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

Sao Tome and Principe to address maternal deaths and business impact on child rights

Sao Tome and Principe presented its consolidated 2^nd to 4^th periodic reports on the situation of the implementation of the Convention on the Rights of the Child in the country. The 5^th and 6^th periodic reports are expected by June 2018.

IBFAN did not present any alternative report.

Discussion on infant and young child feeding

The Committee did not address issues related to breastfeeding. However, it tackled the question of maternal mortality in relation to HIV/AIDS infections. The delegation of Sao Tome and Principe explained that it is currently taking steps to eradicate these infections by 2015. Counseling centers for sexual health have been established in schools and awareness-raising activities are being organized for young persons.

Concluding Observations

No recommendation specifically refers to breastfeeding in the Concluding Observations. The CRC Committee instead mentioned the importance of a good health care system. It drew attention to its General Comment no. 15 (2013) on the right of the child to enjoy the highest attainable standard of health. It therefore recommended Sao Tome and Principe to: “(a) allocate adequate human, technical and financial resources to improve the quality of health care and provide quality training for the health care personnel, particularly at local levels; (b) Undertake surveys and studies on the extent and root causes of maternal mortality throughout the country and apply the findings therein for formulating and implementing comprehensive programmes for addressing maternal deaths: and, (c) Seek financial and technical assistance from UNICEF and the World Health Organization (WHO), among others, in this regard” (para 48-49).

The CRC Committee also insisted on improving the access to safe drinking water. It recommended the State party to: “(a) intensify its efforts to improve access to safe drinking water and sanitation, and in doing so pay particular attention to rural and outlying areas” (Para 54-55).

Another paragraph was dedicated to HIV/AIDS. The Committee recognized the efforts of Sao Tome and Principe to decrease the mother-to-child transmission of HIV/AIDS rate by spreading HIV/AIDS testing for pregnant women. However, the Committee noticed that regular follow-up on infected mothers and children remain inadequate and that the access to antiretroviral treatment limited. Therefore, the CRC Committee recommends Sao Tome and Principe to: “(a) Sustain the measures in place to prevent the Mother-to-Child transmission of HIV/AIDS and develop a roadmap to ensure the implementation of effective preventive measures; (b) Improve follow-up treatment for HIV/AIDS-infected mothers and their exposed infants[...] and (d) Improve access and coverage of Antiretroviral Therapy and Antiretroviral prophylaxis for HIV infected pregnant women. In doing so, the Committee recommends that the State party seek technical assistance from, inter alia, the United Nations Joint Programme on HIV/AIDS (UNAIDS) and UNICEF” (para 52-53).

Finally, the CRC Committee drew Sao Tome and Principe’s attention to the General Comment No. 16 (2013) on State obligations regarding the impact of the business sector on children’s rights and recommended Sao Tome and Principe to have a clear regulatory framework and effective implementation and monitoring mechanisms to ensure that business activities do not negatively affect the rights of the child. Concerning that issue, the Committee recommended in particular Sao Tome and Principe to: “(b) Ensure effective implementation by companies, especially those of the extractive industries, of international and national environment and health standards, effective monitoring of implementation of these standards and appropriately sanctioning and providing remedies when violations occur, as well as ensure that appropriate international certification is sought; (c) Require companies to undertake assessments, consultations, and full public disclosure of the environmental, health-related and human rights impacts of their business activities and their plans to address such impacts; and, (d) Be guided by the United Nations “Protect, Respect and Remedy” Framework, accepted unanimously in 2008 by the Human Rights Council, while implementing these recommendations” (para 23- 24).

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

Armenia to Adopt the Draft Law on the International Code and Strengthen BFHI Monitoring

In view of the 63^rd session of the CRC Committee, IBFAN presented an alternative report on the situation of infant and young child feeding in Armenia, prepared by Confidence Health NGO in collaboration with GIFA. The report showed in particular how the International Code on Marketing of Breastmilk Substitutes is heavily violated in hospitals and how NGOs registered violations of the International Code also in some baby-friendly certified hospitals since the implementation and monitoring of the Baby-Friendly Hospital Initiative (BFHI) has been discontinued in 2008. In addition, the report mentions the existence of a draft law on the marketing of breastmilk substitutes, its weaknesses and possible improvements. However, after the report was written there have been some positive developments that resulted in a strengthening of the draft law.

The CRC Committee reviewed the situation of children’s rights in Armenia on Wednesday 29^th May. The issue of breastfeeding and infant and young child feeding were raised by the Committee, in particular in connection with the issues of the International Code and of BFHI. Questions were answered by the representative of the Ministry of Health (MOH).

The International Code of Marketing of Breastmilk Substitutes

The Committee inquired on the plans of the government to finalize the draft law on the marketing of breastmilk substitutes and to adopt it as law and monitor it.

On this point, the Armenian delegate noted that the Country is in the process of adopting a law[i] prohibiting advertising of artificial food, including infant formula, and providing for measures to punish health workers that cooperate with distributors of infant formula. The parliament has just had a hearing on this law, and the MOH representative expressed her persuasion that the law will go through, despite lobbying against it by companies, because legislators look very favourably at it.

Baby-Friendly Hospital Initiative

The Committee asked information on government’s plans to monitor practices in hospitals, where breastfeeding is not always properly encouraged and where infant formula can be provided to mothers.

MOH representative reported that 60% of babies are born in baby-friendly hospitals, where infant formula provision is not allowed, and explained that monitoring of baby-friendly hospitals is carried out by NGOs.

The CRC Committee expressed its disappointment on the lack of government initiative in monitoring of baby-friendly hospitals practices and on the lack of countrywide implementation of the initiative, and asked the government to justify it.

The MOH delegate explained that in all Armenian hospitals babies are kept with the mother; however she acknowledged that the supply of infant formula to mothers is indeed an actual practice. She also explained the lack of State monitoring of BFH with the fact that very active NGOs – especially IBFAN – are carrying it out and the State works hand in hand with them in this area. The delegate further acknowledged that sometimes medical personnel work with distributors of infant formula and may encourage mothers to use it. In this case she considers the State collaboration with NGOs a positive practice.

Undernourishment

More broadly on nutrition, the representative acknowledged that the Country faces a problem of undernourishment mostly related to lack of vitamins. In Armenia children are not going hungry but they are not developing fully: there is a problem of undergrowth that a strategy developed with the assistance of UNICEF tries to tackle. The government delegate reminded that it is not only a health problem, but also of poverty and education.

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[i] The draft law is named "Breastfeeding promotion and regulation of infant food marketing”

60TH COMMITTEE ON THE RIGHTS OF THE CHILD

Governments to Strengthen Their Laws To Fully Comply With International Code

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

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

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

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

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

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

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

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

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

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

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

Child Rights and Business

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

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

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.