first hour of life, even though delayed breastfeeding is proven to have a negative impact on neonatal mortality. Additionally, the rate of exclusive breastfeeding under 6 months was only 20% in 2011, and there are no recent data on its progress, while the rate of continued breastfeeding at 2 years dropped from 35.7% in 2006 to 23% in 2011. Such poor breastfeeding records show a lack of general information on optimal breastfeeding practices, from the mothers’ side as well as from the health professionals, who lack the resources and capacity to proper inform pregnant women about their nursing role. Moreover, such rates are also the result of the distribution of free infant formula to all infants, as part of Iraq’s Public Distribution System for food rations.

The draft National Strategy for Infant and Young Child Feeding was prepared in 2005 and was aimed at raising awareness on infant and child feeding problems and practices. However, it is not unknown whether this strategy has been implemented so far. The draft National Strategy provides for specific training to health professionals on HIV and infant feeding issues, and thus it is not clear whether the provision of the strategy is implemented, as well as the whole strategy itself.

Regarding protection of breastfeeding, only voluntary provisions exist in Iraq to implement the International Code of Marketing of Breastmilk Substitutes. A draft law was prepared in 2011, with the goal of transposing into law most provisions of the International Code, but to date there is no information available on its adoption and implementation. The coverage rate of the Baby-Friendly Hospital Initiative (BFHI) in the hospitals and maternities in Iraq was 59% in 2009/2010, but there are no recent data on the current number of hospitals certified as “Baby-Friendly” and on whether these institutions still respect the criteria of the BFHI.

Maternity protection is not adequate, considering that the paid maternity leave duration is only 62 days. Finally, no information is available on the provision of a strategic plan to protect and promote breastfeeding in case of emergencies.

Discussion on infant and young child feeding

The CRC Committee commended the delegation of Iraq about the progress made on immunization and on institutional deliveries, highlighting that this is a very positive result considering the difficult context Iraq is in. However, it observed that there is still a high rate of preventable infections among children, such as diarrhea, and asked for comments on that as well as on the issue of chronic undernutrition. Moreover, the CRC Committee asked what efforts are being made at the health care system level in order to reduce the number of preventable maternal deaths.

The delegation of Iraq did not provide answers on the topics that have been touched related to health, justifying this with the absence of the representative of the Ministry of Health, who could not participate to the session due to budget issues.

Concluding Observations

In its Concluding Observations, the Committee made several recommendations indirectly related to infant and young child. After expressing concerns on the high rate of under-five mortality and the high prevalence of chronic under-nutrition and maternal mortality, the Committee highlighted also that “while the armed conflict is having a devastating impact on the availability and quality of healthcare, the State party devotes a low percentage of the federal budget to its healthcare system” (§ 60).

The Committee thus recommended Iraq to “reduce maternal mortality by providing access to emergency obstetric care and ensuring access to trained delivery care at home, services at maternal and child health clinics with trained health care providers” and to “allocate all necessary human, technical and financial resources for interventions aimed at reducing preventable and other diseases, particularly diarrhoea, acute respiratory infections and under nutrition” (§ 61a-b). Finally, the Committee also recommended that Iraq to “take all necessary measures to sufficiently equip hospitals as a matter of priority” (§ 61c).

Jamaica at the CRC: Low Breastfeeding Records and Insufficient Maternity Leave

On January 19^th and 20^th, 2015, the Committee on the Rights of the Child considered the combined Third and Fourth Periodic Report of Jamaica on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Jamaica was led by M.P. Honorable Lisa Hanna, Minister of Youth and Culture.

 

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

General overview of breastfeeding in Jamaica

Despite the high rate of skilled attendance at birth (98.3%) and institutional delivery (97.1%), optimal breastfeeding practices are still not widespread in Jamaica. This is confirmed by the low rates of early initiation of breastfeeding (62.3%), exclusive breastfeeding under 6 months (23.8%) and continued breastfeeding ate at 2 years of age (31.2%). These figures show a lack of knowledge on the importance of the early initiation of breastfeeding among the health care workers assisting deliveries and, at the same time, constitute an evidence of non-compliance with the step 4 of the Baby-Friendly Hospital Initiative (BFHI). Another alarming fact relates to the median duration of exclusive breastfeeding, which is only three weeks for the average Jamaican mother.

The draft National Infant and Young Child Policy, revised in 2014, states important goals related to supporting breastfeeding in communities and the workplace, spreading the BFHI in all institutions, improving the data collection system, building capacity within all relevant agencies and at different levels of the health system, among others. However, to date, this draft has not yet been accepted and thus, the activities carried out by the National Infant and Young Child Feeding Committee remain unclear. Breastfeeding and HIV-related strategies are mentioned in the draft Policy, and thus, have not been endorsed yet. The same applies to infant and child feeding in emergencies, which has been addressed in the draft Policy in the form of specific provisions, but there is no information available on its concrete application.

