59TH CRC Committee: Governments to Improve Exclusive Breastfeeding and Enforce the International Code

The 59^th session of the Committee on the Rights of the Child (CRC Committee) took place from 16 January to 3 February 2012 in Geneva. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 6 countries: Azerbaijan, Cook Islands, Madagascar, Myanmar, Thailand and Togo. 

The rates of exclusive breastfeeding in the group of countries under review are particularly low, e.g. 5% in Thailand, 12 % in Azerbaijan and 15% in Myanmar. Therefore, the CRC Committee stressed the necessity for the governments to take all possible efforts to improve exclusive breastfeeding in their countries. Governments were recommended to raise awareness among the public and educate the communities and mothers in particular about the importance of breastfeeding and the risks of artificial feeding.  

Almost all governments went home with a recommendation to adopt or strengthen their regulation of the marketing of breastmilk substitutes. Azerbaijan was urged to establish “monitoring and reporting mechanisms” with regards to their law which implements the International Code, and was advised to disseminate information widely about these measures. The government of Madagascar was given a recommendation to effectively enforce its National Code of Marketing of Breastmilk Substitutes and establish monitoring systems to detect cases of violations. Thailand was urged to adopt legal regulation for the marketing activities of breastmilk substitutes in accordance with the International Code and to ensure effective monitoring and compliance.

The Committee paid attention also to the issue of obesity and the marketing of junk, sugary and fatty foods to children. In the case of the Cook Islands, the Committee expressed concern for the increasing obesity rates and recommended the government to adopt regulation to restrict and monitor the marketing of these types of foods. 

The Committee considers important the role of the health systems in protecting, promoting and supporting breastfeeding. It urged countries to make their hospitals baby-friendly, to support the Baby-Friendly Hospital Initiative (BFHI) and to sensitize and train of health workers that are involved in maternity work. 

On issues related to child nutrition more generally, the Committee expressed its concern with regards to child malnutrition in all countries under review. It focused on the need to improve equal access to health care services and decrease inequalities, increase budget allocations to the health sector, strengthen the primary health care system, improve maternal health care services, etc.

For more details on the recommendations related to infant and young child feeding (IYCF) to each of the countries, please refer to the table below:

59 CRC January 2012

 

Country		Summary of specific recommendations on IYCF
1	Azerbaijan	Direct: (para 59-60 on Breastfeeding): measures to improve excl bf; raise awareness about the importance of bf and risks of artificial feeding; pay particular attention to early initiation of bf; establish monitoring and reporting mechanisms to regulate marketing of BMS and disseminate info about access to these; strengthen BFHI and provide sufficient fund; strengthen maternity protection by extending its duration and scope and developing child care centres and workplaces; adopt and comply with the ILO 183.
2	Cook Islands	Indirect (para 42-43 on Health care and health services): concerns about increasing rates of obesity; raise public awareness on negative health impacts of processed food; establish regulations to restrict and monitor advertising and marketing of junk, sugary and fatty foods.
3	Madagascar	Direct (para 49-50 on Health and health services): take all efforts to increase exclusive bf in the first 6 months; ensure enforcement and monitoring of the National Code of marketing of BMS. Indirect (para 49-50): address acute and chronic malnutrition; strengthen programmes to prevent mother-to-child transmission of HIV; ensure adequate access to maternity health-care services.
4	Myanmar	Direct (para 63-64 on Health and health services): promote exclusive bf till 6 months by raising awareness of health personnel and the public; reduce and eliminate child malnutrition; reduce infant, child and maternal mortality; increase resources for reproductive health; ensure free and equal access to primary health care.
5	Thailand	Direct (para 60-61 on Breastfeeding): strengthen and expand its efforts to promote the early initiation of bf; promote exclusive and continued bf; raise awareness and educate the public, mothers in particular on the importance of bf and risks of artificial feeding; adopt legal regulation to implement the International code including effective monitoring and compliance; convert all maternity institutions into baby friendly hospitals; ensure that health-care professionals involved in maternity work are trained on breastfeeding. Indirect (para 58-59 on Health care and health services): accelerate measures to ensure nutrition for all children and address disparities; conduct an analysis on the causes of malnutrition.
6	Togo	Indirect (para 53-54 on Health and health service): concerned about the high rates of child mortality and preventable diseases; strengthen primary health care; address preventable health problems among children such as diarrhoea, acute respiratory diseases, measles and malnutrition.

