Croatia at the CRC: Job Insecurity for Working Mothers and Low Rate of Exclusive Breastfeeding

On the 15th September 2014, the Committee on the Rights of the Child considered the combined Third and Fourth Periodic Report of the Republic of Croatia on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Croatia was led by the Assistant Minister for Social Policy, Strategy and Youth, Ministry of Social Policy and Youth, Mr. Hrvoje Sararić and includes the Senior Expert Advisor, Service for Children and Family, Ministry of Social Policy and Youth, Ms. Sabina Morosini Turčinović.

On this occasion, IBFAN presented an alternative report to inform the CRC Committee on the situation of infant and young child feeding in Croatia.

General overview of breastfeeding in Croatia

Information related to breastfeeding is not part of the national data collection survey. Such data are instead based on reports prepared by individual institutions or researchers.

In Croatia breastfeeding is generally considered the appropriate and desirable way to feed a newborn baby. Indeed, the rate of early initiation of breastfeeding is high (98%-99% in 2008-2009 and 91%-94% in 2011). However, there is a lack of awareness of the benefits of exclusive breastfeeding and the risks associated to formula feeding. This leads to premature cessation of breastfeeding. Indeed, the rate of exclusive breastfeeding at 6 months is very low (14.8%). Finally, Croatia lacks also of human milk banks, as there are none in the country.

In 2006 a National Breastfeeding Committee (NBC) was established by the Ministry of Health. In 2007 the National Program for Breastfeeding Protection and Promotion was completed by the NBC. However, such Program has not been implemented yet.

The Ordinance on Baby Foods for Infants and Young Children and Processed Cereal-Based Foods for Infants and Young Children (OJ 74/08) transposes the International Code of Marketing of Breastmilk Substitutes for the first time into a national legal measure. However, an appropriate monitoring system is missing.

It is worthwhile to mention that numerous courses on breastfeeding are available for health professionals in Croatia, albeit on a voluntary basis. However, the knowledge, attitudes and practices of most health professionals are still deficient.

The Baby-Friendly Hospital Initiative (BFHI) was successfully revived by UNICEF Croatia in 2006. As a consequence, 30 out of 31 maternity facilities are currently designated as ‘Baby-Friendly’. However, there has been a rapid drop in ‘Baby-Friendly’ standards following the BFHI designation.

Croatian job market (in both private and public sectors) discriminates against women. In particular, contracts are often terminated when the woman becomes pregnant or gives birth. By contrast, different kinds of maternity leave are available. Moreover, during the first 12 months after the child’s birth, mothers who are breastfeeding are entitled to two hours absence from work.

Plans of action and accompanying materials need to be prepared and finalised by the NBC and the Ministry of Health in order to be capable of coping with future emergencies.

Discussion on infant and young child feeding

The Committee specifically addressed the issue of breastfeeding. It welcomed the increase of mothers who choose to breastfeed (95%). However, it expressed concern with regard to baby food companies’ marketing and advertising concerning formulas and breastmilk substitutes.

The Delegation of Croatia pointed out the adoption in 2012 of a specific program aiming at promoting breastfeeding as the best practice and encouraging women to breastfeed. It also stressed the existence of a Committee for the Promotion and Protection of Breastfeeding.

Croatia expressed satisfaction with regard to the results brought by such a Program, especially in relation to breastfeeding in the first 3 months of life. Indeed, according to the Delegation, in the 3-year period of implementation of such Program, exclusive breastfeeding have increased dramatically. 95% of women exclusively breastfeed during the first days, whilst this rate decreases with time going by. In particular, 40% of women exclusively breastfeed after six months.

By addressing a specific concern of the Committee, the Delegation clarified that children can stay day and night with mothers who breastfeed while in hospitals.

The Delegation highlighted then the existence of a group for support led by nurses which gathers women and advised them in relation to breastfeeding. Furthermore, 8 counselling teams exist, which are well-recognised also outside the country.

It was acknowledged that until 2007, women in hospitals used to receive the so-called “happy baby” package, which contained advertisement for baby formulas. However, in 2007, a guideline was adopted prohibiting this package as well as other kind of advertisement in hospitals. Nonetheless, in the knowledge of the Delegation, this kind of advertisement is currently made in pharmacies, shopping malls and other places. Croatia declared its willingness to persist with the above-mentioned Program and continue to encourage breastfeeding. It also asserted that aggressive advertising will be prohibited, even outside the hospital system.

