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.

Breastfeeding and child rights in Luxembourg

Luxembourg presented its consolidated 3^rd and 4^th periodic report on the situation of the implementation of the Convention on the Rights of the Child in the country. The combined 5^th to 6^th periodic report is expected by October 2019.

IBFAN submitted an alternative report on the situation of infant and young child feeding in Luxembourg. The report highlights the fact that breastfeeding rates are insufficient. Only 6% of infants are exclusively breastfeeding during the first 6 months; this rate has indeed decreased since 2001. In 2005, the government of Luxembourg assured it will establish a national plan for promoting and protecting breastfeeding. Until now two plans have been adopted, one between 2006 and 2010 and the other between 2011 and 2015. Unfortunately, the action plan has not been backed with sufficient budget, leading to restricted implementation. More and more women stop breastfeeding their children before they reach 6 months. The report also underlines the fact that only half of the four maternity hospitals are baby-friendly, while there is a lack of information to mothers about breastfeeding from midwives and breastfeeding counselors. The report states that the implementation of the International Code of Marketing of Breastmilk Substitutes and resolutions is weak as it conforms to the EU Directive 2006/141/EC and not to the WHO Code. Concerning maternity protection at work, breastfeeding breaks are paid by the employer and women need to present a medical certificate for the whole duration of breastfeeding. This may lead certain women to feel pressured not to ask for the break or not taking them for the entire breastfeeding period, which in turn could explain the decreasing rate of exclusive breastfeeding at 6 months.

Discussion on infant and young child feeding

During the dialogue with the government delegation, CRC Committee has raised questions on breastfeeding. The Committee members pointed to the fact that exclusive breastfeeding is practiced by always fewer women. They asked whether health professionals receive training on breastfeeding, and on the impact of cesarean section on breastfeeding rates. The Committee members asked whether promotion of breastmilk substitutes is authorized in hospitals. They highlighted the fact that the promotion of infant formula in hospitals, and lack of regulation of their marketing together with a lack of support to understand the importance of exclusive breastfeeding up to 6 months, can undermine the successful breastfeeding by mothers, and recommended to Luxembourg to have strong regulations on the marketing of breastmilk substitutes coupled with a good monitoring of the Code and resolutions, as well as adequate maternity protection for working women so that mothers are really supported to breastfeed. The Committee also addressed the need to turn all four hospitals into baby-friendly.

The Luxembourg delegation reported that concerning the decreasing rate of exclusive breastfeeding, it is mainly women of low social and economical background who stop more and more breastfeeding their children after 6 months. The government of Luxembourg highlighted the fact that it is currently working in collaboration with international partners on the project to change the image of breastfeeding in order to convince mothers to continue breastfeeding their child until 6 months.

Concerning the Baby-Friendly Hospital Initiative, the delegation of Luxembourg said that one of the objectives of the national programme is to put BFHI in the national criteria for maternity units.

Concluding Observations

Although issue related to breastfeeding such as the BFHI, the marketing breastmilk substitutes, adequate budgeting of the national action plan and maternity protection were tackled during the Committee, we regret to see that no recommendations on this issue in the Concluding Observations were given to Luxembourg. 

For more information on breastfeeding in Luxembourg please see http://www.liewensufank.lu/fr

China to strengthen legislation on food safety and the International Code

China presented its consolidated 3^rd and 4^th periodic report on the situation of the implementation of the Convention on the Rights of the Child. The next consolidated 5^th to 6^th periodic report is expected by March 2019. The Chinese delegation was composed of 44 members headed by H.E. Mr. Guide Jia, Deputy Director-General at the Department of Treaty and Law and Ministry of Foreign Affairs.

