Inadequate Infant Feeding Practices in Indonesia (CRC)

On the 5th of June 2014, the Committee on the Rights of the Child completed its consideration of the combined 3rd and 4th periodic reports of Indonesia on the implementation of the provisions of the Convention on the Rights of the Child in the country. 

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

General overview of breastfeeding

IBFAN’s alternative report highlighted that inadequate infant feeding practices co-exist with high rates of child mortality in Indonesia. Indeed, the rate of early breastfeeding initiation is low (less then 30 %) and more than half of the children are not breastfed until 6 months of age, while a third of the children under five years old are stunted. Besides, complementary foods are introduced too early to almost 45% of the children. The lack of any policy or programme on infant and young child feeding has also been emphasized, as well as an absence of sanctions in case of violations of the International Code of Marketing of Breastmilk Substitutes, despite the implementation of many provisions of this Code into national legislation. The absence of data on the number and quality of Baby-friendly hospitals has also been shown as problematic. Finally, the absence of maternity protection for women working in the informal sector, as well as the lack of public awareness about HIV/AIDS and infant feeding, have been emphasized.

Discussion on infant and young child feeding

The Committee noted that while in the 1990s, Indonesia had made progress in reducing neonatal and infant mortality, this advancement had slowed down in recent years. In addition, in regard to the high infant mortality rate in certain provinces, the expert has asked about the implementation of the Baby-friendly Hospital Initiative in Indonesia. In general, the expert has asked about the actions taken by State party to promote breastfeeding.

The Indonesian delegation responded by stating that there had been a national breastfeeding programme in place since 1990 promoting breastfeeding up until six months of age.  Nevertheless, the delegation admitted that the rate of early breastfeeding in Indonesia still remains low, and added that the provision of lactation rooms for breastfeeding mothers is scheduled in the government agenda.  

Concluding Observations

In its Concluding Observations, regarding the general implementation of the Convention, the Committee urged Indonesia to upgrade its system of data collection (para 7 (a)).

Regarding the issue of health, the Committee specifically requested the country to substantially increase the allocations in the area of health to adequate levels and to expand access to primary health-care services across all provinces (para 16 (a) and 48). It also emphasized the need to “ensure the provision of primary health-care services for all pregnant women, including access to postnatal care, and children, focusing on interventions to reduce preventable and other diseases, particularly diarrhoea, acute respiratory infections and undernutrition”, and called for the promotion of good infant and young child feeding practices (para 48 (a)). In addition, Indonesia has been urged to “strengthen and expand access to preventive health care for all pregnant women and children, particularly infants and children under the age of 5”. They should include preventive health interventions such as universal immunization services, oral rehydration therapy and treatment for acute respiratory infections (para 48 (b)). According to the Committee, the country should also “take all necessary efforts […] to reduce maternal mortality” (para 48 (c)). Regarding the issue of HIV/AIDS, the government was requested to “sustain the measures in place to prevent mother-to-child transmission as well as provide for counselling and improve follow-up treatment for HIV/AIDS-infected mothers and their infants to ensure early diagnosis and early initiation of treatment” (para 52).

Besides, the Committee emphasized the low rate of exclusive breastfeeding in the country and issued direct recommendations related to infant and young child feeding: it recommended Indonesia to “strengthen the promotion of breastfeeding, including by establishing a programme to promote and enable all mothers to successfully breastfeed exclusively for the first six months of the infant’s life” and to “adopt the International Code of Marketing of Breast Milk Substitutes” (para 56).

Breastfeeding Challenges in India (CRC)

On the 3^rd of June 2014, the Committee on the Rights of the Child completed its consideration of the combined 3rd and 4th periodic report of India on the implementation of the provisions of the Convention on the Rights of the Child in the country. 

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

General overview of breastfeeding in India

About 26 million babies are annually delivered in India. According to the National Family Health Survey-3 (NFHS-3) data, 20 million are not able to receive exclusive breastfeeding for the first six months of their life and about 13 million do not get good timely and appropriate complementary feeding after six months along with continued breastfeeding. The rate of early initiation of breastfeeding within one hour following the delivery is of only 23.4% and exclusive breastfeeding up to the age of six months is of 46.3%. 