Furthermore, the Committee asked more generally for further information with regard to children’s rights and the business sector. Mr. Sararić, the Head of the Delegation, acknowledged that a balance between personal and working life is difficult in Croatia. However, the Croatian Government is endeavouring to better tackle this issue through the National Family Policy which is still under progress. Relevant measures need to be identified yet. In particular, Mr. Sararić mentioned the necessity to raise awareness about the strong need of family-working life balance within the business sector.

Concluding Observations

In its Concluding Observations, the Committee made several indirect recommendations. With regard to the general measures of implementation, it urged Croatia to “expedite the adoption of the new National Strategy for Protection and Promotion of the Rights of the Child for 2014-2020 and ensure that it includes concrete goals and measures” (§9) and “to expeditiously improve its data collection system” (§15).

Regarding health issues, the Committee recommended that Croatia “strengthen its efforts to ensure that all children enjoy equal access to health services” as well as “allocate adequate human resources to maintain the quality of health care”.

Additionally, the Committee issued direct recommendations related to infant and young child feeding (§ 49). It requested Croatia to “take action to improve the practice of exclusive breastfeeding, through awareness-raising measures, the provision of information and training to relevant officials, particularly staff working in maternity units, and parents”. It also recommends that the Government “take all the necessary legislative and structural measures, including monitoring, to control the marketing of breast-milk substitutes”.

Press release: UN Global Compact Office says it has no role to play in protecting integrity of initiative as Nestle continues to violate its principles – Baby Milk Action, 2 July 2014

• Link to the press release on Baby Milk Action's website

Baby Milk Action has today sent an open letter to the Executive Director of the UN Global Compact, George Kell, over the failure of the Global Compact Office to hold Nestlé to account for breaking its stated commitment to abide by the Global Compact Principles.

Nestlé is a sponsor of Global Compact events, which Baby Milk Action describes as a self-evidence conflict of interest.

The Global Compact was introduced by then UN Secretary General Kofi Annan to encourage corporations to align ‘their operations and strategies with ten universally accepted principles in the areas of human rights, labour, environment and anti-corruption.’

Last week, the US and EU opposed moves for legally-binding measures to hold corporations to account at a meeting of the UN Human Rights Council, citing the Global Compact as an alternative approach. For the past five years, Baby Milk Action has been pursuing complaints against Nestlé for violating the Global Compact Principles in the way it markets its baby foods. However, the Global Compact Office refuses to take action specified in so-called Integrity Measures, or to explain its refusal.

Left, Nestlé promotes its infant formula as the ‘natural start’ (and that it is the ‘gentle start’ and ‘protects’ babies) – practices executives at the highest level of the company defend. Babies fed on formula are more likely to become sick than breastfed babies (the true ‘natural start’) and, in conditions of poverty, more likely to die. These and other Nestlé practices violate UN World Health Assembly marketing requirements and the Convention on the Rights of Child (particularly, Article 24 (2) (e)), and so the Global Compact Principles.

Baby Milk Action welcomes the fact the UN Human Rights Council voted to set up a working group to draft a Treaty to hold corporations accountable for human rights abuses as it states its experience has shown the Global Compact to be ‘worse than useless’.

Mike Brady, Campaigns Coordinator at Baby Milk Action, said:

‘Nestlé has indicated it will continue the violations of the Global Compact Principles we have reported and the Global Compact Office says it has no role to play in stopping it and will close the case. The Treaty proposed by the UN Human Rights Council is essential as the Global Compact has proven to be worse than useless at stopping these human rights abuses.’

Mr Brady has written on holding corporations accountable as a member of a UN Task Force on International Dimensions of the Right to Food under the UN System Standing Committee on Nutrition. Proposals from the Task Force on protecting the right to food are presented in the book Global Obligations for the Right to Food (published in 2008), and include possible approaches for legally-binding measures to hold corporations accountable (chapter 4, Mike Brady).

Baby Milk Action’s letter to George Kell

2 July 2014

Dear Mr Kell,

UN Global Compact Office failing to apply Global Compact Integrity Measures

We are contacting you to raise the failure of the UN Global Compact Office (GCO) to respect the Global Compact Integrity Measures and to confirm whether you are aware of these failings.