In view of the session, IBFAN presented an alternative report on the situation of infant and young child feeding in China, prepared by IBFAN East-Asia. The report shows that in China breastfeeding declined rapidly during the 1980s due to the promotion of breastmilk substitutes and inappropriate medical practices. With the implementation of BFHI since 1992 and of national regulation on the marketing of breastmilk substitutes (China’s Regulation) since 1995, breastfeeding’s superiority has been recognized and mothers are encouraged and supported to breastfeed their infants. However, breastfeeding promotion in community and work place has not yet received enough attention. One of the challenges regards the popularity of formula feeding and persistence of inadequate feeding practices related to giving water to infants 0-5 months. Another challenge is how to ban the marketing promotion of infant formula which undermines mothers’ confidence on successful breastfeeding. It is difficult for health authorities to supervise, conduct training and reassessments of the baby-friendly health facilities in China given the great number of concerned facilities (over 60 thousands). Finally, it is hard to ensure mothers’ entitlement to paid maternal leave and breastfeeding facilities, especially during the rapid social and live style charging in China.

Discussion on infant and young child feeding

During the dialogue with the government delegation, issues related to breastfeeding and infant and young child feeding have been raised by the CRC Committee, in particular relation to breastfeeding programmes and the baby-friendly hospital initiative (BFHI). The delegation of China did not address these issues in its responses. The Committee pointed out that the exclusive breastfeeding rate is falling, claiming that this is due to incidents of contaminated milk. The Committee insisted on the importance of establishing and reinforcing breastfeeding programmes, as well as promoting the Baby-Friendly Hospital Initiative. The Chinese delegation did not address these issues.

With regards to HIV and AIDS, the CRC Committee asked if there is any programme protecting young people and mothers.

The Chinese delegation answered that the government had implemented a project of HIV prevention and that to date, around 90,000 HIV-positive pregnant women have accessed appropriate services. This has led to a decrease of mother-to-child transmission rate.

Concluding Observations

In its Concluding Observations, the CRC Committee made recommendations on promoting exclusive breastfeeding, BFHI and on adopting the International Code of Marketing of Breastmilk Substitutes. The Committee also mentioned the importance of respecting child rights in relation to the business sector.

Regarding breastfeeding in particular, the CRC Committee was concerned “about the decrease in the exclusive breastfeeding and the incidents of contaminated infant formula in mainland China” (para 64). It strongly recommended that the government of mainland China: “(a) Intensify its efforts to reform laws and strengthen implementation of regulations on food and health safety standards, including for business sector and ensure that any officials or companies violating international and national environment and health standards are appropriately sanctioned and remedies provided when violations occur; (b) Collects systematic data on children affected and take all measures to ensure that all children and their families have access to effective redress, including free medical treatment and adequate compensation; (d) Promote exclusive breastfeeding and the establishment of Baby-Friendly Hospitals and adopt a Code of Marketing of Breast-Milk Substitutes with appropriate controls on the marketing of artificial infant formula” (para 64-65)

In relation to Health and health services, the Committee recommends that “mainland China strengthen its efforts to address, as matter of urgency, the existing disparities in health outcomes and resource allocations in order to ensure that all children enjoy the same access to and quality of health services, paying special attention to children in vulnerable situations, especially children living in poverty and rural areas and children of migrant workers. In particular, it recommends that mainland China take all measures to eliminate child and maternal mortality, including by improving health infrastructure and the availability and accessibility to emergency obstetric and neonatal care and skilled birth attendants at primarily health facilities in rural and poor areas.” (para 62)

The CRC Committee, in its General Comment 16 (2013), specifically calls on States “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”.

The Committee drew attention of China to its general comment no. 16 in the recommendations related to Child Rights and the business sector. It recommended to mainland China to strengthen the implementation of regulations in order to ensure that the business sector respects international and national human rights and complies with labour, environment and with child rights in particular. The CRC Committee therefore recommended that mainland China: “(c) Establish monitoring requirements for all industries 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 impacts; and (d) Investigate and hold accountable government officials, including local officials, suspected of failing to uphold environmental regulations or preventing people from accessing information or medical care, and ensure that children and their families have immediate and full access to effective and medically approved treatment and long-term remedies, including rehabilitation services and compensation” (para 22-23).

Lithuania's lack of support for breastfeeding programme implementation

Lithuania presented its consolidated 3^rd and 4^th periodic reports on the situation of the implementation of the Convention on the Rights of the Child in the country. The consolidated 5^th to 6^th periodic report is expected by November 2018.

