IBFAN Oral Statement on Panel IV - Scope: Human rights to be covered under the Instrument

Thank you Chairperson. 

I am speaking on behalf of the International Baby Food Action Network and the Pesticide Action Network Asia, both members of the Treaty Alliance. 

As highlighted by human rights experts as well as by our networks engaged with communities on the ground, corporate abuses affect the whole range of human rights defined in the core human rights instruments, from civil and political to economic, social and cultural rights.

 Our organizations have documented a great number of cases in which people’s health has been negatively affected, children’s development has been jeopardized, food and water have been contaminated and natural resources depleted by activities of business enterprises. Their activities, which include the production and use of highly hazardous chemicals and pesticides, do not only cause direct harm to populations and damage the environment. They also lead to long-term negative impacts on health that are sometimes irreversible and intergenerational.

Misleading marketing causes long-term effects on people’s health and development. For example, when baby food companies promote their breastmilk substitutes in violation with the WHO Code, they undermine breastfeeding optimal practices, therefore exposing infants and young children to a greater risk of mortality and compromising their future health, growth and wellbeing. 

We would like to reiterate that all human rights are universal and inalienable as well as interdependent and indivisible. A treaty that would cover only a narrow scope of human rights would be meaningless to the affected people. Therefore, the future treaty should incorporate all human rights contained in the core human rights conventions as well as the relevant ILO conventions, in particular those related to labour rights, maternity protection, rights of indigenous people, and agricultural and migrant workers. Thank you.

FIAN International and IBFAN’s Submission on Adolescents’ Right to Adequate Food and Nutrition and Related Rights

Input Towards the Elaboration of the General Comment on the Rights of Adolescents of the Committee on the Rights of the Child (March 2015)

FIAN International and IBFAN welcome the Committee on the Rights of the Child’s decision to develop a General Comment on the Rights of Adolescents as well as its call for civil society submissions in the preparation of this General Comment. This contribution seeks to provide information and recommendations about the right to adequate food and nutrition of adolescents and related rights (e.g. the right to health, the right to sexual and nutrition education and the right to information). We hope that the Committee will consider the following issues and recommendations during the preparation of its General Comment.

The information contained in this submission is based, inter alia, on information obtained by FIAN International and IBFAN through exchanges with their national groups and affected communities during the course of their work, especially during the process of documenting cases of violations of the right to adequate food and nutrition and related rights.[1]

The Right to Adequate Food and Nutrition, a Comprehensive Concept

We understand the human right to adequate food and nutrition as a comprehensive concept intrinsically linked to the full realization of women’s and children’s rights, and within the conceptual framework of food sovereignty. As a result, States should be held accountable to respect, protect, and fulfil the right to adequate food and nutrition in an integrated manner by ensuring that all structural causes of hunger and malnutrition are addressed in all relevant governance and policy processes – from causes related to access, control, management and ownership of land, seeds, forests and water bodies, to food processing, marketing and promotion, protection in schools and in the workplace, promotion, protection and support of breastfeeding, and to decent income and consumption patterns, up until the very moment in which food is effectively consumed. Ignoring the holistic reality of the human right to adequate food and nutrition, as part and as result of social processes, leads to the fragmented understanding of food and nutrition, creates gaps in human rights promotion and protection and overlooks the intertwined rights and subjectivities of mothers, infants and young children during pregnancy and lactation.

