Timor-Leste at the CRC: Low Coverage of Skilled Attendance at Birth and High Prevalence of Acute Malnutrition

On September 25, the Committee on the Rights of the Child considered the combined 2^nd to 3^rd periodic report of Timor-Leste on the situation of the implementation of the Convention on the Rights of the Child in the country.

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

General overview of breastfeeding in Timor-Leste

Timor-Leste is characterized by high rates of child stunting (50%), underweight (about 38%) and moderate or severe malnutrition (about 11%), associated with low delivery care coverage and evidences of inappropriate feeding practices. Almost 30% of babies are born without the assistance of a skilled attendant, while only 22% of mothers give birth at health facilities. Additionally, the median duration of breastfeeding had decreased from 17.7 months in 2003 to 17.5 months in 2009/10 and less than 20% of children aged 6-23 months receive timely and appropriate complementary feeding.

IBFAN further noted the absence of a National Breastfeeding Committee and the lack of national guidelines for Infant and Young Child Feeding (IYCF). Breastfeeding indicators are not regularly and systematically monitored and the new legislation implementing the International Code of Marketing of Breast-milk Substitutes (hereafter: the Code) has not yet been endorsed by the Ministry of Health and is thus not enforced.  

The lack of appropriate pre- and in-service training programmes on infant and young child feeding is also of concern, as well as the lack of standards and guidelines for mother-friendly childbirth.

The report also flagged the low number of hospitals that are certified as “Baby Friendly” (2 out of 6 hospitals, i.e. 33.3%).

IBFAN further stressed the insufficient duration of the maternity leave (12 weeks) and the absence of legal provision allocating breastfeeding breaks. Finally, it noted that no specific programmes on IYCF and HIV/AIDS have been developed.

Discussion on infant and young child feeding

In its preliminary statement, the delegation began by mentioning the implementation of the integrated community health services through the SISCa programme. The programme is implemented in 13 districts, 65 Sub-Districts, and 442 villages. The delegation also mentioned the health promotion programmes aimed at pregnant women and granting them prenatal care and counseling. Finally, the delegation underlined the launch of the National Commission on Child rights in 2014, which is mandated to promote, defend and monitor children’s enjoyment of their rights.

The CRC Committee highlighted the most important problems in the country, such as the high rates of poverty, hunger, child malnutrition, stunting and wasting as well as the huge differences between rural and urban areas in terms of enjoyment of equal services and possibilities. It noted with concern the inconsistent data collection, as ministers do not use similar indicators, and the lack of regulation to control business sector activities that could affect children and their families. More specifically, the Committee noted that about 7 out of 10 children are not breastfeed until 2 years of age and asked what is done to encourage mothers to breastfeed. It also pointed out the insufficient duration of the maternity leave as well as the absence of provision allowing working women to take breastfeeding breaks.

The delegation of Timor-Leste recognized that malnutrition constitutes a major challenge for the country. Consequently, some programmes and measures have been put in place to remedy the situation, such as the promotion of appropriate infant feeding practices (exclusive breastfeeding under 6 months, adequate introduction of complementary food for children between 6-23 months, continued breastfeeding until 2 years or beyond, appropriate feeding for infants born from HIV-infected mothers). Regarding maternity protection, the delegation explained that working women are entitled to 90 days of maternity leave and once they return to their workplace, they are allowed to take 3 hours per day to breastfeed.

In its follow-up questions, the Committee emphasized breastfeeding as being the best nutrition for infants and asked whether the Ministry of Health was planning to ratify the law implementing the International Code of Marketing of Breastmilk Substitutes. The Committee also stressed the low number of hospitals certified as “Baby-Friendly” and asked how many hospitals have currently complied with the Ten Steps to Successful Breastfeeding.