The IBFAN alternative report of Lithuania was prepared by the Initiative group of breastfeeding mothers and breastfeeding promoters of NGO "Pradžių pradžia" (IBFAN Lithuania). The report reflected the ‘Declaration on Breastfeeding Support and Relate Issues in Lithuania’ which was addressed to the highest authorities such as the Ministry of Health and Ministry of Education of the Republic of Lithuania, and was also shared with all universities and medical colleges and faculties of the country during the World Breastfeeding Week in 2011.

The report shows that in Lithuania, executive health policy does not direct any attention towards an integral programme on protection, support and promotion of breastfeeding. Dissemination of evidence-unbased information and misleading advertising is the key reason for refraining from breastfeeding or choosing a comparatively short period of breastfeeding. Article 24 of the Convention of the Rights of the Child is not appropriately respected and no mechanisms exist for control of its implementation: a comparatively large number of mothers continue refraining from or choose especially short periods of breastfeeding[1]. Thus, responsible state bodies that do not take action to encourage mothers to feed infants in a natural way, fail implementing public health strengthening actions based on disease prevention, which results in increased personal health care costs and sickness benefits. Currently, no substantial actions are taken to upgrade breastfeeding-related qualifications of health care specialists. Certain seminars on nutrition of infants and children for health care specialists are supported and organized by companies distributing breastmilk substitutes which violate the International Code of Marketing of Breastmilk Substitute and resolutions. What is more, accessibility to personal health care services for breastfeeding women is not sufficiently communicated and organized. There are very few baby-friendly hospitals and in other health care institutions, the quality of services is very low or services that ensure successful breastfeeding are nonexistent. Consequently, a birth-giving mother, limited by time and distance, cannot freely choose a health care institution. Mothers and newborns experience discrimination as they end up in a hospital without the BFHI status.

During the discussion between the government delegation and the CRC Committee, issues related to breastfeeding were not discussed.

Concluding Observations

We regret that the CRC Committee has made no specific recommendation on infant and young child feeding to the government of Lithuania in its Concluding observations.

In par. 39 and 40 regarding health care and services, the Committee regretted the decreasing budget allocations to maternal and child health care programmes. It reminded Lithuania to pay attention to its General Comment no. 15 (2013), which insists 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 increase its budget allocations for maternal and child health programs. The Committee also recommends that the State party ensure maternal care for women who choose to deliver at home by providing access to emergency obstetric care, trained care at delivery, and post partum care.”

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[1] Statistical data of research made at Health authority of Lithuania show that: just 30% of infant are breastfeed more than 0,5 year. For more see: http://www.tavovaikas.lt/kudikis/mityba-ir-sveikata/isaiskejo-kiek-sutaupo-seima-per-metus-maitinant-kudiki-krutimi.d?id=62015889

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

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

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

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

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

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

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

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

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

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

For the full report read here

ISRAEL’S BREASTFEEDING PRACTICES ARE IMPROVING

On Monday 3^rd May 2013 the situation of children’s rights in Israel, including the Occupied Palestinian Territories, have been reviewed by the Committee on the Rights of the Child (CRC Committee) at its 23^rd session.

The International Baby Food Action Network (IBFAN) presented an alternative report on the situation of infant and young child feeding.

The issue of breastfeeding was tackled by the CRC Committee that asked about the absence of a database for the collection of data and of a law on marketing of breastmilk substitutes and about the situation of BFHI and of maternity protection at work.

In particular, one Committee mentioned the maternity protection law providing that a female employee who is prohibited from working at certain jobs by law because of her breastfeeding is entitled to be excused from work and this absence is tantamount to leave without pay and asked clarification on its interpretation in order to avoid discrimination of women that decide to breastfeed.

The delegation could not answer all the questions due to time restraints; however they reported improvements in breastfeeding rates as they already reached the goals set by the government for the year 2020. To further support breastfeeding, each government facility must provide space for breastfeeding or for expressing breastmilk.

The delegation also explained how the International Code of Marketing of Breastmilk Substitutes is enforced is some situations, for example vis-à-vis advertising companies. In addition, they mentioned the 2003 Remedia case concerning a bulk of imported infant formula that lead to some children dying and some other being irreversibly harmed due to lack of a fundamental vitamin, and as a result all imported formula is now carefully examined. It was also noted that HIV positive mothers are given free breastmilk substitutes.

