Venezuela at the CRC: Strong Legislation but Lack of Data

On the 1^st and 2^nd September 2014, the Committee on the Rights of the Child considered the combined third to fifth periodic reports of Venezuela on the situation of the implementation of the Convention on the Rights of the Child in the country. The Delegation of Venezuela, led by the Minister of Popular Power for Women and Gender Equality (Ministerio del Poder Popular para la Salud, MPPS), Ms. Andreina Tarazón, was constituted of 31 members, including the General Director of the Health Committee of the Ministry of Popular Power for Education, Ms. Asia Yadira Acosta.

IBFAN presented an alternative report to inform the CRC Committee on the situation of infant and young child feeding in Venezuela.

General overview of breastfeeding in Venezuela

The report highlighted a significant deficit in data collection on infant and young child feeding (IYCF). The available data on IYCF are from 2008 and show that more than 70% of children are not exclusively breastfed until 6 months of age while almost 13% are predominantly breastfed until 6 months of age, although it is considered as an inadequate practice. Some 75% of the children are introduced to complementary food before the recommended age of 6 months. In addition, when bottle feeding, the dilution of the powder milk or formula has shown to be inadequate in more than 70% of cases.

Nonetheless, the Government of Venezuela has shown its will to encourage breastfeeding. Firstly, one of the goals set in the “Plan de la Patria Socialista de la Nación 2013-2019” is to increase exclusive breastfeeding by 70%. Secondly, breastfeeding is promoted as a priority by the MPPS and is referred to in the Organic Law on Children and Adolescents Protection (Ley Orgánica para la Protección de Niños y Adolescentes, LOPNA). Thirdly, the International Code of Marketing of Breastmilk Substitutes, as well as the Baby-Friendly Hospital Initiative (BFHI), were formally implemented into national legislation through two ministerial decisions in 2004. However, in 2010, only 17 out of 204 hospitals were certified as ‘baby-friendly’ and violations of the Code can still be detected, such as the use of health claims, promotion of ‘baby competitions’, corporate sponsoring of  medical events.

Regarding training of health professionals, courses on breastfeeding are organized jointly by the Childcare and Paediatricians Venezuelan Society and the UNICEF. Besides, a course on breastfeeding counselling is organized at national level; since its launch, more than 3,000 accredited breastfeeding counsellors have been trained. Finally, the GALACM-UCV breastfeeding support group also gives training courses on breastfeeding. Nevertheless, in 2009, it is of concern that about 35% of surveyed mothers did not receive information on breastfeeding during pregnancy.

In Venezuela, mothers are entitled to a maternity leave that has been increased from 12 to 20 weeks in 2012. Yet, IBFAN report calls for the extension of the maternity leave up to 40 weeks of corrected age for mothers with premature babies.

Regarding IYCF and VIH/AIDS, a programme on the prevention of vertical transmission is carried out in order to ensure the supply of infant formula during the first year of life for children of HIV-positive mothers. Finally, the national legislation states that breastfeeding should be protected in case of emergencies.

Discussion on infant and young child feeding

The Delegation of Venezuela affirmed that a humanist approach is taken in the field of reproductive health and that the government guarantee the provisions of medical services in this field through the programme Barrio Adentro. A specific programme entitled Misión niño Jesús aimed at pregnant women has been implemented.  In addition, the Delegation stated that the government provides support to improve the nutrition of mothers and children, especially by timely supplementation. Finally, it highlighted that 8 human milk banks have been implemented in  the country.

Concluding Observations

In its Concluding Observations, the Committee made several indirect recommendations. With regard to general measures of implementation, it urged Venezuela “to finalize the design of the National Plan of Action for Children and Adolescents (2015-2019)” (§11) as well as “to expeditiously complete and implement its data collection system” (§20).

As far as health issues are concerned, it recommended that Venezuela “collect disaggregated data on children’s health related issues, in particular on child mortality, including under five mortality, maternal mortality, vaccination coverage, nutrition and breastfeeding; allocate adequate human, technical and financial resources to the national public health system; building on data related to the causes, design a strategy to reduce child and maternal mortality, which includes the implementation of the two existing protocols on maternal and neonatal mortality and continue its efforts to reduce malnutrition and increase vaccination coverage” (§53 (a)-(d)). Furthermore, The Committee also addressed the issue of HIV/AIDS mother-to child transmission by requesting the government to “collect disaggregated data on HIV/AIDS related issues, in particular on [...] number of cases of mother-to-child transmissions, [...] and number of children and pregnant women under treatment” and “ensure that all HIV/AIDS positive pregnant women receive adequate treatment” (§61(a),(c)).

The Committee also issued direct recommendations related to infant and young child feeding (§53(e)). It recommended that Venezuela “increase its efforts to promote breastfeeding by developing a comprehensive programme of action to promote exclusive breastfeeding, including training for staff in hospital maternity wards, closely monitor the implementation of the International Code of Marketing of Breast-milk Substitutes and develop awareness raising campaigns”.