We have been reporting egregious violations of the Global Compact Principles by Nestlé to the GCO over the past five years in accordance with the Integrity Measures, but have found it to be a futile exercise. In its latest message to us of 11 June 2014, the GCO is again stating it will take no action. Are you, as Executive Director, aware that the GCO’s refuses to take the action specified in the Integrity Measures and do you endorse this position?

In the past, we have requested clarification as to why it will not take the action it could or should take under the Integrity Measures, quoting the actual text in our letter dated 29 August 2011. The GCO’s response on 10 November 2011 merely stated: ‘Regarding the letter addressed to the UN Global Compact, we do not plan to provide a point by point response’.

We have tried writing to the Global Compact Board and Advisory Council via the GCO. The GCO told us (21 December 2011): ‘The Global Compact Board is kept up to date of all matters raised under the integrity measures. We do not forward them individual letters.’ We have received no response from the Board or Council. Accordingly, we are making this letter public and will gladly report your response to it.

The Global Compact website claims the initiative is ‘voluntary yet accountable’.

This claim on the Global Compact website is not borne out by our experience. There is no accountability given that:

• the Global Compact posts misleading Communications on Progress from corporations to its website with no form of checking.
• the GCO has received our evidence of violations of the Global Compact Principles and Nestlé’s refusal to end them, but does not take the action it could or should take under the Integrity Measure.

Under the Integrity Measures the GCO could provide advice and guidance to Nestlé on ‘actions to remedy the situation that is the subject matter of the allegation in order to align the actions of the company with its commitments to the Global Compact principles’. However, the GCO repeatedly tells us (for example, 30 July 2012), ‘The Global Compact Office is a voluntary initiative and does not have the mandate nor the resources to investigate or manage disputes.’

We are in on-going communication with Nestlé and have demonstrated to the GCO that executives refuse to end practices that violate the Global Compact Principles. The GCO should surely proceed to ‘review of the nature of the matter submitted and the responses by the participating company’ and then ‘remove that company from the list of participants and to so indicate on the Global Compact website’ as set out in the Integrity Measures.

One can only conclude that GCO is unwilling to apply the Integrity Measures due to the self-evident conflict of interest of Nestle being a sponsor of Global Compact events [example from 2013 and, above, from 2010], making the GCO financially indebted to the company.

The Global Compact Office closes cases without investigation

To keep the GCO updated on Nestlé’s on-going violations of the Principles we wrote to the GCO on 14 March 2014, attaching our latest correspondence with Nestlé (dated 3 March). We provided evidence of misleading statements included in the Communications on Progressposted to the UN Global Compact website (which bring the initiative into disrepute) and practices that violate human rights (which break the Global Compact principles).

The Global Compact Office replied to us on 29 April 2014, as follows:

With regard to the attached letter addressed to you from Nestle’s in response to your letter dated 3rd March 2014, we would kindly request that you please inform us whether you are satisfied with the content of the communication or if there are any other issues that should be addressed by the company. If not, please note that the matter will be considered closed by the Global Compact Office.

We responded on 9 May 2014:

If you read Nestlé’s letter you will realise that it is unsatisfactory as Nestlé is refusing to take action to stop the violations of the Global Compact Principles we have reported to it.

Rather than closing the case, it would be welcome if the UN Global Compact can provide the ‘guidance and assistance’ to Nestlé referred to in the Integrity Measures, encouraging it to take ‘actions to remedy the situation that is the subject matter of the allegation in order to align the actions of the company with its commitments to the Global Compact principles’. Please refer back to our letter of 3 March for the details.

The GCO said it had not received our original letter of 14 March 2014 (which enclosed a copy of our 3 March letter to Nestlé) so we sent it again. (We asked the GCO to investigate why correspondence sent to the address indicated on the Global Compact website had not been received as there may be other complaints that are being lost by the GCO, but have heard nothing from the GCO on this point.)

After we re-sent the information, the GCO contacted us on 11 June 2014, stating:

We have examined the matter and, as of now, we do not see any further role for the Global Compact in this process. Unless you have any additional issues that you would like to raise with the company for their response, please note that we will consider this matter closed under our Integrity Measures. 