Finally, the Committee was concerned by reports of delays at checkpoints also involving pregnant women that are seeking medical assistance.

The delegation informed that within the West Bank all roadblocks have been removed and therefore there are no restrictions on the freedom of movement. To enter Jerusalem there still are checkpoints and roadblocks but there are not recent reports of delays in passage of pregnant women and all the military personnel is specifically trained to let though medical cases as expeditiously as possible.

BREASTFEEDING IN UZBEKISTAN AT THE CRC COMMITTEE

At the 23^rd session of the Committee on the Rights of the Child (CRC Committee) the situation of children’s rights in Uzbekistan has been reviewed on Tuesday 4^th May. IBFAN presented its alternative report on the state of infant and young child feeding in the Country, noting the high infant and maternal mortality rates and the very low rate of exclusive breastfeeding at 6 months of age (only 26%).

The CRC Committee asked information on measures to prevent infant and maternal mortality and on breastfeeding practices and the implementation of the International Code on Marketing of Breastmilksubstitutes.

The Uzbek delegation mentioned two programs designed and implemented in the Country in collaboration with UNICEF, namely the ‘Growth and development for young children’ program and the ‘Breastfeeding’ program to monitor the health of newborns. As a result of these efforts, over the last 10 years the proportion of breastfeeding has increased to 80%.

It is not clear if the data provided by the delegation concerns exclusive breastfeeding and if it reports a national average or it relates only to focus communities involved in UNICEF programs, therefore such data does not provide a clear picture of the situation of breastfeeding rates in Uzbekistan.

The question on marketing of breastmilk substitutes remained unanswered.

Concerning maternal and infant mortality, the Country delegation reported a 10% of maternal mortality in 2012 and a 4% of infant mortality in the same year. These data are much lower than those reported by UNICEF in 2010-2008 (30% of maternal mortality and 44% of infant mortality) and it might be due to discrepancies in data collection, a general problem acknowledged by the Uzbek delegation and being tackled at the national level.

Breastfeeding in Rwanda

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

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

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

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

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

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

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

A Study founds that "Breast milk destroys HIV and blocks oral transmission"

Breast milk has a strong virus killing effect and can protect against oral transmission of HIV, a new study has found. More than 15 percent of new HIV infections occur in children.

Read the ARTICLE from Hindustantimes.com

Extremely Low Rates of Exclusive Breastfeeding in Algeria

The CRC Committee reviewed the combined 3rd and 4th report of Algeria on 8^th June 2012. IBFAN-GIFA had submitted an alternative report on the situation of infant and young child feeding in Algeria. The report focused on the extremely low rates of exclusive breastfeeding in Algeria. IBFAN also expressed concern over the lack of implementation and monitoring of the International Code of Marketing of Breast milk Substitutes (the Code).

Algeria registers very low breastfeeding rates, especially exclusive bf for the first 6 months (7%).  The Committee addressed the issue of bf in Algeria and stressed the importance of early initiation of bf and exclusive bf up to 6 months of the child’s life. 

The causes of infant mortality should also be considered by the government of Algeria as important issues to research. The Committee recommended that Algeria improve the guarantee of healthcare for mothers before, during, and after birth. The improvement of implementation and monitoring of the Code was also an important issue discussed by the Committee.

The CRC Committee’s 60^th session ended with the review of Algeria. The concluding observations and recommendations will be published in the following week and we’ll keep you updated on the outcome.

Greece: Unfavourable Environment Leads to Extremely Low Breastfeeding Rates

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

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

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

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

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

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

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

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

Violations of the Code in Australia lead to Low Breastfeeding Rates

Australia reported for the fourth time at the CRC Committee on the 4^th and 5^th of June 2012. IBFAN had submitted an alternative report on the situation of infant and young child feeding in Australia.

The Committee members addressed issues of infant and young child feeding as part of the health topic. The Committee acknowledged the high rates of early initiation of breastfeeding in Australia, however these were followed by reports of extremely low exclusive and continued breastfeeding rates across the country. The Committee remarked that the exclusive breastfeeding rates are going down, and this can be attributed to the poor monitoring of the International Code ofMarketing of Breastmilk Substitutes (the Code), which has led to a large amount of advertisement on infant and toddler formula.

