Great success for the discussion evening 'Nestlé in Pakistan: The Baby Formula Scandal exposed' during the International Film Festival and Forum on Human Rights 2015

On February 27, 2015, during the International Film Festival and Forum on Human Rights (FIFDH) held in Geneva, the movie Tigers was screened within the framework of a discussion evening entitled 'Nestlé in Pakistan : The Baby Formula Scandal exposed' organized in collaboration with IBFAN-GIFA.

The feature film Tigers is based on the true story of a former Nestlé salesman, Mr Syed Aamir Raza. He blew the whistle after the shock realization of the impact of his employer’s activities on children’s health. That decision had terrible consequences on its private life and he had then to seek asylum in Canada, where he spent long years away from its family before they could finally be reunited in exile.

Mr Aamir Raza attended the screening and took part in the debate that followed, together with Ms Yasmine Motarjemi (former corporate food safety manager at Nestlé and whistleblower) and Mr Mike Brady (Baby Milk Action/IBFAN UK). The co-author of the movie, Mr Andy Paterson, was also present and answered some questions about the preparation of the movie. The debate was moderated by Mr Alain Maillard, chief editor for Edito, and led to a very fruitful discussion with the public. 

Related links:

• Article on the event in the newspaper Le Courrier - February 27, 2015 (in French)
• Webcast of the debate

Breastfeeding and child rights in Luxembourg

Luxembourg presented its consolidated 3^rd and 4^th periodic report on the situation of the implementation of the Convention on the Rights of the Child in the country. The combined 5^th to 6^th periodic report is expected by October 2019.

IBFAN submitted an alternative report on the situation of infant and young child feeding in Luxembourg. The report highlights the fact that breastfeeding rates are insufficient. Only 6% of infants are exclusively breastfeeding during the first 6 months; this rate has indeed decreased since 2001. In 2005, the government of Luxembourg assured it will establish a national plan for promoting and protecting breastfeeding. Until now two plans have been adopted, one between 2006 and 2010 and the other between 2011 and 2015. Unfortunately, the action plan has not been backed with sufficient budget, leading to restricted implementation. More and more women stop breastfeeding their children before they reach 6 months. The report also underlines the fact that only half of the four maternity hospitals are baby-friendly, while there is a lack of information to mothers about breastfeeding from midwives and breastfeeding counselors. The report states that the implementation of the International Code of Marketing of Breastmilk Substitutes and resolutions is weak as it conforms to the EU Directive 2006/141/EC and not to the WHO Code. Concerning maternity protection at work, breastfeeding breaks are paid by the employer and women need to present a medical certificate for the whole duration of breastfeeding. This may lead certain women to feel pressured not to ask for the break or not taking them for the entire breastfeeding period, which in turn could explain the decreasing rate of exclusive breastfeeding at 6 months.

Discussion on infant and young child feeding

During the dialogue with the government delegation, CRC Committee has raised questions on breastfeeding. The Committee members pointed to the fact that exclusive breastfeeding is practiced by always fewer women. They asked whether health professionals receive training on breastfeeding, and on the impact of cesarean section on breastfeeding rates. The Committee members asked whether promotion of breastmilk substitutes is authorized in hospitals. They highlighted the fact that the promotion of infant formula in hospitals, and lack of regulation of their marketing together with a lack of support to understand the importance of exclusive breastfeeding up to 6 months, can undermine the successful breastfeeding by mothers, and recommended to Luxembourg to have strong regulations on the marketing of breastmilk substitutes coupled with a good monitoring of the Code and resolutions, as well as adequate maternity protection for working women so that mothers are really supported to breastfeed. The Committee also addressed the need to turn all four hospitals into baby-friendly.

The Luxembourg delegation reported that concerning the decreasing rate of exclusive breastfeeding, it is mainly women of low social and economical background who stop more and more breastfeeding their children after 6 months. The government of Luxembourg highlighted the fact that it is currently working in collaboration with international partners on the project to change the image of breastfeeding in order to convince mothers to continue breastfeeding their child until 6 months.

Concerning the Baby-Friendly Hospital Initiative, the delegation of Luxembourg said that one of the objectives of the national programme is to put BFHI in the national criteria for maternity units.