The delegation referred to the 2013 Demographic Health Survey whereby the following results were established: early initiation of breastfeeding=93%, exclusive breastfeeding at 3 months=63%, breastfeeding between 12-15 months=75% and  continued breastfeeding 20-23 months=39%. Moreover, the delegation explained that 5 hospitals and 65 different health centers were complying with the Baby-Friendly Hospital Initiative.  The delegation added that the Prime Minister decided until November 28, 2016, all families should be visited by healthcare professionals. A programme of medical training has been set up in partnership with the Cuban government in order to increase the number of doctors. In the future, each of the 200 villages should be attributed 1 doctor and 2 nurses.

Concluding Observations

The Concluding Observations have not yet been released. This article will be updated following their publication.

Netherlands at the CRC: Inadequate Official Information on Breastfeeding and Absence of a National Programme

On May 27th, 2015, the Committee on the Rights of the Child considered the fourth periodic report of Netherlands on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Netherlands was led by Mrs. Angelique Berg, Director General for Public Health, Ministry of Health, Welfare and Sports (Netherlands), H.E. Mrs. R. Bourne-Gumbs, Minister of Education, Culture, Youth and Sports (Sint Maarten), H.E. Mrs. Rutmilda Larmonie Cecilia, Minister of Social Development, Labor and Welfare (Curaçao) and H.E. Mr. Pauldrick F.T. Croes, Minister of Social Affairs, Youth and Labor (Aruba).

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

General overview of breastfeeding in Netherlands

Generally, there is a lack of regular and systematic collection of data on infant and young child feeding practices in the country and the few data available do not monitor the official WHO/UNICEF indicators (e.g. the rate of early initiation of breastfeeding within one hour after birth is not monitored). Data reveal that some 20% of the newborns received infant formulae within 24 hours after birth, due to a lack of adequate guidance provided by birth attendants. Besides, the country does not organize specific capacity building courses on HIV/AIDS and infant feeding aimed at health professionals.

It is of concern that despite the WHO recommendation to introduce complementary foods from 6 months onwards, official institutions such as the Netherlands Nutrition Centre and the Dutch Youth Health Centre advice to introduce complementary foods at 4 months. Besides, there is currently no Breastfeeding Masterplan in place and the National Prevention Plan does not include breastfeeding. The monitoring role of the National Breastfeeding Council should also be clarified.

In addition, no breastfeeding promotion campaign is being conducted in the country and the International Code of Marketing of Breastmilk Substitutes is not fully implemented while one third of hospitals and maternities are not certified as “baby-friendly”.

The duration of paternity leave duration (2 days plus 3 unpaid) is also too short to ensure that fathers are able to support mothers in establishing exclusive breastfeeding. Finally, there are no specific guidelines or policies regarding breastfeeding support or protection in case of emergency.

Discussion on infant and young child feeding

Responding to the State report, the Committee expressed concern about the mention of breastfeeding being “women’s own choice” which seems to leave new mothers alone with the decision of breastfeeding their baby rather than providing them with adequate information and support in this regard.

The Committee also expressed concerned about the Dutch official recommendations to introduce complementary feeding at 4 months rather than at 6 months as recommended by the World Health Organization. It also pointed out the lack of implementation of theInternational Code of Marketing of Breastmilk Substitutes. It specifically asked for further explanations on the measures taken bto prevent undue marketing of breastmilk substitutes and to ensure exclusive breastfeeding until 6 months of age. The Committee also asked questions on the measures to address the epidemic of obesity in the country.

The delegation affirmed that in Netherlands, misleading marketing is prohibited by the Commodities Act. It also highlighted that some 80% of mothers start breastfeeding right after the birth, while 47% still breastfeed after 3 months and 38% exclusive breastfeed until 6 months. Regarding breastfeeding promotion, the government indicated that it provides mothers with full information on the importance of breastfeeding through the Netherlands Nutrition Centre.

The representative of Sint Maarten underlined that obesity constitutes a huge challenge in the island. Therefore, programmes are implemented in collaboration with the Ministry of Health and Education to promote physical education, weight monitoring and a healthy eating in public schools. In relation with breastfeeding, the delegation declared that promotion of optimal breastfeeding practices such as exclusive and continued breastfeeding is done through the dissemination of information brochures among mothers.

