Germany presented its consolidated 3rd and 4th periodic report on the
situation of the implementation of the Convention
on the Rights of the Child (CRC) in the country.
IBFAN presented an alternative report and an annex to inform the CRC
Committee on Germany’s situation on the issue of
infant and young child feeding.
General overview of breastfeeding in German
The alternative report insists on the lack of up-to-date information concerning
breastfeeding practices. Indeed, there is only one national survey with data on breastfeeding practices
and this data go back to 2005, assessing that initiation of breastfeeding was
of 81.5% and that children were exclusively breastfed during a mean duration of
4 to 6 months, while WHO
recommends exclusive breastfeeding to 6 months. The report highlights that in the most
vulnerable social classes, breastfeeding is less practiced. Another discrepancy
in practices has also been found between the different Länder. Regarding the
implementation of the International
Code, Germany
has adopted the EU Directive 2006/141/EC on infant formulae and follow-on formulae, which is weaker than the Code. However, even this legislation is
neither monitored nor enforced. The marketing of breastmilk substitutes is
aggressive and “gifts”, among other things, are provided to patients by doctors
and nurses. Hipp provides, for example, a special programme that gives the
attendants credits for their obligatory continued education. In addition,
Germany faces another issue related to conflicts of interest: some scientists
are paid by baby food industry to carry out studies on breastfeeding. As
demonstrated in the literature, such business interests may seriously affect
the results of these studies and thus influence the reliability of the data and
ultimately lead to distortion of policy decisions. Finally, only 78 out of
about 800 hospitals complied with the requirements of the WHO/UNICEF Baby-friendly
Hospital Initiative (BFHI). Furthermore, due to economic
pressure on hospitals to work profitably and more workload for less staff,
baby-friendly hospitals face difficulties to keep up their standards. The
national health insurance does not consider their services as a quality
standard and therefore, does not get any extra payment and support.
Discussion on infant and young child feeding
The CRC Committee asked if Germany implemented the
International Code. The issue of maternity protection rules, especially
maternity leave, has also been discussed, as well as the existence of any potential barriers to
breastfeeding in public. The Committee then raised its concern about the
increasing rate of attachment disorders between the mothers and their children
in Germany, stressing the importance of breastfeeding to build attachment in
the early stage of life. The German delegation did not address in their response any of these
issues.
A wide range of other topics related to the rights of the child were
tackled during the session: the impact of the business sector on children’s
rights, children with disabilities, children from ethnical and social
minorities, birth registration, corporal punishment, help lines for children,
juvenile justice, education, harmful practices on children, children in
institutions and baby-boxes.
CRC Committee's Concluding Observations
In its Concluding Observations, the CRC Committee recommended Germany to
establish a comprehensive data collection system (para 16), to respect
children’s rights in relation to the business sector (para 23), to raise
awareness about healthy eating habits (para 57) and to promote breastfeeding
while informing the public on the risks of formula feeding (para 63).
In the first instance, the CRC Committee requested the State Party to “establish a comprehensive and
integrated data collection system on
children covering all Länder and the entire period of childhood up to the age
of 18, and to introduce indicators on children’s rights on which progress in
the realization of those rights could be analysed and assessed.
Further, the Committee
recalled its 2013 General Comment N° 16 on
State obligations regarding the impact of the business sector on children’s
rights, that specifically calls on States “to implement and enforce
internationally agreed standards concerning children’s rights, health and
business including the [...] International Code of Marketing of
Breast-milk Substitutes and relevant subsequent World Health Assembly
resolutions”. In the section Children's
right and the business sector, the Committee recommended Germany to “(a)
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 environmental and other standards, especially
those relating to children’s rights; (b) Take into consideration the best interests of the child when
adopting budgetary measures such as subsidies for business affecting
children rights; (c) Examine and adapt its legislative framework (civil,
criminal and administrative) to ensure
the legal accountability of business enterprises and their subsidiaries operating in or
managed from the State party’s territory, regarding violations of child and
human rights.”
The CRC 2013 General Comment N°15 on the
right of the child to the enjoyment of the highest attainable standard of
health (art. 24) explicitly recognises
the importance of breastfeeding for the achievement of the
right of the child to health. It urges States,
in the effort of diminishing infant and child mortality, to devote particular
attention to neonatal mortality and suggests, inter alia, to “pay
particular attention to ensuring full protection and promotion of breastfeeding
practices”. Moreover, “exclusive breastfeeding for
infants up to 6 months should be protected
and promoted and breastfeeding should continue together with appropriate
complementary foods preferably until two years of age as feasible.
States’ obligations in this area are defined in the “protect, promote and
support framework”, adopted unanimously by the World Health Assembly in
its 2002 Global Strategy for Infant and Young Child Feeding". Regarding Health and
health services, Germany is urged to pay attention to the General
Comment N° 15 and to “undertake advocacy
and awareness-raising programmes targeting
schools and families, emphasizing the importance of physical exercise, healthy eating habits and lifestyles, as well as take all
necessary efforts to address the existing disparities in health outcomes.
Special attention should be paid to children and young people in vulnerable
situations, especially those from socially disadvantaged or migration
backgrounds”. The Committee furthermore recommended the State Party to “take
every necessary legislative and structural measure to ensure that every child
within the State party has access
to breastfeeding through the control of infant formula which will promote better bonding
between infants and mother."
Last but not least, as the Committee noted
with concern that breastfeeding rates were declining in Germany, it recommended
the government to “strengthen its efforts to promote exclusive and continued
breastfeeding by providing
access to materials, and educating and raising awareness of the public on the
importance of breastfeeding and the risks of formula feeding. The Committee
urges the State party to strictly
enforce the International Code of
Marketing of Breast-milk Substitutes.”