The Right to Adequate Food and Nutrition under the CRC

Under the Convention on the Rights of the Child (CRC), States Parties’ obligations to respect, protect and fulfill the right to adequate food and nutrition are described under articles 24 and 27. More specifically, under article 24, States Parties “recognize the right of the child to the enjoyment of the highest attainable standard of health”, which is elaborated in the article and perceived to encompass the right to adequate food and nutrition. Under this article, the CRC recognizes that the right to adequate food and nutrition in relation with the right to health goes beyond the provision of nutritious food and calls for the nutrition information and education of, as well as support to, those responsible for the children’s care and well-being, in particular mothers and parents. In this context, the CRC states that in addition “to combat[ing] disease and malnutrition…through the provision of adequate nutritious foods”[2], States Parties shall also take steps “to ensure appropriate pre-natal and post-natal health care for mothers”[3] and “ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition, the advantages of breastfeeding…”.[4] In its article 27.3, the CRC further links the right to adequate food and nutrition to social protection measures by stating that States shall take steps “to assist parents and others responsible for the child to implement this right and shall in case of need provide material assistance and support programmes, particularly with regard to nutrition…”.

The Adverse Impact of Child Marriage and Early Pregnancies on Adolescents’ Right to Adequate Food and Nutrition and Related Rights

Central to the realization of adolescents’ right to adequate food and nutrition is the understanding of the role of harmful acts and practices committed against adolescent girls, when they are deprived of the totality of their rights and their freedom to choose how to live their lives. Child, early and forced marriages as well as teenage surrogacy are harmful practices and a violation of human rights under article 24.3 of the CRC, with significant intergenerational implications for the right to adequate food and nutrition of the adolescent girl, the woman she will become, the children she might have and her community as a whole. They often result in the deprivation of the human rights (e.g. their right to education, reproductive rights, etc.) of the girls who are victims to these violations, and are linked to early and adolescent pregnancy, possibly associated with nutritional deprivation and stunting, risk of death, distancing from family, and increased workload and obligations. This scenario results in adolescent girls who become pregnant at an early age, many of them already stunted, to become chronically undernourished, further stunted and anemic.[5] Early or adolescent pregnancy places a severe burden on the nutritional well-being, growth, and development of the still growing girl, even if provided with an adequate diet because these have to compete with the nutritional demands of bearing a child. Furthermore, the risk of maternal malnutrition and mortality in these girls is increased by three to four times in comparison to the risk for an adult woman.[6] In fact, complications from pregnancy and childbirth are among the most important causes of death for girls aged 15-19 in low- and middle-income countries.[7]

For the child who is born as a result of a child, early and forced marriage and/or as a result of an early pregnancy, the realization of his or her right to adequate food and nutrition, and thus of other human rights, is severely impaired for his or her lifetime.[8] The infant mortality and malnutrition rates associated with adolescent pregnancies are higher than those of adult pregnancies.[9] Furthermore, adolescent mothers have a higher risk of having low birth weight babies.[10] Low birth weight babies have a much higher risk of dying before reaching age 5, of developing more severe malnutrition, specially stunting[11], and of developing chronic degenerative diseases in adult age[12]. Low birth weight, wasting, stunting, and child malnutrition, has the further consequence of impaired cognitive development and malnutrition, including under-nutrition and obesity, in adulthood.[13] Therefore, policies and interventions aimed at addressing hunger and malnutrition need to place the emphasis on guaranteeing the needed social and legal protection against discrimination of girls, in particular against child marriage and early pregnancies. Policies need to take a more holistic approach, place the focus on the underlying structural causes and on the role of the realization of women’s and girls’ human rights throughout the lifespan, and capture the significant role that girls’ good nutritional status has for the potential future offspring.

The Importance of Sexual and Nutrition Education for the Fulfillment of Adolescents’ Right to Adequate Food and Nutrition and Related Rights