In addition, the delegation stated that in Aruba there is currently a national plan to protect and promote breastfeeding as well as the implementation of Baby-Friendly Hospital Initiative. The mission of the Pro Lechi Mama Aruba Foundation, created in 2002, is to empower women to breastfeed through educational activities and practical support. It also provides information on breastfeeding to health care providers. According to the delegation, these measures have positively influenced breastfeeding rates in the island (e.g. the rate of exclusive breastfeeding raised from 3.1% in 2002 to 13.4% in 2010).

Finally the delegation of Curacao explained that there is also a foundation in charge for promoting optimal breastfeeding practices on the island and that breastfeeding is promoted within free baby well clinics in which children are followed up until 5 years of age. The Curacao delegation added that mothers are allowed to breastfeed at their workplace and that incarcerated women are allowed to keep their child with them until they reach the age of 6 months.

Concluding observations

In its Concluding Observations, the Committee did not specifically address breastfeeding, but it made recommendations indirectly related to infant and young child feeding.

The Committee first noted the lack of a central system that regularly collects data; therefore, it recommended Netherlands to improve its data collection system, including qualitative and quantitative indicators in all areas of the Convention (§16-17). 

The Committee also made recommendations on the importance of respecting child rights in relation to the business sector, highlighting the importance of establishing and implementing regulations to ensure the compliance of the business sector with international and human rights, particularly with regard to children rights (§23). Thus, referring to its General Comment No 16 (2013) on State obligations regarding the impact of the business sector on children’s rights, the Committee recommended Netherlands to establish a clear and regulatory framework for the industries to ensure that their activities do not affect negatively children rights (§23a), ensure the effective monitoring of implementation of international and environmental and health standards and implement an appropriate sanctioning system and remedy mechanism (§23b). 

Regarding health, the Committee expressed concerns about the high rates of infant mortality (§42a) and the limited access to health care services for children with low economic or social status (§42c). Consequently, the Committee urged Netherlands to take measures to prevent infant mortality by providing effective and quality neonatal and other care services for infants in the whole country (§43a) and to ensure that all children have free access to basic health care services (§43c-d). 

Lastly, with regard to nutrition, the Committee noted the significant numbers of child obesity and overweight (§42b) and therefore recommended Netherlands to “provide access to nutrition education and sufficiently nutritious food to all children in the State party in order to promote healthy eating habits” (§43b).

Switzerland at the CRC : Lack of Political Will and Financial Means to Ensure Protection, Promotion and Support of Breastfeeding

On January 21st and 22nd, 2015, the Committee on the Rights of the Child considered the combined second to fourth periodic report of Switzerland on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Switzerland was led by Ambassador Stéphane Cueni and Mrs. Anne-Claude Demierre, State Counsellor of the canton of Fribourg.

On this occasion, IBFAN presented an alternative report to inform the CRC Committee on the situation of infant and young child feeding in Switzerland. IN addition, as a member of the Swiss NGO Child Rights Network Switzerland, IBFAN-GIFA also contributed to the joint report of the network.

General overview of breastfeeding in Switzerland

IBFAN report highlighted that Switzerland does not have a comprehensive national strategy on protection, promotion and support to infant and young child feeding in line with the Global strategy for infant and young child feeding adopted at WHA in 2002. The Swiss national strategy to promote healthy diets initiated in 2008 includes promotion of breastfeeding, and there is a national foundation tasked with breastfeeding promotion, but only a few cantons are funding small-scale breastfeeding promotion activities as part of their obesity prevention programs. Overall, political will and national planning and resources are insufficient to create a favorable environment for mothers and parents to make informed decisions and put them into practice. Although more than half of Swiss babies are born in baby-friendly hospitals, scarce international indicators reveal poor breastfeeding practices (rate of exclusive breastfeeding under 6 months: 14%, rate of early initiation of breastfeeding: 66% and no data on continued breastfeeding at 1 or 2 years). The rate of C-sections, a barrier to early initiation, is very high (33%).