Regarding protection of breastfeeding, only voluntary measures are in place to implement the International Code of Marketing of Breastmilk Substitutes and there is no enforcement mechanism. 

The Jamaican legislation does not provide for an adequate duration of maternity leave (12 weeks) and for proper relevant benefit coverage (only 8 weeks). Furthermore, employers are not required to provide breaks for nursing mothers and fathers are not entitled to any paternity leave.

Discussion on infant and young child feeding

The CRC Committee addressed specifically the issue of breastfeeding in Jamaica, asking the reasons behind such low breastfeeding rates in the country, despite the tremendous positive developments Jamaica has presented in many other areas of the Convention. It was also asked whether there could be a link between the low breastfeeding indicators and the fact that the legislation does not provide for employers to allow breastfeeding breaks to nursing mothers. The delegation replied mentioning that Jamaica was one of the first countries in the world to adopt in the 1970s an act on the maternity leave which gives women the right to a paid 3-month leave. The delegation also highlighted that Jamaica has a matriarchal society for which many mothers are working and that they do breastfeed their children up to 6 months of age. Pointing out that breastfeeding is encouraged in hospitals, the Head of Delegation described the personal experience of going to the hospital to deliver her baby and being told not to bring any bottles because that was a breastfeeding-policy hospital. 

The CRC Committee commented that, however, it is important to provide that the maternity leave is long enough and guarantees that mothers can breastfeed their children up to 6 months exclusively, reminding that this is also a very strong WHO recommendation. Maternity leave becomes thus an essential point when discussing measures aimed at encouraging women to breastfeed their children, if not up to 2 years, up to 6 months at least. The Committee then added that the positive outcomes of breastfeeding are seen later, in the better health status of children and, but not only, in the emotional bonding, which is also essential.

Concluding Observations

The Committee issued both indirect and direct recommendations related to infant and young child feeding to Jamaica (see the Concluding Observations).

After commending the State party for the decrease in infant mortality rates, the Committee expressed concerns over the “perinatal mortality levels, the increase in maternal mortality, the persistent levels of undernourishment among the poorest children, the general shortage of health care providers and access by children to quality health care, the low levels of breastfeeding and the high rate of children classified as overweight and obese” (§ 44).

Therefore, the Committee recommended Jamaica to ensure adequate provision of prenatal and post natal care, as well as to address the increase in maternal mortality (§ 45a) and to increase the number and coverage of health care professionals for an improved children’s access to health care services (§ 45c). Regarding nutrition, the Committee urged Jamaica to “introduce targeted action to prevent the undernourishment of children, including the promotion of proper infant and young child feeding practices” (§ 45b). On children obesity in particular, the Committee recommended to intensify measures to raise awareness of healthy nutrition among parents, children and the public in general, and to promote healthy eating habits (§ 45f).

With regard to breastfeeding, the Committee specifically recommended Jamaica to “take action to improve the practice of exclusive breastfeeding for the first six months, through awareness-raising measures, including campaigns, providing information and training to relevant officials, particularly staff working in maternity units, and parents” (§ 45d). Finally, the Committee recommended the State party to regulate the marketing of breastmilk substitutes (§ 45e).

Tanzania at the CRC: Suboptimal Breastfeeding Practices and Low Rate of Institutional Delivery

On January 15^th and 16^th, 2015, the Committee on the Rights of the Child considered the combined third to fifth periodic reports of the United Republic of Tanzania on the situation of the implementation of the Convention on the Rights of the Child in the country. The Tanzanian delegation was led by Mrs. Sophia Simba, Minister for Community Development, Gender and Children.

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

General overview of breastfeeding in the United Republic of Tanzania

In Tanzania, high rates of neonatal, infant, under-5 and maternal mortality coexist with a low rate of skilled attendant at birth (49%). Suboptimal breastfeeding practices are widespread: some 1 child out of 2 is neither breastfed during the first hour after delivery nor exclusively breastfed until 6 months of age. In addition, early introduction of complementary food is a recurring problem and vast majority of babies under 3 months old are fed with water, juice, porridge or other foods, increasing the risk of infections and malnutrition. There is also a cultural belief that the colostrums is dirty and should be discarded.

Although the 1992 Food and Nutrition Policy pointing out the high rate of malnutrition among children linked with inadequate breastfeeding and weaning is still in place, as well as the National Nutrition Strategy 2011/12-2015/16 and the 2004 National Strategy on Infant and Young Child Nutrition, several problems persist in the country regarding promotion and support of breastfeeding. First, information on the activities undertaken to promote breastfeeding is lacking, as well as information on specific trainings or courses on optimal breastfeeding practices aimed at health professionals. The High Level Steering Committee on Nutrition, created in 2011, in charge to coordinate multi-sectorial interventions to reduce child malnutrition and promote optimal breastfeeding. However, it has only a coordinating role and does not carry out any monitoring activity. Finally, there is no information on the existence of a specific National Breastfeeding Committee or Coordinator.