Concluding Observations

Although issue related to breastfeeding such as the BFHI, the marketing breastmilk substitutes, adequate budgeting of the national action plan and maternity protection were tackled during the Committee, we regret to see that no recommendations on this issue in the Concluding Observations were given to Luxembourg. 

For more information on breastfeeding in Luxembourg please see http://www.liewensufank.lu/fr

Sao Tome and Principe to address maternal deaths and business impact on child rights

Sao Tome and Principe presented its consolidated 2^nd to 4^th periodic reports on the situation of the implementation of the Convention on the Rights of the Child in the country. The 5^th and 6^th periodic reports are expected by June 2018.

IBFAN did not present any alternative report.

Discussion on infant and young child feeding

The Committee did not address issues related to breastfeeding. However, it tackled the question of maternal mortality in relation to HIV/AIDS infections. The delegation of Sao Tome and Principe explained that it is currently taking steps to eradicate these infections by 2015. Counseling centers for sexual health have been established in schools and awareness-raising activities are being organized for young persons.

Concluding Observations

No recommendation specifically refers to breastfeeding in the Concluding Observations. The CRC Committee instead mentioned the importance of a good health care system. It drew attention to its General Comment no. 15 (2013) on the right of the child to enjoy the highest attainable standard of health. It therefore recommended Sao Tome and Principe to: “(a) allocate adequate human, technical and financial resources to improve the quality of health care and provide quality training for the health care personnel, particularly at local levels; (b) Undertake surveys and studies on the extent and root causes of maternal mortality throughout the country and apply the findings therein for formulating and implementing comprehensive programmes for addressing maternal deaths: and, (c) Seek financial and technical assistance from UNICEF and the World Health Organization (WHO), among others, in this regard” (para 48-49).

The CRC Committee also insisted on improving the access to safe drinking water. It recommended the State party to: “(a) intensify its efforts to improve access to safe drinking water and sanitation, and in doing so pay particular attention to rural and outlying areas” (Para 54-55).

Another paragraph was dedicated to HIV/AIDS. The Committee recognized the efforts of Sao Tome and Principe to decrease the mother-to-child transmission of HIV/AIDS rate by spreading HIV/AIDS testing for pregnant women. However, the Committee noticed that regular follow-up on infected mothers and children remain inadequate and that the access to antiretroviral treatment limited. Therefore, the CRC Committee recommends Sao Tome and Principe to: “(a) Sustain the measures in place to prevent the Mother-to-Child transmission of HIV/AIDS and develop a roadmap to ensure the implementation of effective preventive measures; (b) Improve follow-up treatment for HIV/AIDS-infected mothers and their exposed infants[...] and (d) Improve access and coverage of Antiretroviral Therapy and Antiretroviral prophylaxis for HIV infected pregnant women. In doing so, the Committee recommends that the State party seek technical assistance from, inter alia, the United Nations Joint Programme on HIV/AIDS (UNAIDS) and UNICEF” (para 52-53).

Finally, the CRC Committee drew Sao Tome and Principe’s attention to the General Comment No. 16 (2013) on State obligations regarding the impact of the business sector on children’s rights and recommended Sao Tome and Principe to have a clear regulatory framework and effective implementation and monitoring mechanisms to ensure that business activities do not negatively affect the rights of the child. Concerning that issue, the Committee recommended in particular Sao Tome and Principe to: “(b) Ensure effective implementation by companies, especially those of the extractive industries, of international and national environment and health standards, effective monitoring of implementation of these standards and appropriately sanctioning and providing remedies when violations occur, as well as ensure that appropriate international certification is sought; (c) Require companies to undertake assessments, consultations, and full public disclosure of the environmental, health-related and human rights impacts of their business activities and their plans to address such impacts; and, (d) Be guided by the United Nations “Protect, Respect and Remedy” Framework, accepted unanimously in 2008 by the Human Rights Council, while implementing these recommendations” (para 23- 24).

Children’s Rights in Guinea-Bissau at the CRC Committee

The situation of children’s rights in Guinea-Bissau has been reviewed by the Committee on the Rights of the Child (CRC Committee) at its 63^rd session, on June 7^th 2013.