In addition, protection of breastfeeding is insufficient. Indeed, the Swiss law does not cover all provisions of the International Code of Marketing of Breastmilk Substitutes and applies only to infant formula until 6 months; what is more, monitoring at national level is not independent, as the panel responsible is jointly composed of experts and members of the baby food industry. In consequence, as an example, mothers of 4 month year old babies receive gift packages at home containing samples of follow-on formula and complementary foods marketed for infants from 4 months. Parents often receive conflicting information, including from health professionals who lack appropriate independent training and are faced with potential conflicts of interest induced by financial ties between their professional associations and the baby food industry.

On a more positive note, IBFAN noted that Switzerland ratified the ILO Convention 183 on maternity protection, by revising their legislation to ensure that all working mothers are granted paid breastfeeding breaks until their child is one year of age.

Discussion on infant and young child feeding

The Committee expressed concern about the increase of obesity in children. Mentioning specifically breastfeeding, the Committee noted that even though breastfeeding is officially recommended, the efforts to promote optimal breastfeeding practices are yet not satisfactory: there is a lack of training aimed at health professionals, no national strategy on breastfeeding and only very little funds allocated to breastfeeding promotion.

Regarding obesity, the delegation explained that Switzerland has adopted a 2013-2016 Nutrition Strategy based on the 6^th Swiss Nutrition report, the European White Paper and the WHA Strategy for diet, physical activity and health. A National Plan of Action has also been put in place and is coordinated by Promotion Santé Suisse in 20 cantons. On the issue of breastfeeding, the delegation answered that much attention is paid to the health of mothers and children within the above-mentioned National Nutrition Strategy and that Federal Food Safety and Veterinary Office supports and promotes breastfeeding through the Swiss Foundation for the Promotion of Breastfeeding. In the last years, two important steps have been taken in relation with breastfeeding: 1/ a new legislation on maternity protection has been implemented, which provides paid breastfeeding breaks to working mothers, and the ILO Convention 183 has been subsequently ratified; 2/ a new ordinance has been adopted in 2008, which limits the marketing of infant formula until 6 months of age.

The Committee then raised follow-up questions on the protection of breastfeeding, emphasizing the lack of implementation of the International Code and relevant subsequent WHA resolutions into the Swiss legislation and asking if there was any immediate plan to strengthen the national legislation implementing the Code and to set up an independent monitoring mechanism. In addition, the Committee asked if, considering the need for 6 months of exclusive breastfeeding, Switzerland was planning to extend the duration of the maternity leave accordingly.

The delegation could not answer on the question on breastfeeding protection and the International Code because of lack of information. On the issue of maternity leave, it explained that the government is not considering an extension of the duration of 14 weeks, which comply with European standards, but is now working on strengthening the paternity leave.

The Committee again referred to breastfeeding and asked if there was any intention to increase to rate of hospitals certified as “baby-friendly” (about 55%).

The delegation answered that some hospitals are indeed certified, but that some others have refused to enter into the process. Currently, there is no government plan to extend the number of certified health facilities. The delegation added that a canton express concern about the fact that women were being pressured to breastfeed and said that some degree of freedom should be allowed. Mothers should be able to choose to breastfeed or not. The delegation further stated that there shouldn’t be a state plan on this issue.

The Committee finally noted that breastfeeding is also crucial for emotional bonding and attachment between the mother and her child and that Switzerland should reconsider its approach related to the Baby-Friendly Hospital Initiative. Noting that nowadays, two incomes are often necessary to support a family and that most of women no longer stay at home to take care of their children, the Committee invited Switzerland to extend the maternity leave, because it is the only way to enable women to breastfeed exclusively for 6 months.