Breastfeeding and the right to sexual and reproductive health

Breastfeeding has not been properly recognized by the international community as an essential part of women's reproductive cycle or as a sexual and reproductive right although there are sufficient medical, legal and social grounds to expound it as such. From a human rights perspective, several international instruments already provide basis for breastfeeding to be interpreted as a human right, related directly  to the right to health and to food. However, breastfeeding is constantly undervalued and threatened,  because of misinformation and commercial pressures, or because it is a maternal practice seen by some as being incompatible with other roles that women have, in particular their occupational role. Dominant social values, structures and institutions, which are rapidly spreading across the globe, often exploit and undervalue women's physical needs and both their productive and reproductive contributions.
Hence the international community needs to recognize the protection and facilitation of women's right to breastfeed as a component of their right to sexual and reproductive health.

IBFAN (International Baby Food Action Network) and WABA (World Alliance for Breastfeeding Action) have made a very interesting contribution to the General Comment on Sexual and Reproductive Health Rights, by the Committee on Economic Social and Cultural Rights (CESCR). Their submission explores the links between breastfeeding and women's sexual and reproductive health , and makes recommendation of how this should be dealt with in a huam rights framework. 

FULL TEXT HERE

58TH CRC COMMITTEE RECOMMENDS GOVERNMENTS TO REGULATE UNHEALTHY FOODS

The 58^th session of the Committee on the Rights of the Child (CRC Committee) took place from 19 September to 7 October in Geneva. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 6 countries: Iceland, Italy, Republic of Korea, Panama, Seychelles, Syria.

IBFAN presented alternative reports on the situation of infant and young child feeding, for all 6 countries under review. In 4 cases these reports were written by IBFAN groups in the countries (Iceland, Italy, Panama, and Seychelles). The reports on the Republic of Korea and Syria were written by the Geneva Infant Feeding Association (GIFA).

In its concluding observations, the CRC Committee referred specifically to breastfeeding in 5 out of the 6 countries. With the exception of Korea, all the other countries received concluding observations on infant and child nutrition and breastfeeding in particular. Unfortunately in the case of Korea, the late submission of IBFAN’s alternative report may have prevented the CRC Committee from making use of the information contained in the report.

The CRC Committee has shown a growing concern about the increasing rates of obesity among children both in developed and developing countries, due to unregulated marketing of foods to children and infants and early introduction of complementary foods. Thus the Committee has recommended that State parties establish regulations to restrict the marketing and advertisement of unhealthy foods and breastmilk substitutes for children and infants (Iceland, Italy and Seychelles).

The Committee has paid particular attention to the awareness among the public generally about the importance of breastfeeding and the risks of artificial feeding. It recommended concrete actions such as increasing access to materials on breastfeeding and to education and campaigns. The Committee also considers important the sensitization of government officials, parents and staff working in maternity units. It has also recommended that breastfeeding should be included in nursery trainings (Italy, Panama, Seychelles, Iceland, Syria).

The Committee has once more stressed the importance of the strict enforcement of the International Code of Marketing of Breastmilk Substitutes by Sate parties including through strengthening of national laws whenever necessary, and the need for action in cases of violations (Syria, Seychelles, Panama, Italy, Iceland).  

Moreover, the Committee has recommended that countries establish a National Breastfeeding Committee, improve data collection on breastfeeding and promote baby friendly hospitals (Syria).

On health more generally, the CRC Committee has focused on the need to improve equal access to health care services, and decrease inequalities in access to health care (Korea, Panama, Syria), with particular focus on children of immigrants (Iceland and Italy), disadvantaged areas, low income families (Korea). It has recommended that state parties increase their allocation to the health sector, with a focus on primary health care, and improve the training of their health personnel.