Do you agree that the GCO has no role to play in encouraging participating corporations to stop violations of the Global Compact Principles when executives have indicated they will continue with these practices? Do you agree that corporations should continue to be listed under these circumstances?

No action taken against any corporation for violating the Global Compact Principles

We understand from our communication with the GCO that no company has ever been excluded for violating the Global Compact Principles following a complaint. Companies have been excluded for failing to provide Communications on Progress, but as these reports are posted to the Global Compact site even when they are misleading (as in the case of Nestlé), they are of little value in any case.

We look forward to your response to the questions raised in this letter and the clarifications requested in our letter to the GCO of 29 August 2011.

We will be publishing this as an open letter and will add your response, if and when we receive it.

Yours sincerely,

Mike Brady

Campaigns Coordinator

Baby Milk Action

CC: The Honourable Ban Ki-Moon, UN Secretary General.

Elena Bombis, Advisor, Legal & Policy, Supply Chain Sustainability, UN Global Compact.

Why non-binding international regulatory instruments do not work: A case study on breastfeeding protection

In 1981, the World Health Assembly (WHA) adopted the International Code of Marketing of Breastmilk Substitutes (the Code), to date completed and extended by fifteen subsequent relevant WHA resolutions forming integral part of it. The Code aims to ensure that parents can make fully informed decisions about infant and young child feeding by banning marketing practices that undermine breastfeeding. The Code thus contributes to safeguarding the health of infants and young children. In 1989, the Convention on the Rights of the Child (CRC) has enshrined breastfeeding protection, promotion and support in its article 24, which articulates the right of the child to the enjoyment of the ‘highest attainable standard of health’. The CRC’s General Comment No. 15 (2013), which interprets this right, specifies that besides States’ obligation to implement and enforce the Code (para 44), baby food companies have the direct obligation to comply with it in all contexts (para 81, emphasis added).

Notwithstanding this obligation, since 1981, baby food companies have systematically violated the Code provisions by malevolent marketing practices and tactics that mislead consumers and health professionals. The latest monitoring report Breaking the Rules 2014 published by the IBFAN’s International Code Documentation Centre covers 27 companies and presents 813 violations in 81 countries. It reminds the world that breastfeeding rates will continue to decline with the inevitable consequence of increased mortality and morbidity in infants and young children as long as corporate strategies that violate the Code continue. At present, there is no effective global mechanism that would ensure accountability of baby food companies which all seem prone to evade their human rights obligations in the absence of an effective sanction mechanism. Relying on implementation of the Code at country level has proven to be an unsatisfactory solution as all over the globe, baby food companies systematically resisted these efforts. Even in the minority of countries that have been successful and adopted adequate laws to regulate marketing of breastmilk substitutes, these companies, using their political influence and economic power, directly challenged the domestic law (e.g. in India) or resisted the adoption of enforcement mechanisms (e.g. in the Philippines).

The 33-year experience of Code implementation provides a strong argument to illustrate the necessity of a binding treaty on obligations of TNCs under human rights, a crucial step to the fulfilment of human rights of every human being, in this particular case of every child. Non-binding international recommendations, such as the Code, or “voluntary” corporate social responsibility measures, such as those indicated in the UN Guiding Principles, have failed to make TNCs liable for their human rights violations. Were a binding treaty on TNCs’ obligations adopted, violations of child rights caused by baby food companies would no doubt diminish, and those identified could be prosecuted and firmly sanctioned by an independent international judicial body. The treaty would help ensure the right of children to adequate food and nutrition as well as to health through the respect of the Code at global scale.

Low Breastfeeding Rates in Jordan (CRC)

On the 26^th of May 2014, the Committee on the Rights of the Child considered the combined fourth to fifth periodic reports of Jordan on the situation of the implementation of the Convention on the Rights of the Child (CRC) in the country.

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

General overview of breastfeeding in Jordan

In Jordan, the rate of early initiation of breastfeeding is low (38.8%) what, compared to the very high rate of institutional delivery (almost 99%), questions the quality of the training provided to health professionals. Furthermore, almost four children out of five are not exclusively breastfed until 6 months of age, while more than 45% of the infants under 1 month of age are fed with infant formula and some 24% of the children of 4-5 months of age are weaned prematurely. These data should be assessed in close conjunction with the high stunting rate of the children under 5 years of age are stunted (8%). The country has implemented most, but not all, of the provisions of the International Code of Marketing of Breastmilk Substitutes as legally enforceable measures.