Concluding Observations

In its Concluding Observations, the Committee referred indirectly and directly to infant and young child feeding. Regarding promotion of breastfeeding, the Committee recommended Switzerland to “strengthen its efforts to promote exclusive and continued breastfeeding by providing access to materials, and raising awareness concerning the importance of breastfeeding and the risks of formula feeding” (§ 59a). Regarding support to breastfeeding, the Committee stressed the need to “review and strengthen training for health professionals on the importance of exclusive breastfeeding, and to “further increase the number of hospitals certified as baby-friendly” (§ 59b-c). Moreover, Switzerland was urged to “develop a comprehensive national strategy on infant and young children feeding practices” and to make sure that the national recommendations on breastfeeding comply with the relevant WHO recommendations (§ 59d-e). Finally, the Committe recommended to “ensure that the International Code of Marketing of Breastmilk Substitutes is strictly enforced” and to “consider extending maternity leave to minimum six months” (§ 59f-g).

Colombia at the CRC: Concerns about Declining Breastfeeding Rates and Lack of Breastfeeding Promotion

On January 20^th and 21^st, 2015, the Committee on the Rights of the Child considered the combined fourth and fifth periodic reports of Colombia on the situation of the implementation of the Convention on the Rights of the Child in the country. The Colombian delegation was led by Mrs. Cristina Plazas Michelsen Costa, Director of the Colombian Institute of Family Wellbeing.

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

General overview of breastfeeding in Colombia

The report highlighted that despite a high rate of institutional delivery (95%), the rate of early initiation to breastfeeding is low (57%) and has recently declined, which indicates that health professionals are not enabled to ensure optimal breastfeeding practices within hospitals. Besides, the rate of exclusive breastfeeding under 6 months has decreased since 2004 and currently, almost 6 children out of 10 are not exclusively breastfed until 6 months of age. The Colombian National Demographic and Health Survey 2010 has also shown that on average, babies are given other liquids than breastmilk at 2.7 months and that the practice of bottle feeding, which is common during the first year of life, has increased in the last decade. This situation is closely connected with the lack of promotion strategy on optimal breastfeeding practices and aimed at mothers, caregivers and community through media.

Regarding protection of breastfeeding, IBFAN noted that the International Code of Marketing of Breastmilk Substitutes and its subsequent relevant World Health Assembly resolutions are still not fully implemented into legislation and that violations of the Code, including donations of infant formula to health institutions and delivering of gifts to mothers through health workers, are common.

The report also flagged the very low rate of implementation of the Baby-friendly Hospital Initiative in the country. The latest statistic, dating back to 2009, shows that only 0.06% of the total number of health facilities of the country are certified as “baby-friendly”. In addition, there is no monitoring of this accreditation process at the country level.

Finally, IBFAN expressed concern about the lack of maternity protection for women working in the informal sector as well as the lack of any national plan to ensure protection and support of breastfeeding in case of emergencies.

Discussion on infant and young child feeding

During its discussion with Colombia, the CRC Committee addressed specifically the issue of breastfeeding. It mentioned the low breastfeeding rates and noted with particular concern the decline of the rate of exclusive breastfeeding under 6 months. It asked which efforts have been made to ensure that health professionals are properly trained on optimal breastfeeding practices and that mothers are aware of the importance of breastfeeding their child.                                                                                                               

The Colombian delegation answered that the decline of the rate of exclusive breastfeeding is a concern for the government and states the importance of taking action on this regard. It noted that a national breastfeeding plan is in place and that breastfeeding is closely connected with the employment condition of mothers. As part of the gender equality governmental project, the length of the maternity leave has recently been increased to 14 weeks, and the legislation also entitles working fathers to 1 week of paternal leave. In addition, the delegation added that some 17 human milk banks have been implemented throughout the territory in order to make it easier for every child to have access to breastmilk, and that breastfeeding-friendly rooms have been settled in employment areas in order to support working mothers to breastfeed. Finally, regarding the specific problem of teenage pregnancies, the delegation assured the Committee that special facilities have been put in place to ensure that young mothers are able to continue to go to school while breastfeeding their child.