Summary of concluding observations on IYCF: CRC Session 58 - 2011

Country		Summary of specific recommendations on Infant and Young Child Feeding (IYCF)
1	Iceland	Very low rates of exclusive breastfeeding; promote exclusive and continued breastfeeding; raise awareness to the public; enforce and monitor the International Code. The problem of obesity among children: continued education on health and nutrition and the negative impacts of obesity
2	Italy	Improve exclusive breastfeeding for six months; awareness raising, campaigns, information and training of government officials, maternity unit staffs and parents; strengthen and regularly monitor regulations about the marketing of foods for children and breastmilk substitutes (BMS); take action against violations of these regulations. Problem of obesity; awareness raising programs on the importance of physical health and healthy eating practices; effective implementation of the National Prevention Plan 2010-2012.
3	Korea	Child rights and the business sector: lack of comprehensive framework regulating and mitigating the adverse Human Rights impacts of companies in the country and abroad.
4	Panama	Strengthen promotion of breastfeeding; enforce the International Code.
5	Seychelles	Strengthen efforts to promote exclusive and continued breastfeeding; provide materials and education and raise awareness of the public on the importance of breastfeeding an risks of artificial feeding; strictly enforce the International Code. Health care and health services: concerned about the increasing obesity among children; raise public awareness on the negative impacts of processed foods; establish regulations to restrict and monitor advertising of unhealthy foods.
6	Syria	Establish a breastfeeding committee; systematically collect data on breastfeeding; ensure the enforcement of the International Code; promote Baby-Friendly Hospital Initiative; include breastfeeding in nursery trainings. Increase number of hospitals providing specialized services for children; improve the quality of nutritional education and counselling services.

Breastfeeding: an important intervention for child survival in Cambodia

(Geneva 3 June 2011)
The Committee on the Rights of the Child (CRC) has reviewed the 2nd periodic report of Cambodia. 

The CRC members were much concerned about the high levels of child mortality and malnutrition which impacts 40% of children under five in Cambodia. 

The government delegation reported that the high mortality rate is related to malnutrition: 50 % of child mortality is due to diarrhea and respiratory infections. 

The government of Cambodia has implemented the Child Survival Strategy in order to tackle these problems through 12 interventions, which are mostly focused on breastfeeding.

The Ministry of Health has taken care of acute malnutrition by providing micronutrients to children in some provinces and has strengthened the care of children in hospitals. It has also taken other measures such as iodizing the salt. 

The delegation said that the high infant mortality rate was related to the health of the mother and for children that died within the first 30 days, it was primarily due to problems during the pregnancy, the mother’s nutrition or a difficult labour. 50% of child juiveries were done by trained birth attendants and 70 % of mothers came to the clinic for pre and post natal services. The government provided at least one midwife per health centre and would increase this to two midwives.

For a summary of all the discussions please read the Press Release from UNOG
For more information on the situation of infant and young child feeding in Cambodia, please refer to the IBFAN alternative report.

The government of Egypt commits to "sign" the International Code in the near future

(Geneva, 6/06/2011) 
Today the Committee on the Rights of the Child (CRC) reviewed the 3rd and 4th periodic report of Egypt. The report was submitted by the pre-revolution government.

Many Committee members asked questions based on the alternative report provided by IBFAN on the situation of infant and young child feeding. In particular, one Committee member (Ms. Mauras) when talking about the impact of private sector on child rights, raised the concern that many private companies have been found to market and promote breastmilk substitutes in hospitals and maternity clinics. This happens even though there is a law in Egypt, but which is not strictly implemented, said the Committee member.

The Committee’s rapporteur on Egypt, Ms. Lee, wanted to know why has the BFHI stopped since 1990s. 

The government responded to these questions when addressing issues of early child development and malnutrition. The head of the delegation. Ms. Lamiaa Mohsen, said that Egypt pays high attention to fundamental interventions such as breastfeeding, even though she is aware that there are problems concerning exclusive breastfeeding and continued breastfeeding. However, the government has started a programme with UNICEF to revitalize the BFHI and to recertify 200 hospitals in 7 governorates. Plans are there to expand to other 7 governorates. This programme will include training of health personnel. Also, she mentioned the creation of a website where people can access information. 

Another Committee member, Ms. Herzcog, raised concerns on the issue of maternity protection. Egypt provides only a limited maternity leave and only for women working in the public sector. She asked whether the government has any plans to provide better conditions for women that will give birth, taking into consideration the ILO Convention 183 and the WHO recommendation for exclusivebreastfeeding up to 6 months. What conditions are there for those mothers who have no right to maternity leave?

The head of the delegation said that a training on maternity protection had been planned for March, in collaboration with IBFAN, but did not take place due to the political revolution. She said this will hopefully take place in the upcoming 3 to 4 months. 