The promotion of girls’ and women’s overall rights across their life spans, which, among others, include access to self-determination and autonomy, education, productive resources, jobs, income, sexual and reproductive rights, adequate preventive and curative health care, fair and unbiased partnerships, and in particular the right to sexual and reproductive health education and counseling services, not only enables women and girls to freely decide whether and when to become mothers, but it also has a positive impact on their overall nutritional status, their pregnancy outcomes and for their babies’ survival and health and that of their entire communities for present and future generations.[14] The CRC Committee already raised concerns about the high maternal mortality teenage and pregnancy rates linked with insufficient access by teenagers to reproductive health education and counselling services[15] and flagged sexual education as being an effective tool for the prevention of gender-based violence.[16] In 2010, the Special Rapporteur on the right to education stated that “[i]nternational human rights standards clearly establish the human right to comprehensive sexual education, which is indivisible from the right to education and is key to the effective enjoyment of the right to life, health information and non-discrimination, among others.”[17] Therefore, it is crucial that all adolescents, and in particular girls, have access to sexual and reproductive health education. Sexual and reproductive health education constitutes indeed a key intervention to ensure that all adolescents are able to enjoy their sexual and reproductive rights to their fullest extent by empowering them to detect and denounce sexual abuses and harmful practices, make free, informed decisions about their sexuality, and adopt a responsible sexual behavior.

Pursuant to article 24.2 (e) CRC, all segments of society, in particular children and parents, should have access to information and education on the advantages of breastfeeding and should be provided with basic knowledge on child health and nutrition. The Committee further specified that “[i]nformation and life skills education should address a broad range of health issues, including: healthy eating …”[18] and that “[s]exual and reproductive health education should include self-awareness and knowledge about the body, including anatomical, physiological and emotional aspects”[19]. Therefore, States should ensure that comprehensive, clear and unbiased information on optimal breastfeeding practices and their impact on child and maternal health is systematically included in sexual and reproductive health education of adolescents. In addition, adolescents should be provided with thorough information and education on healthy eating habits as well as on optimal child nutrition and health. These interventions would enable adolescents to take the best decisions regarding their own health and nutrition, and the way to feed their child. Thus, the inclusion of breastfeeding and healthy eating habits within sexual, reproductive health and life skills curricula of adolescents would help break the intergenerational cycle of malnutrition and enhance the overall health condition of all segments of the population.

The Support to Breastfeeding Teenage Mothers, an Obligation for States

The Global Strategy for Infant and Young Child Feeding, adopted by the World Health Assembly in 2002, calls on States to take concrete measures and to adopt, implement and monitor policies and programmes which aim to protect, promote and support appropriate infant and young child feeding and in particular breastfeeding. Protection of breastfeeding includes, among other interventions, the implementation and monitoring of the International Code of Marketing of Breastmilk Substitutes as well as the adoption and monitoring of a policy on adequate maternity entitlements. Support of breastfeeding requires interventions which aim at facilitating early, exclusive and continued breastfeeding, such as provision of skilled counselling on breastfeeding, promotion of good nutrition for pregnant and lactating mothers and provision of guidance on appropriate complementary feeding with emphasis on the use of suitable locally available foods which are prepared and fed safely.  [20]  

In the case of children living in exceptionally difficult circumstances, e.g. children born to adolescent mothers, additional and specific supporting measures are required. Teenage mothers are especially vulnerable and often face discrimination regarding their ability to pursue their school curricula. The lack of appropriate childcare and breastfeeding facilities in schools might affect their decision about the feeding of their child and thus, lead to adverse consequences for their health and development and the health and development of their child. In order to avoid such adverse consequences, and to fulfil their obligation to support these teenage mothers in their decision to breastfeed, States should develop policies which ensure that teenage mothers are able to continue studying while caring for their babies. They should therefore implement specific supporting measures such as availability of and access to childcare facilities and breastfeeding rooms in schools and provision of child-friendly skilled counselling on breastfeeding. In addition, pregnant and lactating adolescents should be provided with specific maternity follow-up such as the systematic and regular monitoring of their nutritional status and access to clean water. In case of any form malnutrition or lack of access to clean water, extra food rations and drinking water should be granted throughout the whole pregnancy and lactation period.

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[1] More information on this topic and the links between women’s rights and the right to adequate food and nutrition can be found in Anne C. Bellows, Flavio L.S. Valente, and Stefanie Lemke. (Eds.) Gender, Nutrition and the Human Right to Adequate Food: towards an inclusive framework. New York: Taylor & Francis/Routledge. (Expected date of publication: 2015).