Breastfeeding Challenges in India (CRC)

On the 3^rd of June 2014, the Committee on the Rights of the Child completed its consideration of the combined 3rd and 4th periodic report of India on the implementation of the provisions of the Convention on the Rights of the Child in the country. 

IBFAN presented an alternative report to inform the CRC Committee on the situation on the issue of infant and young child feeding in India.

General overview of breastfeeding in India

About 26 million babies are annually delivered in India. According to the National Family Health Survey-3 (NFHS-3) data, 20 million are not able to receive exclusive breastfeeding for the first six months of their life and about 13 million do not get good timely and appropriate complementary feeding after six months along with continued breastfeeding. The rate of early initiation of breastfeeding within one hour following the delivery is of only 23.4% and exclusive breastfeeding up to the age of six months is of 46.3%. 

However, the national legislation implementing the International Code of Marketing of Breastmilk Substitutes, called the Infant Milk Substitute Act, is still not effectively enforced. Therefore, an effective monitoring mechanism is required at state and district level. In addition, there is no comprehensive adequate training of health professionals done by the government, even though BPNI/IBFAN India has developed a training course and trained more than 15'000 health workers since 2004. Besides, the alternative report emphasized that an increasing number of institutional deliveries occur without adequate space, staff or infrastructure. The Baby-friendly Hospital Initiative (BFHI), launched in the country in 1993, has not been properly revived since then. 

Finally, it has been noted that he national legislation on maternity protection does not cover women working in private and informal sector. Clearly, the support to working mothers needs to be extended to women in the unorganized sector as they form the major part (almost 90%) of working women. Lastly, the alternative report states that the national guidelines on Infant Feeding and HIV have not yet been made into policy, and that there is no policy on infant feeding in case of emergency.

Discussion on infant and young child feeding

The Committee raised the issue of maternal malnutrition and child stunting, and asked if there is any programme to address mother malnutrition. Furthermore, the Committee insisted on optimal infant and young children feeding practices, especially breastfeeding, to combat children malnutrition, which is proven to affect, inter alia, children’s learning capacities. The Committee highlighted the decline in breastfeeding rates in recent years and asked whether there were any programmes in place to remedy this situation. The issue of regional disparities  in breastfeeding rates has also been raised, as well as the promotion of infant formula, despite the implementation of the IMS Act. The Committee showed concern for the Code violations that occur in India and wondered if they are the consequences of a lack of monitoring of the national legislation. It finally asked if there was any implementation of the BFHI at national level and if there were any national guidelines or policy on HIV and infant feeding.

The delegation of India responded that the exclusive breastfeeding rate in India is about 40%, which is relatively high compared to other countries.  It added that the high rate of institutional delivery (78%) gives the country a great opportunity to promote optimal breastfeeding practices to young mothers, and that dedicated breastfeeding counsellors are deployed in maternity wards throughout the country.  The delegation expressed the hope that the actions taken would lead to an increase in breastfeeding rates. It admitted that India had been slow to implement the International Code of Marketing of Breastmilk Substitutes, but it stated that government is currently awareness-raising on the IMS Act among the district health officers. Regarding the issue of HIV and infant feeding, the delegation answered that the existing national guidelines do provide the appropriate guidance to the population.

Concluding Observations

In its Concluding Observations, the CRC Committee made a wide range of indirect recommendations related to infant and young child feeding. At the level of general implementation, the Committee urged India to prioritize the development of the National Plan of Action to implement the 2013 National Policy for Children (para 14 (a)). It requested also the country to expeditiously improve its data collection system (para 20), and to provide all professionals working for and with children with adequate and systematic training in children’s rights, which includes in particular health workers (para 26). In the light of the CRC General Comment No. 16 on State obligations regarding the impact of the business sector on children’s rights, the Committee also insisted on the need to 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 other standards, especially those relating to children’s rights (para 30 (a)).

Regarding health issues, the Committee requested India to increase the resources allocated to the health sector and to ensure that they are appropriate (para 18(a) and 64 (b)), with “particular attention to specific maternal and child health care policies, programmes and schemes to improve the health situation of children, in particular to respond to high rates of acute respiratory infections, malnutrition and diarrhoea”. The Committee also called for to the “effective implementation of the National Food Security Act (2013) which contains provisions aiming at combating children’s undernourishment” (para 64 (d)). The Committee also addressed the issue of HIV/AIDS mother-to child transmission by urging the government to “sustain the measures in place to prevent mother-to-child transmission of HIV/AIDS and develop a roadmap to ensure the implementation of effective preventive measures” and “improve access and coverage of antiretroviral therapy and prophylaxis for HIV-infected pregnant women […]” (para 68 (b) and (e)).

In addition, the Committee issued direct recommendations related to infant and young child feeding (para 64 (d)). It urged India to “enhance efforts to promote exclusive breastfeeding practices, including the promotion of breastfeeding from birth, complementary feeding strategies with or without provision of food supplements as well as micronutrient interventions for mothers” and called for the “effective implementation of, and compliance with, the International Code of Marketing of Breast-milk Substitutes”, and establishment of a “monitoring and reporting system to identify violations of the Code”, as well as of “stringent measures” in all situations of violations of the Code. The Committee thus specified that “violations include the promotion and distribution of samples and promotional materials by the private sector institutions involved in the Infant Formula marketing and distribution”.

