Honduras at the CRC: Lack of Funding for the Implementation of National Policies and Insufficient Maternity Leave

On May 20 and 21, 2015, the Committee on the Rights of the Child considered the combined fourth and fifth periodic report of Honduras 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 Honduras.

General overview of breastfeeding in Honduras

IBFAN pointed out the decline in the rate of early initiation of breastfeeding within one hour after birth between 2005-2006 (79%) and 2011-2012 (64%) which appears to be even higher in rural areas (70% in 2011-2012) according to the survey ENDESA 2011 - 2012. IBFAN also noted with great concern that the rate of early initiation of breastfeeding is lower among children born with delivery assistance by health professionals. In addition, in 2011-212 almost 7 children out of 10 were not exclusively breastfed until 6 months of age, while half of them were bottle-fed. 

IBFAN further highlighted the absence of funding allocated to the implementation of national policies and plans on breastfeeding and infant nutrition by the National Breastfeeding Committee (CONALMA). For example, due to the lack of funding, all the activities designed in the National Breastfeeding and Complementary Feeding Plan 2009-2013 could not be implemented. As a result of such poor funding of national policies and plans, there is a deficiency in the training of health professionals on optimal breastfeeding practices which leads to a lack of skilled counseling on infant and young child feeding. 

Only few provisions of the International Code of Marketing of Breastmilk Substitutes are implemented and there is a lack of knowledge on the Code among health personnel resulting regular Code violations. 

Regarding maternity protection, the report stressed that the maternity leave (12 weeks, of which 6 weeks after delivery) does not allow mothers to breastfeed exclusively for 6 months. There is no paternity leave entitlement and many workplaces are lacking nursing areas and childcare facilities. Finally, IBFAN emphasized the absence of any preparedness plan to ensure the protection and support of breastfeeding in emergencies. 

Discussion on infant and young child feeding

The discussion between the Committee and the delegation has been very much focused on the issue of the violence against children and the condition of by migrant children. The issue of the prohibition of abortion has also been raised by several members of the Committee 

However, the Committee raised concerns about the high rates of teenage pregnancies in the country, and asked what is done to prevent them. It also emphasized the high rates of malnutrition in the country. More specifically, the Committee asked the delegation about the measures taken to protect and promote breastfeeding.

Regarding adolescent pregnancies, the delegation explained the First Lady recently launched a prevention campaign and that a multisectoral approach is followed by the government. For example, there are clinics specifically aimed at adolescents, where they can go without their parents. The delegation also specified that no women who require treatment are turned away even in the case they have had an abortion. The delegation stressed that since 2010, a guidance on how to teach sexual education to adolescent is in place, but it admitted that the government needs to step up its efforts in this area.

Regarding breastfeeding, the delegation mentioned the 2013 law on breastfeeding protection, promotion and support and specifically referred to the articles 10 (on the constitution of the CONALMA), and 19 to 31 (on the regulation of the marketing of breastmilk substitutes).

Concluding observations

In its Concluding Observations, the Committee made several indirect recommendations to Honduras in relation with infant and young child feeding. However, it did not refer specifically to breastfeeding.

The Committee first urged Honduras to provide the adequate resources for the effective functioning of data collecting systems, by including disaggregated data and high quality and timely information (§16a-c).

After welcoming the decline of infant and under-5 mortality and the adoption of the Breastfeeding Law, the Committee expressed its concerns on the “delay of adopting a primary health-care strategy and the limitations imposed on the Expanded Programme of Immunization” (§60). In this regard, the Committee recommended Honduras to adopt of a primary-health care strategy (§61a) and the adequate allocation of human, technical and financial resources to the immunization programme (§61b). The Committee also stressed the need to improve the coverage and the quality of health services, particularly in rural and indigenous areas (§61c). Regarding HIV/AIDS, the Committee highlighted the importance sustain measures to prevent mother-to-child transmission (§67b) and to improve the follow-up treatment for infected mothers and their children (§67c).

Lastly, regarding nutrition, the Committee highlighted the high level of chronic malnutrition, which affects twice as many children in rural as in urban areas (§68) and thus recommended the State party to strengthen its efforts to reduce the rated of chronic malnutrition (§69c).

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).

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).

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).