Regarding protection of breastfeeding, in 1994, Tanzania has adopted a National Regulation for Marketing of Breastmilk Substitutes and Designated Products. However, its revision has not been endorsed yet and there is very poor awareness of its content at all levels and in most sectors.

In addition, in 2010, only 37% of the hospitals in the country were certified as “baby-friendly" and maternity leave is only available every 3 years and does not cover women in the informal sector. Even though 9 women out of 10 know that HIV can be transmitted through breastfeeding, the estimated rate of mother-to-child transmission in 2013 was 15.8%. Last but not least, the country does not have any plan to protect and support breastfeeding in case of emergencies.

Discussion on infant and young child feeding

The CRC Committee first noted that in the last years, the overall budget allocated to health has decreased and that the country shows high rates of maternal, neonatal and infant mortality. It asked the delegation if there is any initiative or measure in place to address the issue of the very high maternal mortality, which has a direct impact on child survival. 

The Committee also raised specific questions on breastfeeding. It asked for further clarifications on the activities to promote breastfeeding in relation with the National Breastfeeding Week. Regarding the High Level Steering Committee on Nutrition, it asked which is its role regarding breastfeeding promotion in the country, especially within hospitals facilities.

The Tanzanian delegation answered that during the National Breastfeeding Week, awareness-raising activities such as seminars, distribution of ICT materials, workshops on importance of breastfeeding, trainers’ training on breastfeeding and HIV, information on the International Code and on optimal breastfeeding practices have been organized and a promotional campaign on exclusive breastfeeding until 6 months of age has been launched. The delegation added that the High Level Steering Committee on Nutrition is in charge to ensure that proper resources are allocated to provide good nutrition to the population including through fortification of oil, wheat and maize.

The Committee expressed further concern about the very low rate of institutional delivery and asked how, in this conditions, does the government ensure that all mothers have access to correct information about the best way to feed their child. Besides, it emphasized that almost half of the mothers do not breastfeed until 6 months and asked what measures are taken to tackle this issue. It also asked what kind of regulations of the marketing of breastmilk substitutes are in place in order to allow mothers to make the correct information, and noted that guaranteeing that mothers are enable to optimally  breastfeed leads to huge public savings and places children in the best situation to start their life.

In a follow-up question, the Committee noted that the rate of early initiation of breastfeeding is very low in the country and emphasized its crucial importance for the baby’s as well as for the mother’s health. The Committee also asked if there is any programme to help mothers in terms of lactation, noting that the rate of continued breastfeeding until 2 years is particularly low. Regarding breastfeeding protection, supposedly ensured by the implementation of the Baby-friendly Hospital Initiative, it asked if there is any regulation regarding baby foods advertisements in hospitals. On the access to emergency obstetric care, the Committee asked what is the coverage of skilled attendants at birth and if there are trainings for traditional birth attendants. Regarding the large number of young mothers, it asked if there are any family planning services in the country.

The delegation highlighted the importance of breastfeeding in the first months of life for the healthy development of brain. It explained that breastfeeding importance is raised in one of the guidelines on IMCI (Integrated Management of Child Illnesses) and also through parenting education. Promotion of breastfeeding is also done through dissemination of ICT materials in health centers, hospitals and schools. The delegation further noted that the Tanzania Food and Drugs Authority has implemented regulations on the marketing of breastmilk substitutes and is providing information through national media on the best use of breastfeeding instead of formula feeding. Besides, the Tanzania Bureau of Standards is in charge of controlling the food standards and making screens.

Concluding Observations

In its Concluding Observations, the Committee issued recommendations indirectly related to infant and young child feeding. With regard to health and health services, the Committee stated its concerns over the persistent high maternal mortality and morbidity rates, the limited access to health care services to children poverty and remote and rural areas, and the prevalence of chronic malnutrition, leading to stunting and the limited access to safe drinking water and sanitation (§ 53).

Therefore, the Committee urged Tanzania to allocate sufficient financial and human resources to health services, particularly mentioning the trained care at delivery as well as improved care for new-borns and during the neonatal period, antenatal care and services for infants and preschool children at primary health centres (§ 54a). It also requested Tanzania to “establish more child and maternal health clinics and access to safe and trained delivery [...]” (§ 54b).

Specifically addressing the issue of children nutrition, the Committee recommended Tanzania to “strengthen national strategies to address the critical nutritional needs of children, particularly among the most vulnerable groups, through targeted interventions” and to “improve access to safe drinking water and adequate sanitation facilities and ensure sustainability, availability, sufficiency and affordability to all, particularly children” (§ 53c-d).

Finally, the Committee urged the country to implement the OHCHR Technical guidance child mortality (A/HRC/27/31) (§ 54 e) which includes specific recommendations on breastfeeding protection (including the implementation of the International Code) and promotion.