[2] CRC Article 24.2(c).

[3] CRC Article 24.2(d).

[4] CRC Article 24.2(e).

[5] See United Nations Children’s Fund (UNICEF), Child under nutrition in India: a Gender issue, 2009. Accessed March 31, 2015, http://unicef.in/Story/108/Child-Undernutrition-in-India-A-Gender-Issue. 

[6] See United Nations Children’s Fund (UNICEF), State of the World Children – 2011, 22. Accessed March 31, 2015, http://www.unicef.org/adolescence/files/SOWC_2011_Main_Report_EN_02242011.pdf. 

[7] See World Health Organization (WHO). Women’s health fact sheet. Accessed March 31, 2015, http://www.who.int/mediacentre/factsheets/fs334/en/. 

[8] For a specific country example of the impact of child, early and forced marriage on women’s human rights throughout the life span, including the right to health and education, see Plan Nepal, Save the Children, and World Vision International, Child Marriage in Nepal – Research Report, 2012. Accessed March 31, 2015, http://www.wvi.org/nepal/publication/child-marriage-nepal. 

[9] See United Nations Children’s Fund (UNICEF), State of the World Children – 2011, 22. Accessed March 31, 2015, http://www.unicef.org/adolescence/files/SOWC_2011_Main_Report_EN_02242011.pdf. 

[10] See World Health Organization (WHO). Adolescent pregnancy fact sheet. Accessed March 31, 2015, http://www.who.int/mediacentre/factsheets/fs364/en/. 

[11] Stunting, or low height for age, is usually caused by continued insufficient nutrient intake and frequent infections, higher prevalence below age 2. Wasting, or low weight for height, is a strong predictor of infant or child mortality, and is usually associated with acute lack of adequate nutrient intake and disease. For more information, see United Nations Children’s Fund (UNICEF), Progress for Children: A World Fit for Children Statistical Review. Accessed March 31, 2015, http://www.unicef.org/progressforchildren/2007n6/index_41505.htm. 

[12] See United Nations Children’s Fund (UNICEF), State of the World Children – 2011, 22. Accessed March 31, 2015, http://www.unicef.org/adolescence/files/SOWC_2011_Main_Report_EN_02242011.pdf.

[13] See United Nations Standing Committee on Nutrition (UNSCN), Sixth report on the world nutrition situation. Accessed March 31, 2015, http://www.unscn.org/files/Publications/RWNS6/html/. 

[14] For more information on the links between women’s rights and the right to adequate food and nutrition, see De Schutter, Olivier. Women’s Rights and the Right to Food. Report presented at the 22^nd Session of the United Nations Human Rights Council. [A/HRC/22/50], 2012. Accessed March 31, 2015, http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/AHRC2250_English.PDF. 

[15] See CRC/C/15/Add. 137, para 48.

[16] See CRC General Comment No 15 (2013) on the right of the child to the enjoyment of the highest attainable standard of health (art. 24), para. 60.

[17] See Singh, Kishore. Interim report of the Special Rapporteur on the right to education. Report presented at the 65th Session of the United Nations General Assembly. [A/65/162], 2010, para 75. Accessed March 31, 2015, http://www.ohchr.org/EN/HRBodies/SP/Pages/GA65session.aspx. 

[18] See CRC General Comment No 15 (2013) on the right of the child to the enjoyment of the highest attainable standard of health (art. 24), para. 59.

[19] See CRC General Comment No 15 (2013) on the right of the child to the enjoyment of the highest attainable standard of health (art. 24), para. 60.

[20] See World Health Organization (WHO), Global Strategy for Infant and Young Child Feeding, 2003. Accessed March 31, 2015, http://apps.who.int/iris/bitstream/10665/42590/1/9241562218.pdf?ua=1&ua=1.  