Concluding Observations

In its Concluding Observations, the Committee made several indirect and direct recommendations to Colombia in relation with infant and young child feeding.

Regarding health and health services, the Committee recommended Colombia to “ensure the availability and accessibility of health services for all children […] by allocating adequate resources and monitoring the implementation of relevant policies” (§ 40a). In particular, the Committee highlighted the child and maternal mortality rates which continue to be very high (§ 39f), and thus recommended the State party to “increase its efforts to reduce maternal and child mortality, including by implementing the OHCHR Technical guidance on child mortality” (§ 40c) which includes specific recommendations on breastfeeding protection (including the implementation of the International Code) and promotion. It is to be noted that this technical guidance includes specific recommendations on breastfeeding protection (including the implementation of the International Code) and promotion

Referring specifically to breastfeeding, the CRC Committee expressed its concerns on the decline of exclusive maternal breastfeeding in 2010 and on the persistence of inadequate baby feeding practices. It recommended Colombia to “strengthen efforts to promote breastfeeding through educational campaigns and training to professionals, adequately implement the International Code of Marketing of Breast-Milk Substitutes and the Child-Friendly Hospital initiative [sic]” (§ 40h).

Tanzania at the CRC: Suboptimal Breastfeeding Practices and Low Rate of Institutional Delivery

On January 15^th and 16^th, 2015, the Committee on the Rights of the Child considered the combined third to fifth periodic reports of the United Republic of Tanzania on the situation of the implementation of the Convention on the Rights of the Child in the country. The Tanzanian delegation was led by Mrs. Sophia Simba, Minister for Community Development, Gender and Children.

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

General overview of breastfeeding in the United Republic of Tanzania

In Tanzania, high rates of neonatal, infant, under-5 and maternal mortality coexist with a low rate of skilled attendant at birth (49%). Suboptimal breastfeeding practices are widespread: some 1 child out of 2 is neither breastfed during the first hour after delivery nor exclusively breastfed until 6 months of age. In addition, early introduction of complementary food is a recurring problem and vast majority of babies under 3 months old are fed with water, juice, porridge or other foods, increasing the risk of infections and malnutrition. There is also a cultural belief that the colostrums is dirty and should be discarded.

Although the 1992 Food and Nutrition Policy pointing out the high rate of malnutrition among children linked with inadequate breastfeeding and weaning is still in place, as well as the National Nutrition Strategy 2011/12-2015/16 and the 2004 National Strategy on Infant and Young Child Nutrition, several problems persist in the country regarding promotion and support of breastfeeding. First, information on the activities undertaken to promote breastfeeding is lacking, as well as information on specific trainings or courses on optimal breastfeeding practices aimed at health professionals. The High Level Steering Committee on Nutrition, created in 2011, in charge to coordinate multi-sectorial interventions to reduce child malnutrition and promote optimal breastfeeding. However, it has only a coordinating role and does not carry out any monitoring activity. Finally, there is no information on the existence of a specific National Breastfeeding Committee or Coordinator.

Regarding protection of breastfeeding, in 1994, Tanzania has adopted a National Regulation for Marketing of Breastmilk Substitutes and Designated Products. However, its revision has not been endorsed yet and there is very poor awareness of its content at all levels and in most sectors.

In addition, in 2010, only 37% of the hospitals in the country were certified as “baby-friendly" and maternity leave is only available every 3 years and does not cover women in the informal sector. Even though 9 women out of 10 know that HIV can be transmitted through breastfeeding, the estimated rate of mother-to-child transmission in 2013 was 15.8%. Last but not least, the country does not have any plan to protect and support breastfeeding in case of emergencies.

Discussion on infant and young child feeding

The CRC Committee first noted that in the last years, the overall budget allocated to health has decreased and that the country shows high rates of maternal, neonatal and infant mortality. It asked the delegation if there is any initiative or measure in place to address the issue of the very high maternal mortality, which has a direct impact on child survival. 

