Breastfeeding in Rwanda

On Thursday 30^th and Friday 31^st May the situation of children’s rights in Rwanda has been reviewed by the CRC Committee at its 63^rd session, where the question of breastfeeding has arisen.

IBFAN has submitted an alternative report on the situation of infant and young child feeding in Rwanda. The report notes that there are no baby-friendly hospitals; there is no legislative measure that implements the Code in Rwanda, only a draft measure; the policy on children’s health defines breastfeeding as a duty of mothers, putting the burden on women, and putting them in a vulnerable position and that the duration of maternity leave is short, only 12 weeks, and starting from the second 6 week mothers are entitled to receive only 20% of the salary. In addition, maternity benefits are paid for by the employer, which may result in employers discriminatory employment practices against women.

During the CRC session, the Rwandan delegation reported efforts to educate parents on breastfeeding and train pregnant women during the prenatal and postnatal period, in addition to campaigns on food production that is appropriate for young children.

It further explained that exclusive breastfeeding for 6 months is the practice followed in Rwanda. After a Committee member clarified that for the first 6 months of a baby’s life exclusive breastfeeding is the best feeding practice and that no other milk should be given, the Rwandan delegation added that soy milk is given as a complementary feeding after the first 6 months of age to combat child malnourishment.

The situation of BFHi has been briefly touched upon by a Committee member in the context of Rwanda’s Early Childhood Development Policy but the Country delegation did not elaborate on that.

More broadly on reduction of malnutrition, the delegation provided information on efforts to combat the problem through a national program for elimination of malnutrition. It also reported a 2009 screening program that reached each child in all villages where malnutrition is an issue. The screening program has been followed by an emergency program to accelerate the elimination of malnutrition. Other interventions include information on how to prepare local foods, economic empowerment of families, home gardens and kitchens for villages.

Other questions pertained to education, children with disabilities, leisure time and recreation, refugee law, mechanisms to tackle violence against children, discrimination of minorities, child labour, juvenile justice and adolescent reproductive health.

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”

Breastfeeding situation reported by Guinea not confirmed by data

The situation of the implementation of the Convention for the Rights of the Child in Guinea has been reviewed by the CRC at the 62^nd session, on January 18^th 2013.

IBFAN submitted its alternative report on the situation of breastfeeding in Guinea (also in French). The report highlights the fact that a 1997 draft legislation for the implementation of the Code on Marketing of Breastmilk Substitutes is still stuck in the legislative process and has therefore not yet been adopted. It also notes that, even though mothers continue breastfeeding for an average duration of 2 years, there is a sharp drop in exclusive breastfeeding after the 3^rd month of age leading to an 18% rate of exclusive breastfeeding between the 3^rd and the 6^th month of child’s life.

The CRC Committee raised questions about the alarming maternal and children under-5 mortality rates. The high incidence of child malnutrition and of diseases linked to malnutrition and poverty – such as noma – has also been an issue of concern. The Guinea delegation explained the high mortality rates of both mothers and children by the lack and the poor quality of health services and health personnel. 

Questions about malnutrition have not been addressed in detail, but the Guinean delegation did mention the issue of breastfeeding. The delegation considered that exclusive breastfeeding for the first 6 months of life is considerably promoted in Guinea. It also noted the little presence of breastmilk substitutes on the Guinean market. The delegation reported that working mothers are aware of the importance of breastfeeding and thus they prefer staying at home in order to breastfeed. In health centers there are both prenatal and postnatal support, where mothers are advised to feed their children by exclusively breastfeeding for the first six months. Whenever mother cannot breastfeed because of infections they have and  could transmit to their children,  babies are treated at the infant nutrition centre in order to feed them. 

Data presented in the IBFAN alternative report seem to contradict with the positive picture described by the delegation. We regret that the CRC Committee did not address further questions on this issue to the delegation.

Women with their babies at a community health centre in Conakry, Guinea. Image via IRIN.