A general lack of data on “baby-friendly” hospitals also has been observed. Similarly, a lack of data on HIV/AIDS and infant feeding has been noted. This is especially concerning given that the latter infection is still stigmatized and the population does not receive adequate and comprehensive information about it.

Besides, the alternative report emphasized that not all working women are benefiting from maternity protection and many women still experience occupational segregation.

Finally, it has been highlighted that, despite a national policy and training programme on infant and young child feeding in emergencies, support to optimal breastfeeding practices in refugees’ camps is not ensured and refugee women often face difficulties to access to health care facilities.

Discussion on infant and young child feeding

The CRC Committee pointed out that the rate of exclusive breastfeeding is low and asked if there was any national campaign to encourage mothers to breastfeed for a longer period. 

The delegation of Jordan answered that Jordan has implemented a law prohibiting the marketing of breastmilk substitutes. It stated that awareness-raising campaigns to promote breastfeeding have been launched and information on the best way to incorporate breastfeeding within the family routine has been disseminated.  The delegation also explained that there is a national guidance for medical professionals on the circumstances in which powdered milk should be recommended.

In addition, the delegation also explained that Jordan has the lowest rate of HIV/AIDS in the Arab region and that the national HIV/AIDS strategy includes reintegration measures for infected persons and awareness-raising campaigns on the transmission of the virus.

Concluding Observations

In its Concluding Observations, the CRC Committee recommended Jordan to strengthen its mechanisms for data collection (para 8 (b)). Regarding health issues, it urged the country to “ensure equal access to quality health services by all children, through the adoption of measures aimed at prioritizing children in the most disadvantaged and marginalized situations, especially child refugees, and by addressing child malnutrition and infectious diseases” (para 44). The Committee also emphasized the necessity to “improve access to quality, age-appropriate HIV/AIDS, sexual and reproductive health information and services” (para 48).

However, the Committee issued no direct recommendations related to infant and young child feeding. 

Recommendations related to Breastfeeding by the 65th Committee on the Rights of the Child

The 65^th Session of the Committee on the Rights of the Child (CRC Committee) took place in Geneva from 13 to 31 January 2014. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 6 countries: Congo Brazzaville, Germany, Holy See, Portugal, Russian Federation and Yemen. IBFAN submitted 5 alternative reports on the situation of infant and young child feeding for Congo, Germany, Portugal, Russian Federation and Yemen. The reports were written in collaboration with IBFAN groups in the countries. In its Concluding Observations, the CRC Committee referred specifically to breastfeeding in only 4 out of the 6 countries (Congo, Germany, Portugal and Yemen). The Holy See and the Russian Federation did not receive any direct recommendation on breastfeeding.

The right of the child to health

A particular emphasis has been put on the importance of respecting the right of the child to the enjoyment of the highest attainable standard of health. The CRC Committee referred to its 2013 General Comment N° 15 on the right to health (art. 24) in its recommendations to all reviewed countries, including the Holy See. The General Comment N° 15 explicitly recognizes the importance of breastfeeding for the achievement this right. This General Comment urges States, to devote particular attention to neonatal mortality in their effort to diminish infant and child 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. The Global Strategy calls, among other, for the improvement of the quality and availability of sex-disaggregated data, an issue that has been included in recommendations to Congo, Germany, Portugal and Yemen.

Protect

A great focus was placed on the need to regulate the impact of the business sector on children’s rights. In its recommendations to Congo, Germany and the Russian Federation, the CRC Committee expressly drew attention to its 2013 General Comment N° 16 on State obligations regarding the impact of the business sector on children’s rights, which specifically calls on States Parties 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” (hereafter referred as “the International Code”). Therefore, these three reviewed countries are recommended to ensure the compliance by companies of both international and national health and environmental standards and ensure appropriate sanctions in cases of violations. Congo and the Russian Federation are also recommended to require companies to undertake assessments of the environmental health-related and human rights impact of their business activities.