IBFAN Statement on the occasion of the 25th Anniversary of the Convention on the Rights of the Child

On the occasion of the 25th Anniversary of the United Nations Convention on the Rights of the Child, IBFAN would like to congratulate the States parties as well as the Committee on the Rights of the Child for the work that they have achieved with the aim of realizing children’s rights at global scale. For more than 10 years now, IBFAN has been collaborating with the Committee and sending regular alternative reports and contributions on the issue of infant and young child feeding, channeling information from its global grassroots network to the international policy-making scene.

Breastfeeding constitutes one of the single most effective interventions in order to fulfill the child’s rights to life and to the enjoyment of the highest attainable standard of health. Article 24 of the Convention specifically mentions the importance of providing parents with education and support related to breastfeeding and the CRC General Comment No. 15 stresses the obligation for States to protect, promote and support breastfeeding through the implementation of the World Health Assembly Global Strategy for Infant and Young Child Feeding.

However, breastfeeding continues to face tremendous commercial pressures from the baby food industry. To date, only 37 countries have enacted a law including all the provisions of the International Code of Marketing of Breastmilk Substitutes and the enforcement of such laws is often problematic. The influence of the baby food industry on parents’ feeding choices through misleading marketing campaigns remains substantial and more than one child out of two is not exclusively breastfed until 6 months of age, despite the official recommendations of the World Health Organization.

Addressing this crucial issue, the Committee has repeatedly re-affirmed the necessity for States to promote and support breastfeeding as well as to implement and enforce the International Code and its relevant subsequent World Health Assembly resolutions. This last recommendation has also been highlighted in two General Comments issued by the Committee in 2013: the General Comment No. 15 on the right of the child to the enjoyment of the highest attainable standard of health and the General Comment No. 16 on State obligations regarding the impact of the business sector on children’s rights.

Protecting the right of every infant and young child to benefit from the most adequate food possible and creating an enabling environment for breastfeeding remain at the core of IBFAN’s engagement and we stay committed to work alongside the Committee of the Rights of the Child in the future. IBFAN will continue to provide information to the Committee and to support the effective implementation of its Concluding Observations in reviewed countries, in particular through the World Breastfeeding Trends Initiative. 

Fiji at the CRC: BFHI Implemented, but Still to Be Strengthened

On the 4th and 5th September 2014, the Committee on the Rights of the Child considered the combined Second to Fourth Periodic Report of Fiji 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 Fiji.

General overview of breastfeeding in Fiji

The alternative report showed that 39.8% of infants aged six months or less are exclusively breastfed. Furthermore, a large proportion of children aged 6 months or less are given water (79.6%) as well as sweetened drinks. These data reveal therefore a lack of knowledge about optimal breastfeeding practices.

According to the 2011 World Breastfeeding Trends initiative (WBTi) report on Fiji, a national Infant and Young Child Feeding/Breastfeeding policy was adopted by the Government. Such a policy provided a National Breastfeeding Committee that is however now defunct. Moreover, the WBTi report stresses that “Information, Education and Communication” materials are available only in English.

The Government of Fiji has fully implemented the International Code of Marketing of Breastmilk Substitutes (the Code) in its entirety. However, an informal monitoring in a supermarket in November 2011 highlighted that complementary food labelling the product as suitable for age 4-6 months has been only partially obscured, which constitutes a violation of the Code.

The report highlighted that Fiji has established a national Baby-Friendly Hospital Initiative (BFHI) coordinator. By the beginning of 2009, all its 12 public hospitals were certified as “baby-friendly”. Nevertheless, two main problems have been encountered in its implementation. Firstly, hospitals fail to refresh BFHI courses every two years (as the WHO recommends) and, secondly, mothers are not provided for contacts of health care persons.

According to a study conducted by the Fiji Journal of Public Health, 57% of women who do not exclusively breastfeed pinpoint work as the obstacle to exclusively breastfeeding. The Fijian legislation provides indeed only 84 consecutive (12 weeks) days as maternity leave entitlement. For the first three births, such a leave is paid at the normal remuneration rate, whilst from the fourth child, the mother is entitled to only half the normal salary. Additionally, it is worth noting that there are no provisions concerning paid or unpaid breaks during work hours.

