Obstacles to Optimal Breastfeeding Practices in Uzbekistan (CESCR)

On the 13th of May 2014, the Committee on Economic, Social and Cultural Rights considered the 2nd periodic report of Uzbekistan on the implementation of the International Covenant on Economic, Social and Cultural Rights.

IBFAN presented an alternative report to inform the CESCR Committee on the situation on the issue of infant and young child feeding in Uzbekistan.

General overview of breastfeeding in Uzbekistan

The alternative report highlighted several obstacles to breastfeeding practices in Uzbekistan. First of all, the country has low rates of early initiation to breastfeeding (67%) and exclusive breastfeeding up to 6 months of age (26%). Furthermore, suboptimal infant feeding practices have been observed: the introduction of other liquids-especially water and other milk/formula- and of complementary food in infants’ diet occurs too early. Moreover, the health personnel appear to be not duly trained to promote and support breastfeeding. Besides, the International Code on Marketing of Breastmilk Substitutes is not implemented and the marketing of breastmilk substitutes is not regulated in the domestic legislation. Finally, the maternity leave’s duration after delivery is less than 2 months and the following parental leave is paid inadequately.

Discussion on infant and young child feeding

No specific questions were raised on infant and young child feeding by the experts. Nevertheless, during the discussion, the Uzbek delegation referred to a letter dated on 27 December 2011 from the Permanent Representative of Uzbekistan to the United Nations addressed to the Secretary-General. This letter explained that Uzbekistan hosted an international symposium entitled “National Model of Mother and Child Health-care in Uzbekistan: Healthy Mother, Healthy Child” that took place in Tashkent on 26 November 2011. During the latter symposium, according to the delegation, it has been acknowledged that the Uzbek National Model is one of the most effective strategy for achieving a good development in the area of maternal and infantile health.

CECSR Concluding Observations

In its recommendations towards Uzbekistan, the Committee notes that despite the significant decrease in maternal and child mortality, their occurrence remain relatively high. Therefore, the Committee urges the State party to strengthen its efforts to improve mother and child health, especially during pre-natal and neonatal periods (para 24).

Undue Marketing of Breastmilk Susbtitutes in Czech Republic (CESCR)

On the 9th of May 2014, the Committee on Economic, Social and Cultural Rights considered the second periodic report of the Czech Republic on how the country is implementing the provisions of the International Covenant on Economic, Social and Cultural Rights.

IBFAN presented an alternative country report to inform the CESCR Committee on the situation on the issue of infant and young child feeding.

General overview of breastfeeding

It has been noted that breastfeeding rates have been declining. Exclusive breastfeeding rate at 6 months of age are is low and have been decreasing. There are regional disparities in the breastfeeding rates, which may be due to maternal age and education. Also, it is clearly seen that systematic data on complementary feeding is missing.

Moreover, the International Code of Marketing of Breastmilk Substitutes has not been implemented at the national level. As a consequence, advertisement of infant formula and sponsorship to the health professionals by baby food industry is widespread. Government’s efforts to protect and promote breastfeeding are far from being sufficient. The support given to the National Lactation Centre is very small, and has not yet been officially acknowledged. Furthermore, training of health personnel on the protection, promotion and support of breastfeeding is insufficient. It is carried out only by the National Lactation Centre. Government’s support in this direction is missing. 

The Baby-friendly Hospital Initiative lacks a clear re-assessment mechanism, to ensure that all certified hospitals are adhering to the “Ten Steps to Successful Breastfeeding”. Professionals working in certified baby-friendly hospitals lack regular training on management and protection of breastfeeding.

Discussion on infant and young child feeding

Neither questions from experts nor any interventions from the delegation have been observed on the question of infant and young child feeding.

Instead, the discussion turned around how much of the upbringing of children was being carried out by men. Campaigns to promote burden sharing were underway, but it might take some time to change traditional ways of thinking.

CECSR Concluding Observations

In its Concluding Observations, the Committee has not made any direct or indirect recommendations on the issue of infant and young child feeding. 

Breastmilk Substitutes Undermine Breastfeeding in China (CESCR)

On the 8^th of May 2014, the Committee on Economic, Social and Cultural Rights considered the second periodic report of China as well as reports of the Special Administrative Region of Hong Kong and of the Special Administrative Region of Macao on the implementation of the International Covenant on Economic, Social and Cultural Rights.

In view of the session, IBFAN presented an alternative report on the situation of infant and young child feeding in China, prepared by IBFAN East-Asia.

General overview of breastfeeding

The report shows that in China, breastfeeding declined rapidly during the 1980s due to the promotion of breastmilk substitutes and inappropriate medical practices. With the implementation of the Baby-Friendly Hospital Initiative since 1992 and the national regulation on the marketing of breastmilk substitutes (China’s Regulation) entered in force in 1995, breastfeeding’s superiority has been recognized and mothers are encouraged and supported to breastfeed their infants. However, breastfeeding promotion in community and work place has not yet received enough attention. One of the challenges regards the popularity of formula feeding and persistence of inadequate feeding practices such as giving water to infants under 5 months. Another challenge is the ban the marketing promotion of infant formula which undermines mothers’ confidence on successful breastfeeding. It is difficult for health authorities to supervise, conduct training and reassessments of the baby-friendly health facilities in China given the great number of concerned facilities (over 60,000). Finally, it is hard to ensure mothers’ entitlement to paid maternal leave and breastfeeding facilities, especially considering the rapid evolution of lifestyle in China.

Discussion on infant and young child feeding

No specific questions were raised on the infant and young child feeding.  

Nonetheless, the experts raised questions about the separation of mothers and children in the Hong Kong Special Administrative Region, affecting thousands of children, as there was no legislation that ensured the right of a mother to live with her children. In addition, the experts also raised the issue of pre-natal sex selection because of boy preference, as well as forced abortion, even in the third trimester. The adoption of Chinese babies by overseas parents has also been addressed as a problematic issue; indeed, mostly 100 per cent of these adopted babies were girls.

In relation with maternity protection, we note that the delegation of China has stated that some 46 % of the working population is made of women.

CECSR Concluding Observations

In its Concluding Observations, the Committee recommends China to establish a clear regulatory framework for companies and to adopt appropriate legislative and administrative measures to ensure legal liability of companies (para 13). Moreover, the Committee recommends that the State take measures to eliminate multiple-discrimination faced by rural women in particular in access to health (para 16).  After expressing its concern about the situation of food security in some of the poor areas, the Committee urges the State to strengthen its efforts to protect the right to adequate food.  Indeed, the State should intensify its efforts in order to address effectively the situation of food insecurity and child malnutrition in poor rural areas.  The enforcement of the Food Safety Law is desirable to strengthen its efforts on food safety supervision and to ensure the production, processing, distribution, marketing and consumption of safe food (para 29). 

In addition, the Committee recommends China to undertake all necessary measures to improve its health care and services to guarantee the enjoyment of the right to good quality and affordable health care to all persons in China.  On the same note, a recommendation is also made to increase the budgetary allocations to the health sector and to strengthen training for health care professionals (para 33). 

Besides, the Committee emphasizes the importance of awareness-raising activities aimed at promoting understanding of the modes of transmission of HIV among the population (para 34).

Finally, the Committee urges the State party, Hong Kong, China and Macao, China to build a systematic data collection (para 61) and encourages the State party to engage all relevant actors including NGOs in the process of discussion on the implementation of the present concluding observations at national level (para 65).