In addition, the CRC Committee expressly urged Germany to take every necessary measure to ensure the access to breastfeeding through the control of infant formula. More specifically, the CRC Committee urged Yemen, Congo and Germany to respectively implement and strictly enforce the International Code, while Portugal is asked to strengthen the monitoring of its marketing regulations related to breastmilk substitutes.

Promote

In the case of Congo, the CRC Committee stressed that preventable diseases, including diarrhoea, continue to impact negatively on child mortality rate. Thus, it urged the government to promote infant and young child feeding practices, in particular breast milk, and to adopt a holistic early childhood development strategy covering healthcare, nutrition and breastfeeding.

Furthermore, the CRC Committee raised the issue of new morbidity related to attachment disorders in Germany, which could be related to declines in exclusive breastfeeding practices. It underlined the decline of exclusive breastfeeding rates of children between four and six months and the aggressive marketing of breastmilk substitutes in Portugal. In the case of Yemen, it showed concern about the high rates of chronic malnutrition (stunting), acute malnutrition (wasting) and communicable diseases, especially diarrhoea, among children, linked to the lack of awareness about exclusive breastfeeding practices. Accordingly, the CRC Committee recommended Germany, Portugal and Yemen to promote exclusive breastfeeding.

In regard of General Comment N°15, Germany is specifically requested to better promote healthy eating habits and to pay special attention to children in vulnerable situations.

Support

Congo is urged to ensure provision of primary health care services for all pregnant women and children within accessible health care service with trained health care providers. It is specifically recommended to increase the quality and coverage of training to staff at socio-health units.

The CRC Committee also stressed the need for Yemen to establish baby-friendly hospitals.

The CRC Committee also focused on the need to prevent mother-to-child HIV/AIDS transmission by ensuring the implementation of effective HIV/AIDS preventive measures (Congo), by expanding the coverage of the National HIV/AIDS Prevention and Control Programme (Yemen) and by providing sufficient amount of breastmilk substitutes and anti-retroviral drugs in all regions (Russia).
                                                                                    

Table 1. CRC Committee - Session 65 / 2014 -Summary of Concluding Observations on IYCF