As far as HIV and infant feeding is concerned, it must be noted that a comprehensive policy on infant and young child feeding that includes infant feeding and HIV is lacking.

In coordination with UNICEF and WHO, Fiji developed a flyer on infant feeding during emergencies. However, neither a national plan nor a focus person has been identified to coordinate activities.

Discussion on infant and young child feeding

The Fijian Delegation first stated that the infant mortality rate in Fiji is of 13.7 per 1,000 live births and that perinatal mortality represents an important component of the mortality of children under 5 years old. Regarding maternal health, the Delegation indicated that last year, 4 maternal deaths have been registered in the country. The family health units deal particularly with women’s health, children health (including immunization) and reproductive health as well as with the fight against HIV. The Delegation also indicated that according an immunization state study, the immunization coverage rate is of 84.9%. It further stated that in 2014, collaborative, comprehensive guidelines on child protection aimed at health workers have been issued and that trainings of health professionals on this issue have been organized. Community health trainings are supported by family health units and include training of health professionals on issues related with neonatal intensive care units.

The Committee asked how many women breastfeed their child, by emphasizing that breastfeeding ties very closely with child’s health as well as whether the National Breastfeeding Committee is still operational.

The Delegation noted that suboptimal breastfeeding practices in Fiji contribute to increase the burden of Non-Communicable Diseases (NCDs). Therefore, breastfeeding and infant and young child feeding are part of the National Strategic Plan for NCDs. The Delegation also indicated that during the first decade of 20th century, Fiji has developed the implementation of the BFHI; during this period, the 3 main hospitals of the countries have been certified as “baby-friendly”. However, there is a current decline in the implementation of the BFHI. The Delegation further emphasized Fiji’s endorsement of the International Code on Marketing of Breastmilk Substitutes and informed the Committee that the National Breastfeeding Committee’s plans to hold a meeting on the 24th September 2014. Finally, the Delegation indicated that “Information, Education and Communication” materials are now available in Ataque language but have not been translated into other languages yet.

The Committee expressed further its concern about the current decline of Code implementation. It also highlighted that regular monitoring of the national legislation implementing the Code through an effective monitoring mechanism is crucial. With regard to the implementation of the BFHI and the Ten Steps to successful breastfeeding, the Committee noted that the training of health professionals and the monitoring of these trainings are very important. Finally, the Committee insisted on the importance of monitoring the marketing practices that occur in hospitals in order to make sure that Code policies are followed.

Concluding Observations

In the Concluding Observations, several indirect recommendations were made by the Committee. With regard to the general measures of implementation, it urged Fiji “to take all necessary steps to provide for a timely adoption of [a national comprehensive policy and strategy for children], and to ensure that sufficient human, technical and financial resources are allocated to facilitate its implementation" (§9). It also recommended that Fiji “take all necessary efforts to establish a comprehensive data collection system” (§15). 

Concerning health issues, the Committee recommended that Fiji “strengthen its efforts to further reduce the under-5 and infant mortality rate, especially by focusing on preventive measures and treatment, including immunization, improved nutrition and sanitary conditions, in particular in remote areas”. It also requested the Government to “enforce its efforts to improve prenatal care and further reduce maternal mortality, including by increasing the training of midwives and ensuring the generalization of specific actions to prevent post-partum bleeding and other major causes of maternal death” (§ 42).

Furthermore, the Committee issued direct recommendations related to infant and young child feeding (§54). It recommended that Fiji “ensure that every hospital with a new-born nursery is regularly monitored on adequate implementation of the International Code of Marketing of Breast-milk Substitutes. It also urged Fiji to “raise awareness on the importance of breastfeeding and on the risks of formula feeding” and to “promote proper breastfeeding practices, as well as develop a policy on infant and young child feeding practices, which includes infant feeding and HIV".