IBFAN presented an alternative report on the country situation vis-à-vis infant and young child feeding. The report shows how, although improving, breastfeeding rates are still insufficient: only 38% of infants were exclusively breastfed for 6 months in 2010, and in 2012 72% of babies were initiated to breast within one hour from birth, while the introduction of complementary food is not timely for more than half of infants.

Inadequate breastfeeding practices contribute to the high child and maternal mortality rates in Guinea-Bissau, where 9% of children die before their first year of life. Breastfeeding promotion activities took place in the country thanks to international cooperation partners, however projects are expiring this year and the country does not have the means to maintain them on its own.

Maternity protection at work is another challenge for Guinea-Bissau, where maternity leave is as short as 2 months and the relative benefits are paid by the employer, situation which carries the risk of generating a discriminatory effect against women, as employers may want to avoid paying such benefits.

During the interactive dialogue between the CRC Committee and the country delegation, the issue of breastfeeding has not been addressed in detail but only briefly mentioned in the context of health care. On this point, the country delegation assured the Committee that the national health system extends to all national territory, including rural and remote areas. The country is engaged in developing health plans, including a strategic plan on HIV/AIDS, on water and sanitation, and a financial strategic plan to reach the millennium development goals that will cover breastfeeding promotion and maternal mortality reduction programs. Regarding reproductive health services, the country delegation noted that prenatal consultation is free and includes counselling to pregnant mothers.

Other issues debated at the session included a wide range of topics: child adoption, juvenile justice, birth registration, infanticide, paedophilia, violence against children, child labour, children in street situation, education, child marriage and children with disabilities.

The dialogue between Guinea-Bissau and the Committee has been very collaborative and the country delegation was well aware of Guinea-Bissau’s shortcoming in realizing children’s rights in the country; however it stressed that due to financial constraints many improvements are not achievable at the moment.

ISRAEL’S BREASTFEEDING PRACTICES ARE IMPROVING

On Monday 3^rd May 2013 the situation of children’s rights in Israel, including the Occupied Palestinian Territories, have been reviewed by the Committee on the Rights of the Child (CRC Committee) at its 23^rd session.

The International Baby Food Action Network (IBFAN) presented an alternative report on the situation of infant and young child feeding.

The issue of breastfeeding was tackled by the CRC Committee that asked about the absence of a database for the collection of data and of a law on marketing of breastmilk substitutes and about the situation of BFHI and of maternity protection at work.

In particular, one Committee mentioned the maternity protection law providing that a female employee who is prohibited from working at certain jobs by law because of her breastfeeding is entitled to be excused from work and this absence is tantamount to leave without pay and asked clarification on its interpretation in order to avoid discrimination of women that decide to breastfeed.

The delegation could not answer all the questions due to time restraints; however they reported improvements in breastfeeding rates as they already reached the goals set by the government for the year 2020. To further support breastfeeding, each government facility must provide space for breastfeeding or for expressing breastmilk.

The delegation also explained how the International Code of Marketing of Breastmilk Substitutes is enforced is some situations, for example vis-à-vis advertising companies. In addition, they mentioned the 2003 Remedia case concerning a bulk of imported infant formula that lead to some children dying and some other being irreversibly harmed due to lack of a fundamental vitamin, and as a result all imported formula is now carefully examined. It was also noted that HIV positive mothers are given free breastmilk substitutes.

Finally, the Committee was concerned by reports of delays at checkpoints also involving pregnant women that are seeking medical assistance.

The delegation informed that within the West Bank all roadblocks have been removed and therefore there are no restrictions on the freedom of movement. To enter Jerusalem there still are checkpoints and roadblocks but there are not recent reports of delays in passage of pregnant women and all the military personnel is specifically trained to let though medical cases as expeditiously as possible.

BREASTFEEDING IN UZBEKISTAN AT THE CRC COMMITTEE

At the 23^rd session of the Committee on the Rights of the Child (CRC Committee) the situation of children’s rights in Uzbekistan has been reviewed on Tuesday 4^th May. IBFAN presented its alternative report on the state of infant and young child feeding in the Country, noting the high infant and maternal mortality rates and the very low rate of exclusive breastfeeding at 6 months of age (only 26%).