Uruguay at the CRC: Lack of Monitoring of the Legislation Implementing the Code

On January 19th and 20th, 2015, the Committee on the Rights of the Child considered the combined third to fifth periodic report of Uruguay on the situation of the implementation of the Convention on the Rights of the Child in the country. The Uruguayan delegation was led by Mrs. Alejandra Costa, Director for Human Rights and Humanitarian Law at the Ministry of Foreign Affairs.

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

General overview of breastfeeding in Uruguay

The report outlined that although the rate of exclusive breastfeeding under 6 months is high (65%), some 4 children out of 10 are not breastfed within an hour after birth, which questions the quality of the counselling and support received by mothers in maternities. Besides, more than 7 children out of 10 are not breastfed until the age of 2 years, despite the recommendations of the World Health Organization.

Regarding protection and support of breastfeeding, IBFAN noted that the National Breastfeeding Standard (NNLM) is not fully implemented as many health workers are not trained on its content, including on the InternationalCode on Marketing of Breastmilk Substitutes and the guidelines “Buenas Practicas de Alimentacion del lactante y del nino pequeño”. In addition, there is no monitoring mechanism of the legislation implementing the International Code.

The IBFAN report also highlighted that in 2009-2010, only 35% of the maternities of the country were certified as “baby-friendly” and that the Human Milk Bank receives in-kind donations from Nestlé, which can lead to situations of conflict of interest.

Finally, the report noted that the maternity leave does not allow mothers to breastfeed exclusively for 6 months, and that mothers working in the informal sector are not covered. There are no training courses on HIV and infant feeding for health professionals and there is no national plan to protect and support breastfeeding in case of emergencies.

Discussion on infant and young child feeding

Questioned on the issue of maternal mortality, the Uruguayan delegation responded that measures are taken to ensure that all pregnant women have access to health and that early checkups are carried out. Majority of deliveries occur in institutions and the government has taken action to prevent avoidable maternal deaths within the current national action plan. The next action plan should also cover the issue of nutrition of pregnant women, which is not included in the current action plan.

On the issue of breastfeeding, the Committee first congratulated Uruguay for the implementation of the International Code of Marketing of Breastmilk Substitutes. However, it noted that the International Code is not yet fully implemented and that no monitoring mechanism is in place. It also asked for more information on the training of health professionals regarding optimal breastfeeding practices. It expressed concern about Nestlé’s donations received by Human Milk Bank and deplored the fact that only 35% of the maternities of the country are complying with the requirements of the Baby-friendly Hospital Initiative. Finally, the Committee regretted that women working in the informal sector are not allowed to maternity leave benefits and it stressed the need for Uruguay to adopt a plan to protect and support breastfeeding in case of emergencies.

The Uruguayan delegation answered that the maternity leave has been recently extended to 14 weeks and that after the third month of leave, parents can decide whether the father will take up the leave. However, the delegation admitted that informal workers are not allowed to these benefits. Regarding monitoring of the legislation implementing the International Code, the delegation explained that the government is currently working with UNICEF to develop such a monitoring mechanism. In regard to the implementation, the delegation noted that an initiative called “Good eating habits during breastfeeding” has been developed, as well as a strategy, and stressed the fact that breastfeeding rates have been improved (from 20% in the 1990s to 65% today). 

After follow-up questions from the Committee, the delegation again stressed that monitoring of the legislation implementing the Code is the main challenge for the government regarding breastfeeding. The delegation also admitted that the Human Milk Bank, which is under supervision of the Ministry of Health, has received glass jars to store the breastmilk from Nestlé and that these jars, which cannot be bought on the national market, are free from any advertisement. No funds from the industry are accepted. The delegation added that Uruguay has developed a joint network of human milk banks with Brazil in order to ensure that all children, especially underweight children, have access to breastmilk.

Concluding Observations

In its Concluding Observations, the Committee made recommendations indirectly related to infant and young child feeding, however it did not refer specifically to breastfeeding. Regarding health and health services, the Committee urged Uruguay to “strengthen its efforts to ensure access to quality health services by all children, particularly children living in the most disadvantaged and remote areas of the country”, as well as to “develop policies and programmes to address chronic malnutrition and anaemia” (§ 46).