Colombia at the CRC: Concerns about Declining Breastfeeding Rates and Lack of Breastfeeding Promotion

On January 20^th and 21^st, 2015, the Committee on the Rights of the Child considered the combined fourth and fifth periodic reports of Colombia on the situation of the implementation of the Convention on the Rights of the Child in the country. The Colombian delegation was led by Mrs. Cristina Plazas Michelsen Costa, Director of the Colombian Institute of Family Wellbeing.

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

General overview of breastfeeding in Colombia

The report highlighted that despite a high rate of institutional delivery (95%), the rate of early initiation to breastfeeding is low (57%) and has recently declined, which indicates that health professionals are not enabled to ensure optimal breastfeeding practices within hospitals. Besides, the rate of exclusive breastfeeding under 6 months has decreased since 2004 and currently, almost 6 children out of 10 are not exclusively breastfed until 6 months of age. The Colombian National Demographic and Health Survey 2010 has also shown that on average, babies are given other liquids than breastmilk at 2.7 months and that the practice of bottle feeding, which is common during the first year of life, has increased in the last decade. This situation is closely connected with the lack of promotion strategy on optimal breastfeeding practices and aimed at mothers, caregivers and community through media.

Regarding protection of breastfeeding, IBFAN noted that the International Code of Marketing of Breastmilk Substitutes and its subsequent relevant World Health Assembly resolutions are still not fully implemented into legislation and that violations of the Code, including donations of infant formula to health institutions and delivering of gifts to mothers through health workers, are common.

The report also flagged the very low rate of implementation of the Baby-friendly Hospital Initiative in the country. The latest statistic, dating back to 2009, shows that only 0.06% of the total number of health facilities of the country are certified as “baby-friendly”. In addition, there is no monitoring of this accreditation process at the country level.

Finally, IBFAN expressed concern about the lack of maternity protection for women working in the informal sector as well as the lack of any national plan to ensure protection and support of breastfeeding in case of emergencies.

Discussion on infant and young child feeding

During its discussion with Colombia, the CRC Committee addressed specifically the issue of breastfeeding. It mentioned the low breastfeeding rates and noted with particular concern the decline of the rate of exclusive breastfeeding under 6 months. It asked which efforts have been made to ensure that health professionals are properly trained on optimal breastfeeding practices and that mothers are aware of the importance of breastfeeding their child.                                                                                                               

The Colombian delegation answered that the decline of the rate of exclusive breastfeeding is a concern for the government and states the importance of taking action on this regard. It noted that a national breastfeeding plan is in place and that breastfeeding is closely connected with the employment condition of mothers. As part of the gender equality governmental project, the length of the maternity leave has recently been increased to 14 weeks, and the legislation also entitles working fathers to 1 week of paternal leave. In addition, the delegation added that some 17 human milk banks have been implemented throughout the territory in order to make it easier for every child to have access to breastmilk, and that breastfeeding-friendly rooms have been settled in employment areas in order to support working mothers to breastfeed. Finally, regarding the specific problem of teenage pregnancies, the delegation assured the Committee that special facilities have been put in place to ensure that young mothers are able to continue to go to school while breastfeeding their child.

Concluding Observations

In its Concluding Observations, the Committee made several indirect and direct recommendations to Colombia in relation with infant and young child feeding.

Regarding health and health services, the Committee recommended Colombia to “ensure the availability and accessibility of health services for all children […] by allocating adequate resources and monitoring the implementation of relevant policies” (§ 40a). In particular, the Committee highlighted the child and maternal mortality rates which continue to be very high (§ 39f), and thus recommended the State party to “increase its efforts to reduce maternal and child mortality, including by implementing the OHCHR Technical guidance on child mortality” (§ 40c) which includes specific recommendations on breastfeeding protection (including the implementation of the International Code) and promotion. It is to be noted that this technical guidance includes specific recommendations on breastfeeding protection (including the implementation of the International Code) and promotion

Referring specifically to breastfeeding, the CRC Committee expressed its concerns on the decline of exclusive maternal breastfeeding in 2010 and on the persistence of inadequate baby feeding practices. It recommended Colombia to “strengthen efforts to promote breastfeeding through educational campaigns and training to professionals, adequately implement the International Code of Marketing of Breast-Milk Substitutes and the Child-Friendly Hospital initiative [sic]” (§ 40h).

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).