The Committee asked the government delegation many questions regarding the monitoring of the Code in Australia and how the government reacts to violations. The government mentioned the voluntary agreement with the industry peak body (INC), which restricts the advertising of infant formula (including follow-on formula but not including toddler formula or growing-up milk) to the general public by manufacturers and importers in theory. It does not apply to the activities of retailers and it does not restrict the advertising of feeding bottles and teats or complementary foods that are marketed as suitable for infants less than 6 months old. However, no information was provided on the effective implementation and monitoring of the Code in practice.

The Committee also asked if there are policies in place in Australian hospitals that promote breastfeeding in alignment with the Baby-friendly Hospital Initiative (BFHI). The government did not respond to this question.

The Australian government stated that breastfeeding falls under the category of discrimination in the workplace and that it is illegal for a woman to be discriminated against for breastfeeding once she returns to work.

Turkey’s contradiction: very low early initiation of breastfeeding rates and high rates of hospitalized births

Turkey presented its combined 2^nd and 3^rd report to the Committee on the Rights of the Child on Friday 1^st June 2012. IBFAN presented an alternative report on the situation of infant and young child feeding in Turkey.

The Committee members posed many questions based on IBFAN’s report. It addressed the contradiction between the very low rates of early initiation of bf and the high rates of births taking place in a hospital facility, which reveals a lack of adequate support to breastfeeding by health care professionals.  Thus, the Committee also interrogated on the extent to which existing certified baby-friendly hospitals are being monitored and based on which indicators.

The Committee also posed questions on the measures being taken by the CRC Committee on the effective implementation and monitoring of the International Code of Marketing of Breastmilk Substitutes and on maternity protection measures.

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. 

Cyprus: Scarce information on infant and young child feeding

Cyprus reported for the third time at the Committee on the Rights of the Child (CRC Committee) on 30^th of May 2012. Cyprus delegation was composed of 11  members,  one of which was from the Ministry of Health, Ms. Myrto AZINA-CHRONIDES (Medical Officer 1^st class). She responded the questions of the Committee pertaining to health issues.

The International Baby Food Action Network (IBFAN) sent an alternative report on the situation of infant and young child feeding in Cyprus, which led to several questions being posed by the members of the CRC Committee on this subject.

Committee members acknowledged the fact that there is no data on breastfeeding, including exclusive breastfeeding or other infant feeding practices. They also asked for information on the efforts being made to promote the baby friendly hospital initiative as presently there are no certified baby-friendly hospitals in the country.

The delegation stressed that the government of Cyprus is committed to protecting and promoting breastfeeding and announced that a multidisciplinary committee is preparing a breastfeeding promotion plan. However no information was provided on breastfeeding rates in the country. According to the delegation only one hospital, Makarios, is baby-friendly, even though it is unclear when the certification of this hospital has occurred and whether it has been re-assessed.

According to the government representative, awareness raising programmes on adolescent health and nutrition focus on school as the basis for these programmes. However, Committee members noted that this is not sufficient as there are teenagers that are out of the school system, and most importantly because infant and young child feeing which is vital to the child’s health, cannot happen in school but it starts with pregnancy, birth and then breastfeeding and young child feeding.

Cyprus has adopted the EU Directive 2006/141/EC on infant formulae and follow-on formulae, as a measure to implement the International Code of Monitoring of Breastmilk Substitutes. The CRC Committee asked for more information on the efforts taken to implement and monitor the International Code. To these questions the delegation responded very briefly by saying that breastmilk substitutes are monitored by environmental inspectors on a 24 hour basis. It is thus unclear what are the results of such monitoring and what is the procedure in cases of violations.

The Committee also raised questions regarding the maternity protection of working women.  The delegation said that the government is very strict with promoting breastfeeding, and that women are given a leave anytime they need to breastfeed. While such an approach is welcome, it is unclear whether there is a policy in place to ensure breastfeeding breaks and favourable working conditions for breastfeeding women that work not only in the public sector but also in the private and informal sector.