However, the national legislation implementing the International Code of Marketing of Breastmilk Substitutes, called the Infant Milk Substitute Act, is still not effectively enforced. Therefore, an effective monitoring mechanism is required at state and district level. In addition, there is no comprehensive adequate training of health professionals done by the government, even though BPNI/IBFAN India has developed a training course and trained more than 15'000 health workers since 2004. Besides, the alternative report emphasized that an increasing number of institutional deliveries occur without adequate space, staff or infrastructure. The Baby-friendly Hospital Initiative (BFHI), launched in the country in 1993, has not been properly revived since then. 

Finally, it has been noted that he national legislation on maternity protection does not cover women working in private and informal sector. Clearly, the support to working mothers needs to be extended to women in the unorganized sector as they form the major part (almost 90%) of working women. Lastly, the alternative report states that the national guidelines on Infant Feeding and HIV have not yet been made into policy, and that there is no policy on infant feeding in case of emergency.

Discussion on infant and young child feeding

The Committee raised the issue of maternal malnutrition and child stunting, and asked if there is any programme to address mother malnutrition. Furthermore, the Committee insisted on optimal infant and young children feeding practices, especially breastfeeding, to combat children malnutrition, which is proven to affect, inter alia, children’s learning capacities. The Committee highlighted the decline in breastfeeding rates in recent years and asked whether there were any programmes in place to remedy this situation. The issue of regional disparities  in breastfeeding rates has also been raised, as well as the promotion of infant formula, despite the implementation of the IMS Act. The Committee showed concern for the Code violations that occur in India and wondered if they are the consequences of a lack of monitoring of the national legislation. It finally asked if there was any implementation of the BFHI at national level and if there were any national guidelines or policy on HIV and infant feeding.

The delegation of India responded that the exclusive breastfeeding rate in India is about 40%, which is relatively high compared to other countries.  It added that the high rate of institutional delivery (78%) gives the country a great opportunity to promote optimal breastfeeding practices to young mothers, and that dedicated breastfeeding counsellors are deployed in maternity wards throughout the country.  The delegation expressed the hope that the actions taken would lead to an increase in breastfeeding rates. It admitted that India had been slow to implement the International Code of Marketing of Breastmilk Substitutes, but it stated that government is currently awareness-raising on the IMS Act among the district health officers. Regarding the issue of HIV and infant feeding, the delegation answered that the existing national guidelines do provide the appropriate guidance to the population.

Concluding Observations

In its Concluding Observations, the CRC Committee made a wide range of indirect recommendations related to infant and young child feeding. At the level of general implementation, the Committee urged India to prioritize the development of the National Plan of Action to implement the 2013 National Policy for Children (para 14 (a)). It requested also the country to expeditiously improve its data collection system (para 20), and to provide all professionals working for and with children with adequate and systematic training in children’s rights, which includes in particular health workers (para 26). In the light of the CRC General Comment No. 16 on State obligations regarding the impact of the business sector on children’s rights, the Committee also insisted on the need to establish a clear regulatory framework for the industries operating in the State party to ensure that their activities do not negatively affect human rights or endanger other standards, especially those relating to children’s rights (para 30 (a)).

Regarding health issues, the Committee requested India to increase the resources allocated to the health sector and to ensure that they are appropriate (para 18(a) and 64 (b)), with “particular attention to specific maternal and child health care policies, programmes and schemes to improve the health situation of children, in particular to respond to high rates of acute respiratory infections, malnutrition and diarrhoea”. The Committee also called for to the “effective implementation of the National Food Security Act (2013) which contains provisions aiming at combating children’s undernourishment” (para 64 (d)). The Committee also addressed the issue of HIV/AIDS mother-to child transmission by urging the government to “sustain the measures in place to prevent mother-to-child transmission of HIV/AIDS and develop a roadmap to ensure the implementation of effective preventive measures” and “improve access and coverage of antiretroviral therapy and prophylaxis for HIV-infected pregnant women […]” (para 68 (b) and (e)).

