63rd CRC Committee: Recommendations on breastfeeding to Armenia, Guinea-Bissau, Israel, Rwanda, Slovenia and Uzbekistan

The 63rd session of the Committee on the Rights of the Child (CRC Committee) took place in Geneva from 27 May to 14 June 2013. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 6 countries: Armenia, Guinea-Bissau, Israel, Rwanda, Slovenia and Uzbekistan.

IBFAN submitted alternative reports on the situation of infant and young child feeding for all the countries under review. Some of the reports were written in collaboration with IBFAN groups and contacts in the countries and the regional offices.

In its concluding observations, the CRC Committee referred specifically to breastfeeding in 5 out of the 6 countries. With the exception of Israel, all the other countries received concluding observations on infant and child nutrition, and breastfeeding in particular.

The Committee recommended states to promote adequate infant and young child feeding practices including exclusive breastfeeding of children up to the age of 6 months (Armenia, Guinea-Bissau, Rwanda and Uzbekistan), to support exclusive breastfeeding and ensure that parents and communities are informed about it and its advantages (Guinea-Bissau and Uzbekistan). The Committee has stressed the need to collect data on breastfeeding (Slovenia) and to adopt international definitions for data collection in order to, inter alia, identify intervention for infant mortality reduction including BFHi and breastfeeding information (Uzbekistan). Adopting a national law or policy on breastfeeding is another recommended action (Armenia and Guinea-Bissau).

All countries that received direct recommendations on breastfeeding issues are urged to revitalize or start to implement the Baby Friendly Hospital Initiative.

Emphasis is put on the importance of controlling marketing practices of breastmilk substitutes. Some countries are recommended to monitor, or strengthen the monitoring of, existing marketing regulations and to take action against violations (Armenia and Slovenia), while others are urged to adopt and enforce the International Code of Marketing of Breastmilk Substitutes (Guinea-Bissau, Rwanda and Uzbekistan), with Uzbekistan specifically recommended to adopt it as national law. In the case of Slovenia the recommendations on the Code are quite elaborated, with mention to regulation of also bottles and teats and to safeguarding against marketing in Maternity Care Institutions.

Regarding maternity protection at work, Uzbekistan is recommended to extend the post-birth period of the maternity leave in order to facilitate exclusive breastfeeding for 6 months, while Guinea-Bissau is advised to ratify the ILO Convention concerning the revision of the Maternity Protection Convention (Revised), 1952 (No.183).

On health more generally, the CRC Committee focused on the need to ensure equal access to health care services, with regard to both urban-rural differences and ethnic differences (Armenia, Israel, Rwanda and Slovenia). Access should also not impeded by the practice of informal fees, that should be eliminated (Armenia and Uzbekistan). The Committee highlighted the importance of quality of health care services that should be pursued by allocating adequate human, financial and technical resources to the health sector (Armenia, Guinea-Bissau, Israel, Rwanda and Uzbekistan).

Combating and preventing childhood obesity (Armenia and Slovenia) and preventing mother-to-child transmission of HIV (Armenia, Guinea-Bissau, Uzbekistan) are other important issues addressed in the concluding observations.

For the full report read here

Breastfeeding situation in Slovenia

The situation of the implementation of the Convention on the Rights of the Child in Slovenia has been reviewed at the 63^rd session of the Committee on the Right of the Child (CRC Committee), on Wednesday 6^th June.

IBFAN presented its alternative report where it highlighted that Slovenia has only few provisions of law implementing the International Code of Marketing of Breastmilk Substitutes.

The issue of breastfeeding has been touched upon during the interactive dialogue between the CRC Committee and the country delegation.

Slovenian delegation reported that their country puts a special emphasis on breastfeeding, in laws, policies and guidelines (e.g. in the ‘Guidelines on Healthy Diet for Young Children’), where it has pledged to increase exclusive breastfeeding for the period 0-6 months of the baby’s life.

According to the delegation, breastfeeding rates are high in Slovenia, with 97% of breastfed babies up to 3 months and 2/3 exclusively breastfed in 2010.

Slovenia has also adopted a ban on marketing of breastmilk substitutes, while many maternity clinics are mother-friendly hospitals.

Breastfeeding is included in labour legislation according to which mothers have the right to breastfeed breaks until the baby is 18 months of age, without loss of payment.

The problem of high incidence of obesity in the country was also addressed by the delegation. In a US-EU countries ranking on obesity, Slovenia falls in the first third with the most obese population. Obesity is a complex issue and it is mentioned in several policies: on physical activity, on nutrition, etc. Vending machines have been abolished in schools and a policy on healthy diet in schools is subsidized by the State.

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”

Greece: Unfavourable Environment Leads to Extremely Low Breastfeeding Rates

Greece reported for the second time at the Committee on the Rights of the Child, on the 6^th of June 2012. 

IBFAN had submitted an extensive alternative report on the situation of infant and young child feeding in Greece. The report highlighted the many violations of the International Code of Marketing of Breast milk Substitutes (the Code) in Greece, and expressed concern over the lack of education on breastfeeding and support for mothers who wish to breastfeed.

The Committee asked many questions on health, and in particular on the situation of breastfeeding in Greece. Due to the current economic situation in Greece, many of the questions were related to financial issues, such as how the healthcare system will be affected by the new budget. 

The Committee reminded the delegation that breastfeeding is the most cost effective method of taking care of children and expressed concern with the fact that less than 10% of mothers breastfeed exclusively for the first 6 months, and only 7% continue breastfeeding up to one year. There is a lack of support in Greece for mothers who wish to breastfeed, as 89% of women expressed the intention to breastfeed prior to delivery. This can be attributed to the high rate of C-sections and the high number of free samples of formula given to mothers in hospitals. The Committee reminded Greece that it should work on methods to support mothers who wish to breastfeed and that no free samples of infant formula should be distributed in health facilities in accordance with the Code.

The IBFAN report acknowledges that there are currently no baby-friendly facilities in Greece, however two state hospitals have started the certification process and another two are due to start it. The Committee asked the delegation whether the hospitals would actually finish the certification process in order to be certified as baby-friendly institutions.

The unsatisfactory response by the Greek delegation was that the formal practice of healthcare professionals is to advocate for breastfeeding to mothers and to avoid commercial campaigns with products that are breastmilk substitutes and that the government is unaware of informal practices in hospitals. 

 2 photographs of gift-packs received by post partum women clearly showing a bottle with a rubber teat.Source: IBFAN Alternative Report.

Free gifts of breastmilk substitutes, including bottles and teats are prohibited from the International Code of Marketing of Breastmilk Substitutes.