Nonetheless, it is of serious concern that despite the systematic infringements of the Code committed by baby food companies, the Committee recommended India to “strengthen its efforts to address the existing disparities in access to and quality of health services, including by establishing partnerships with the private sector […]” (para 64 (a)).

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.

60TH COMMITTEE ON THE RIGHTS OF THE CHILD

Governments to Strengthen Their Laws To Fully Comply With International Code

 The 60^th session of the Committee on the Rights of the Child (CRC Committee) took place from 29^th May to 15^th June 2012, in Geneva. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 6 countries: Algeria, Australia, Cyprus, Greece, Turkey, and Viet Nam.

IBFAN presented alternative reports on the situation of infant and young child feeding for all of the 6 countries. The reports of Australia, Greece and Viet Nam were prepared in coordination with the regional and local IBFAN groups. The reports of Algeria, Cyprus and Turkey were written by the Geneva Infant Feeding Association (IBFAN-GIFA).

In its concluding observations, the CRC Committee made observations and recommendations on infant and child feeding and breastfeeding to the 6 countries.

The CRC Committee expressed particular concern over the low exclusive breastfeeding rates at 6 months of age in the countries under review: e.g. less than 1% n Greece, 7% in Algeria, 13% in Viet Nam and nearly 15% in Australia. In its recommendations, the CRC Committee told governments to take all necessary efforts to improve the situation.

The Committee made strong recommendations on the marketing of breastmilk substitutes. It recommended the governments of Australia, Cyprus, Greece, Turkey and Viet Nam to strengthen their laws in order to fully implement the International Code and the relevant subsequent resolutions. In the case of Cyprus, it pointed out that the European Union Directive 2006/141/EC on infant formulae and follow-on formulae is less comprehensive than the International Code, and thus the government was recommended to “strengthen its legislation regulating the marketing of breastmilk substitutes with a view to fully complying with the standards of the International Code of Marketing of Breastmilk Substitutes.” This recommendation applies equally to all the other European countries such as Greece that have adopted the same Directive.

In addition, the CRC Committee recommended the establishment of effective monitoring mechanisms in order to give effect to the International Code. The Committee was particularly concerned about the widespread practice of free samples of formula in the hospitals of Greece and Viet Nam, therefore it recommended the governments to take actions in cases of violations of the International Code.

In general, the CRC Committee recommended governments to adopt comprehensive nutrition policies, strategies and legislation related to positive infant and young child feeding practice. To Australia, the CRC Committee recommended to adequately fund the National Breastfeeding Strategy and to stop including industry representatives in the process of its implementation.

The health system has an important role to play in the promotion, protection and support to breastfeeding and thus attention was to the Baby-Friendly Hospitals Initiative, which should be strongly promoted, implemented and systematically monitored by all governments.  

The Committee considers important the sensitization of the general public, parents and professionals on breastfeeding. It recommended governments to monitor the situation of infant and young child feeding in their countries, strengthen efforts to promote breastfeeding, and sensitize and train health workers, government officials and parents.

In the case of Australia, the CRC Committee also paid attention to the issue of maternity protection. Australia received a recommendation to review its Parental Leave act so as to allow working mothers to exclusively breastfeed their infants for 6 months.

On issues related to child nutrition more generally, the Committee expressed its concern with regards to child malnutrition and health disparities.  It focused on the need to improve equal access to health care services, increase budget allocations to the health sector, in particular for maternal, newborn and child health, etc.

Child Rights and Business

The CRC Committee paid attention to the obligation of the States to hold business corporations accountable for their human rights violations in their territories and abroad, in the cases of Australia and Turkey. These recommendations apply to all business sectors including the baby food sector and may be understood as a recommendation for strengthening monitoring of compliance by baby food companies with the International Code.

For more details on the recommendations related to infant and young child feeding (IYCF) to each of the countries, please refer to the the complete report here

Government announces an increase of maternity leave to 6 months in Viet Nam

On Thursday 31 May 2012, Viet Nam was reviewed by the Committee on the Rights of the Child (CRC Committee). IBFAN had submitted an alternative report on the situation of breastfeeding in Viet Nam.

The Committee members addressed issues of infant and young child feeding as part of the health topic. They highlighted the very low rates of exclusive breastfeeding for children under 6 months of age, and the highly spread violations of the International Code of Marketing of Breastmilk Substitutes. One member said that there is widespread advertisement of infant formula in Viet Nam, including on television, and infant formula companies have contacts with health professionals leading to very low breastfeeding levels among the mothers.

The government delegation mentioned the Decree through which Viet Nam implements the International Code, however it downplayed the problem of violations by saying that similar problems persist in other countries as well.

According to the government representative, one of the main reasons for which Viet Nam has low exclusive breastfeeding rates for the first 6 months (19%) is due to the fact that mothers have to go to work very early, thus one of the measures that the government announced is the prolongation of the maternity leave up to 6 months.