In addition, the Committee issued direct recommendations related to infant and young child feeding (para 64 (d)). It urged India to “enhance efforts to promote exclusive breastfeeding practices, including the promotion of breastfeeding from birth, complementary feeding strategies with or without provision of food supplements as well as micronutrient interventions for mothers” and called for the “effective implementation of, and compliance with, the International Code of Marketing of Breast-milk Substitutes”, and establishment of a “monitoring and reporting system to identify violations of the Code”, as well as of “stringent measures” in all situations of violations of the Code. The Committee thus specified that “violations include the promotion and distribution of samples and promotional materials by the private sector institutions involved in the Infant Formula marketing and distribution”.

Nonetheless, it is of serious concern that despite the systematic infringements of the Code committed by baby food companies, the Committee recommended India to “strengthen its efforts to address the existing disparities in access to and quality of health services, including by establishing partnerships with the private sector […]” (para 64 (a)).

Lack of Adequate Training of Health Professionals in Kyrgyzstan (CRC)

On the 28^th of May 2014, the Committee on the Rights of the Child considered the combined 3rd and 4th periodic report of Kyrgyzstan on the implementation of the Convention on the Rights of the Child in the country. 

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

General overview of breastfeeding in Kyrgyzstan

The report noted that in Kyrgyzstan, high rates of infant and neonatal mortality coexist with inadequate infant feeding practices, such as early weaning and early introduction of complementary food, breastmilk substitutes and other liquids. Almost 2 children out of 3 are not breastfed until the age of 6 months and only about 2 children out of 10 are breastfed until the age of 2 years. Moreover, the report pointed out the lack of adequate training of health care workers and health professionals on optimal breastfeeding practices. Besides, even though many provisions of the International Code of Marketing of Breastmilk Substitutes have now been implemented into law, there is still no independent monitoring.  

In Kyrgyzstan, there is neither information on the total amount of maternity yards in the country, nor recent data on the amount of “baby-friendly” hospitals. Besides, the report has highlighted the regional disparities regarding the knowledge on HIV/AIDS. Finally, the lack of emergency preparedness plan to ensure integrated response to protect and support infant and young child feeding in case of emergencies has been noted.

Discussion on infant and young child feeding

The Committee pointed out that a law on the marketing of breastmilk substitutes was adopted in March 2009. However, mothers are still not provided with adequate information on breastfeeding and additionally, they often received free samples of formula. The Committee also emphasized the lack of monitoring mechanism of the new law as well as the poor support to optimal breastfeeding practices, and noted that only one third of the children were exclusively breastfed until 6 months of age.

The Kyrgyz delegation responded that on the contrary, campaigns to promote breastfeeding have been launched. In 2010, an independent demographic medical survey carried out on a large section of the population by international experts found that 56% of infants were exclusively breastfed until the age of six months of age. According to the delegation, breastfeeding is well promoted in the country through many current initiatives led in collaboration with local health committees. The delegation also explained that the government is planning to promote midwifes’ activities at local level. It stated that pre- and post-diploma vocational training is widespread and that breastfeeding classes are included in the programmes. Finally, it explained that teaching and promotion material has been translated to Kyrgyz and Russian languages.

Concluding Observations

In its Concluding Observations, the Committee urged Kyrgyzstan to develop a comprehensive system for collecting disaggregated data (para 7(b). Regarding health issues, it requested the country to tackle the issues of child mortality resulting of preventable and curable diseases and to ensure children's access to adequate and sufficient food (para 48) and take all necessary measures to prevent transmission of HIV/AIDS by raising awareness of the public (para 50).

The Committee also issued direct recommendations related to breastfeeding (para 53-54). After having noted the adoption of the Law on the promotion of breastfeeding of March 2009, regulating the advertisement and promotion of infant formulas, the Committee expressed concern about the poor implementation of the Law and the reported complicity between medical personnel and baby food industries, which has led to inadequate information and free samples of baby food products provided to mothers. Therefore, the Committee recommended Kyrgyzstan to “take all necessary measures to implement its legislation promoting breastfeeding practices and ensure that all mothers receive adequate information on the benefits of their breast-milk”.  It also recommended Kyrgyzstan to “adopt the International Code for Marketing of Breast-Milk Substitutes.”

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.