The CRC Committee asked information on measures to prevent infant and maternal mortality and on breastfeeding practices and the implementation of the International Code on Marketing of Breastmilksubstitutes.

The Uzbek delegation mentioned two programs designed and implemented in the Country in collaboration with UNICEF, namely the ‘Growth and development for young children’ program and the ‘Breastfeeding’ program to monitor the health of newborns. As a result of these efforts, over the last 10 years the proportion of breastfeeding has increased to 80%.

It is not clear if the data provided by the delegation concerns exclusive breastfeeding and if it reports a national average or it relates only to focus communities involved in UNICEF programs, therefore such data does not provide a clear picture of the situation of breastfeeding rates in Uzbekistan.

The question on marketing of breastmilk substitutes remained unanswered.

Concerning maternal and infant mortality, the Country delegation reported a 10% of maternal mortality in 2012 and a 4% of infant mortality in the same year. These data are much lower than those reported by UNICEF in 2010-2008 (30% of maternal mortality and 44% of infant mortality) and it might be due to discrepancies in data collection, a general problem acknowledged by the Uzbek delegation and being tackled at the national level.

Armenia to Adopt the Draft Law on the International Code and Strengthen BFHI Monitoring

In view of the 63^rd session of the CRC Committee, IBFAN presented an alternative report on the situation of infant and young child feeding in Armenia, prepared by Confidence Health NGO in collaboration with GIFA. The report showed in particular how the International Code on Marketing of Breastmilk Substitutes is heavily violated in hospitals and how NGOs registered violations of the International Code also in some baby-friendly certified hospitals since the implementation and monitoring of the Baby-Friendly Hospital Initiative (BFHI) has been discontinued in 2008. In addition, the report mentions the existence of a draft law on the marketing of breastmilk substitutes, its weaknesses and possible improvements. However, after the report was written there have been some positive developments that resulted in a strengthening of the draft law.

The CRC Committee reviewed the situation of children’s rights in Armenia on Wednesday 29^th May. The issue of breastfeeding and infant and young child feeding were raised by the Committee, in particular in connection with the issues of the International Code and of BFHI. Questions were answered by the representative of the Ministry of Health (MOH).

The International Code of Marketing of Breastmilk Substitutes

The Committee inquired on the plans of the government to finalize the draft law on the marketing of breastmilk substitutes and to adopt it as law and monitor it.

On this point, the Armenian delegate noted that the Country is in the process of adopting a law[i] prohibiting advertising of artificial food, including infant formula, and providing for measures to punish health workers that cooperate with distributors of infant formula. The parliament has just had a hearing on this law, and the MOH representative expressed her persuasion that the law will go through, despite lobbying against it by companies, because legislators look very favourably at it.

Baby-Friendly Hospital Initiative

The Committee asked information on government’s plans to monitor practices in hospitals, where breastfeeding is not always properly encouraged and where infant formula can be provided to mothers.

MOH representative reported that 60% of babies are born in baby-friendly hospitals, where infant formula provision is not allowed, and explained that monitoring of baby-friendly hospitals is carried out by NGOs.

The CRC Committee expressed its disappointment on the lack of government initiative in monitoring of baby-friendly hospitals practices and on the lack of countrywide implementation of the initiative, and asked the government to justify it.

The MOH delegate explained that in all Armenian hospitals babies are kept with the mother; however she acknowledged that the supply of infant formula to mothers is indeed an actual practice. She also explained the lack of State monitoring of BFH with the fact that very active NGOs – especially IBFAN – are carrying it out and the State works hand in hand with them in this area. The delegate further acknowledged that sometimes medical personnel work with distributors of infant formula and may encourage mothers to use it. In this case she considers the State collaboration with NGOs a positive practice.

Undernourishment

More broadly on nutrition, the representative acknowledged that the Country faces a problem of undernourishment mostly related to lack of vitamins. In Armenia children are not going hungry but they are not developing fully: there is a problem of undergrowth that a strategy developed with the assistance of UNICEF tries to tackle. The government delegate reminded that it is not only a health problem, but also of poverty and education.