The Committee also raised specific questions on breastfeeding. It asked for further clarifications on the activities to promote breastfeeding in relation with the National Breastfeeding Week. Regarding the High Level Steering Committee on Nutrition, it asked which is its role regarding breastfeeding promotion in the country, especially within hospitals facilities.

The Tanzanian delegation answered that during the National Breastfeeding Week, awareness-raising activities such as seminars, distribution of ICT materials, workshops on importance of breastfeeding, trainers’ training on breastfeeding and HIV, information on the International Code and on optimal breastfeeding practices have been organized and a promotional campaign on exclusive breastfeeding until 6 months of age has been launched. The delegation added that the High Level Steering Committee on Nutrition is in charge to ensure that proper resources are allocated to provide good nutrition to the population including through fortification of oil, wheat and maize.

The Committee expressed further concern about the very low rate of institutional delivery and asked how, in this conditions, does the government ensure that all mothers have access to correct information about the best way to feed their child. Besides, it emphasized that almost half of the mothers do not breastfeed until 6 months and asked what measures are taken to tackle this issue. It also asked what kind of regulations of the marketing of breastmilk substitutes are in place in order to allow mothers to make the correct information, and noted that guaranteeing that mothers are enable to optimally  breastfeed leads to huge public savings and places children in the best situation to start their life.

In a follow-up question, the Committee noted that the rate of early initiation of breastfeeding is very low in the country and emphasized its crucial importance for the baby’s as well as for the mother’s health. The Committee also asked if there is any programme to help mothers in terms of lactation, noting that the rate of continued breastfeeding until 2 years is particularly low. Regarding breastfeeding protection, supposedly ensured by the implementation of the Baby-friendly Hospital Initiative, it asked if there is any regulation regarding baby foods advertisements in hospitals. On the access to emergency obstetric care, the Committee asked what is the coverage of skilled attendants at birth and if there are trainings for traditional birth attendants. Regarding the large number of young mothers, it asked if there are any family planning services in the country.

The delegation highlighted the importance of breastfeeding in the first months of life for the healthy development of brain. It explained that breastfeeding importance is raised in one of the guidelines on IMCI (Integrated Management of Child Illnesses) and also through parenting education. Promotion of breastfeeding is also done through dissemination of ICT materials in health centers, hospitals and schools. The delegation further noted that the Tanzania Food and Drugs Authority has implemented regulations on the marketing of breastmilk substitutes and is providing information through national media on the best use of breastfeeding instead of formula feeding. Besides, the Tanzania Bureau of Standards is in charge of controlling the food standards and making screens.

Concluding Observations

In its Concluding Observations, the Committee issued recommendations indirectly related to infant and young child feeding. With regard to health and health services, the Committee stated its concerns over the persistent high maternal mortality and morbidity rates, the limited access to health care services to children poverty and remote and rural areas, and the prevalence of chronic malnutrition, leading to stunting and the limited access to safe drinking water and sanitation (§ 53).

Therefore, the Committee urged Tanzania to allocate sufficient financial and human resources to health services, particularly mentioning the trained care at delivery as well as improved care for new-borns and during the neonatal period, antenatal care and services for infants and preschool children at primary health centres (§ 54a). It also requested Tanzania to “establish more child and maternal health clinics and access to safe and trained delivery [...]” (§ 54b).

Specifically addressing the issue of children nutrition, the Committee recommended Tanzania to “strengthen national strategies to address the critical nutritional needs of children, particularly among the most vulnerable groups, through targeted interventions” and to “improve access to safe drinking water and adequate sanitation facilities and ensure sustainability, availability, sufficiency and affordability to all, particularly children” (§ 53c-d).

Finally, the Committee urged the country to implement the OHCHR Technical guidance child mortality (A/HRC/27/31) (§ 54 e) which includes specific recommendations on breastfeeding protection (including the implementation of the International Code) and promotion.