Country		IBFAN report	Summary of specific recommendations on IYCF
1	Congo (2nd to 4th periodic report)	yes	Indirect – Data collection (para 19): improve data collection system. The data should cover all areas of the Convention and should be disaggregated by age, sex, geographic location, ethnic and national origin and socioeconomic background in order to facilitate analysis on the situation of all children, particularly those in situations of vulnerability. Children’s rights and the business sector (para 27): establish a clear regulatory framework for the industries operating in the State party to ensure that their activities do not negatively affect human rights, especially those relating to children’s and women’s rights; ensure effective implementation by companies, especially industrial companies, of international and national environmental [...]  health standards, effective monitoring of implementation of these standards and appropriately sanctioning and providing remedies when violations occur; 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 impact; be guided by the United Nations “Protect, Respect and Remedy” Framework. Health care (para 59 a): ensure provision of primary health care services for all pregnant women and children with focus on development of accessible health care services with trained health care providers, intervention to reduce preventable and other diseases, particularly diarrhoeas, acute respiratory infections and undernutrition; strengthen and expand access to preventive health care, and therapeutic services for all pregnant women and children, particularly infants and young children under five years old; continue to disseminate health information and promotion of health education; increase quality and coverage of training to staff at socio-health units and ensure units are adequately staffed and have essential facilities, including obstetric supplies and emergency medicines for children and pregnant women; sustain the measures in place to prevent mother-to-child transmission of HIV. Direct (para 59 b; 66 b): promote IYCF practices, particularly breast milk and infant food based on local foods; adopt a holistic early childhood development (ECD) strategy and invest in the training of ECD teachers and provision of integrated formal and community-based programmes involving parents and covering healthcare, nutrition and breastfeeding, early stimulation and early learning for children for birth to the first year of school.
2	Germany (3rd and 4th periodic report)	yes	Indirect – Data collection (para 16): 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. The data should be disaggregated by age, sex, disability, geographical location, ethnicity, migration status and socio-economic background. Children’s rights and the business sector (para 23): establish a clear regulatory framework for the industries operating in the State party to ensure that their activities do not negatively affect human rights [...], especially those relating to children’s rights; 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; comply with international and domestic standards on business and human rights with a view to protecting local communities, particularly children, from any adverse effects resulting from business operations, in line with the UN “Protect, Respect and Remedy” Framework and the Guiding Principles on Business and Human Rights and by the Committee’s own general comment N° 16. Health care (para 57): advocate and raise awareness through programmes targeting schools and families, emphasizing [...] healthy eating habits. Direct (para 57; 63): [in regard of General Comment 16] 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; strengthen 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; strictly enforce the International Code of Marketing of Breast-milk Substitutes.
3	Holy See (2nd periodic report)	no	none
4	Portugal (3rd and 4th  periodic report)	yes	Indirect – Data collection (para 18): establish a more comprehensive and integrated data collection system on children covering the entire period of childhood up to age 18, and to introduce indicators on children’s rights on which progress in the realization of those rights could be analysed and assessed. The data should be disaggregated by age, sex, geographic location, ethnicity, migration status and socio-economic background to facilitate the determination of the overall situation of children. Health care (para 48): [in regard to General Comment 15] minimize the impact of financial restrictions in the area of health care; austerity measures in the area of health should be evaluated on the basis of a child’s right’s impact assessment to ensure that such measures do not have a negative impact on child health and well-being. Direct (para 56): take action to improve the practice of exclusive breastfeeding for the first six months, through awareness-raising measures including campaigns, information and training for relevant officials, particularly staff working in maternity units, and parents; strengthen the monitoring of existing marketing regulations relating to breast milk substitutes.
5	Russian Federation (4th and 5th  periodic report)	no	Indirect - Children’s rights and the business sector (para 21): pray attention to General Comment 16 on State obligations regarding the impact of the business sector on children’s rights and recommends that the State party establish and implement regulations to ensure that the business sector complies with international and national human rights, particularly with regard to children’s rights; ensure effective implementation by companies, especially industrial companies, of international and national health standards, effective monitoring of the implementation of these standards and appropriately sanctioning and providing remedies when violations occur, as well as ensure that appropriate international certification is sought; 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 impact; be guided by the United Nations “Protect, Respect and Remedy” Framework. Health care (para 52; 54): pray attention to General Comment 15 on the right of the child to the enjoyment of the highest attainable standard of health, and recommends that the State party take measures to regularly assess the health conditions of children deprived of parental care and children in difficult situations in order to prevent irreparable damage to their health;; take all necessary measures to prevent mother to child transmission of HIV/AIDS throughout the country by providing sufficient amount of breast milk substitutes and anti-retroviral drugs in all regions, irrespective of their legal status in the country.
6	Yemen (4th periodic report)	yes	Indirect – Data collection (para 18): improve its data collection system. The data should cover all areas of the Convention and should be disaggregated by age, sex, geographic location, ethnic and national origin and socioeconomic background in order to facilitate analysis on the situation of all children, particularly those in situations of vulnerability. Health care (para 16; 56; 64): establish a budgeting process, which includes child rights perspective and specifies clear allocations to children in the relevant sectors and agencies, including specific indicators and a tracking system; increase substantially the allocations in the areas of health and education; ensure that appropriate resources be allocated to the health sector, with particular attention to specific maternal and child health care and develop and implement comprehensive policies and programmes to improve the health situation of children, in particular to respond to high rates of malnutrition and diarrhoea infections; expedite the process to join as a full member the Scale Up Nutrition Initiative (SUN) and to take effective measures to address the widespread and serious undernourishment affecting children; strengthen its efforts to develop outreach services, including a network of mobile health-care facilities in conflict-affected areas, particularly targeting children and pregnant women, as an interim measure, and ensure that health-care facilities are rehabilitated and not re-occupied for military purposes by either the armed forces or non-State armed groups; ensure universal coverage for HIV testing and free antiretroviral drug provision; pay particular attention to pregnant adolescents in rural areas, pregnant mothers with HIV and children born to mothers with HIV. Direct (para 56): enhance efforts to promote exclusive breastfeeding practices, by ensuring the implementation and compliance with the International Code of Marketing of Breast-milk Substitutes, and establish a monitoring and reporting system to identify violations of the Code. This includes the establishment of baby-friendly hospitals with the promotion of breastfeeding from birth.