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[i] The draft law is named "Breastfeeding promotion and regulation of infant food marketing”

62nd COMMITTEE ON THE RIGHTS OF THE CHILD: Governments to strengthen their efforts to protect and promote breastfeeding

The 62^nd session of the Committee on the Rights of the Child (CRC Committee) took place in Geneva from 14 January to 1 February 2013. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 4 countries: Guinea, Guyana, Malta and Niue.

IBFAN submitted alternative reports on the situation of infant and young child feeding for 3 of the countries under review (Guinea, Malta and Niue). The reports were written in collaboration with IBFAN groups and contacts in the countries.

In its concluding observations, the CRC Committee referred specifically to breastfeeding in 3 out of the 4 countries. With the exception of Guinea, all the other countries received concluding observations on infant and child nutrition, and breastfeeding in particular. This was probably due to the fact that the alternative report on Guinea was submitted very late, only few days before the start of the session. This confirms the need to prepare and submit alternative reports ahead of time in order to make sure that they will inform the Committee members.  

The Committee recommended to promote exclusive breastfeeding of children up to the age of 6 months, to strengthen awareness-raising campaigns on the importance of breastfeeding among the public in general (Guyana and Malta) and to train health professionals and mothers on healthy infant and child nutrition (Malta). The Committee has stressed the importance of breastfeeding in preventing infant obesity and the need to collect systematic data which will enable governments to develop adequate and comprehensive national policies to address infant and young child feeding issues (Malta).

Emphasis was put on the importance of the enforcement of the International Code of Marketing of Breastmilk Substitutes and especially on its regular monitoring and the sanctioning of violations (Guyana and Malta).

Taking steps in order to certify hospitals as baby-friendly according to the Baby Friendly Hospital Initiative was also considered important (Guyana and Malta). Niue has been recommended to strengthen maternity protection at work by providing mothers with adequate facilities for breastfeeding at work and by paying particular attention to mothers employed in the private sector.

On health more generally, the CRC Committee focused on the need to ensure equal access to quality primary health care services (Guinea, Niue) and to health and nutrition services (Guyana). In particular, the urgency of tackling chronic malnutrition and other preventable health problems among children has been highlighted (Guinea and Guyana). 

Table1. Summary of concluding observations on Infant and Young Child Feeding

CRC Session 62 - 2013

Country		IBFAN report	Summary of specific recommendations on infant and young child feeding (IYCF)
1	Guinea (2nd)	Yes	Indirect (Para 66): increase resources allocated to the health sector; comprehensive policies and programmes for improving the health situation of children; greater and equal access to quality primary health services for mothers and children in all area of the country, with emphasis on chronic malnutrition.
2	Guyana (2nd + 3rd + 4th )	No	Direct (Para 53-54): strengthen awareness-raising on the importance of breastfeeding and promote exclusive breastfeeding of children up to the age of 6 months; ensure regular monitoring of existing international marketing regulations relating to breastmilk substitutes and take action against violators; certify hospitals as baby-friendly under the Baby-Friendly Hospital Initiative (BFHI). Indirect (Para 48): implement comprehensive programmes for addressing maternal and perinatal deaths; address preventable health problems among children, including diarrhoea and malnutrition; undertake measures to address the quality, access and utilisation of all health and nutrition services, particularly perinatal facilities, in all the regions.
3	Malta (2nd)	Yes	Direct (Para 53-54): strengthen awareness-raising efforts on the importance of breastfeeding and promote exclusive breastfeeding of children up to the age of 6 months; collect data on breastfeeding with a view to developing a national policy to promote and facilitate breastfeeding; ensure regular monitoring of existing international marketing regulations relating to breastmilk substitutes and take action against violators; act in order to certify hospitals as baby-friendly under the Baby-Friendly Hospital Initiative (BFHI); training for mothers and health professionals on healthy infant and child nutrition; importance of breastfeeding for prevention of obesity.
4	Niue (initial)	Yes	Direct (Para 61-62): strengthen maternity protection at work by providing mothers with adequate facilities for breastfeeding at work; take necessary steps for working mothers in the private sector to enjoy the same maternity rights as those in the public sector. Indirect (Para 56): curb child mortality; continue to improve the quality of decentralized services to outer villages while also providing emergency care for children and mothers when in need.