The CRC chairperson, Mr. Zermatten, posed again the question on maternity leave, asking information about the condition about women in the private sector. Also, he wanted to know if the country intends to adopt the International Code of Marketing of Breastmilk Substitutes, as many companies have been seen in hospitals. 

The head of the delegation reported that maternity leave is of 3 months or 13 weeks. There are plans to extend it to 6 months with a half pay. When mothers go back to work, they have the right to breastfeeding break for 1 hour. According to Ms. Mohsen, private companies also grant maternity leave of the same duration, as obliged by law. However, she recognized that repeated maternity leaves may discourage companies from hiring young women. 

When responding to questions on the International Code, the head of delegation stated that the government of Egypt and the Ministry of Health intends "to sign" the International Code in the near future. In July 2010 the governement of Egypt has issued the By-law 2075/2010 which gives effect to the International Code in Egypt. Therefore we understand the words of the delegation to mean commitment for strong enforcement of this law. This is great news for breastfeeding advocates, and a commitment that NGOs in Egypt should use to hold the government accountable.

Czech Republic: Delegation at the CRC unprepared on the International Code of Marketing of Breastmilk Substitues

(Geneva, 31 May 2011) 
The Czech Republic was reviewed by the Committee on the Rights of the Child (CRC) on the progress of the implementation of the Convention on the Rights of the Child. The most pressing issues revolved around Roma children.

The Committee members posed many questions on the issue of breastfeeding, making wide use of the alternative report provided by IBFAN.

When asked about breastfeeding policies in their country, the representatives of the Ministry of Health (MoH) stated that the government actively supports breastfeeding and exclusive breastfeeding up to 6 months. The government is in the process of preparing a new standard on infant nutrition which will cover both breastfeeding and artificial feeding, according to the government representative.

In addition, CRC members asked the delegation about the measures that the government has taken in order to protect breastfeeding through regulating the marketing of breastmilk substitutes. They said that they have received information that formula is being distributed in  hospitals and requested the government to state the measures taken in this regard.

Following this question, the members of the delegation representing the MoH seemed very confused. They said that they had no information, since this did not belong to the area of work of their Ministry.

CRC Member, Ms. Wijemanne, clarified that the Committee considered important not only the adoption of a national code for marketing of breastmilk substitutes, but also its systematic monitoring. Then she asked the delegation about the duration of maternity leave. Again the representatives of the MoH were confused and required the intervention of the representative of the Ministry of Labour and Social Affairs.

This showed that health issues in general, and breastfeeding in particular are considered in a fragmented and sectoral approach by the government of the Czech Republic. It also shows that the Ministry of Health is not working on the protection of breastfeeding  through the the regulation of marketing of breastmilk substitutes. Nor is it involved in the protection of breastfeeding through maternity protection.

For a summary of the whole discussion please refer to the Press Release from UNOG

The European Parliament stops false claims of baby food industry on infant formula benefits

To learn more on the background of the issue read Baby Milk Action website.

The follwoing is a press release from the Socialist group of the European Parliament:

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Euro MPs today criticised a health claim about follow-on formula milk. The European Parliament's all-party environment and public health committee backed critics who denounced the claim as "misleading" in a vote on a draft resolution by British Labour MEP Glenis Willmott.

Baby milk manufacturer Mead Johnson claims one of its ingredients, the fatty acid DHA, improves children's eyesight.

But the author of the draft parliamentary resolution on the issue, Ms Willmott, said: "DHA is naturally found in breast milk, and it helps the development of children's eyes. The synthesised DHA added to formula milk is different.

"The European Commission has authorised this health claim, but independent studies say there is no proven link between artificially added DHA and eyesight, and some studies have found possible negative effects of DHA supplementation.

"As the scientific evidence is still inconclusive, we cannot allow parents to be misled. Babies' health is too important to be left in the hands of a multinational company's marketing department.

"If an ingredient is genuinely found to be beneficial and risk free then it should be obligatory in all formula milk, and not be used as a marketing ploy by a specific brand."
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Also read this press release from the European Parliament "DHA in baby food: European Committee oposes health claim":

Plans to allow baby food makers to claim that adding the natural fatty acid DHA to baby food "contributes to the normal visual development of infants up to 12 months of age" were rejected by the Environment Committee in a close vote on Wednesday. MEPs believe more research is needed on the effects of DHA supplements. To stop the health claim being permitted, this vote needs to be confirmed by Parliament as a whole. A plenary vote is scheduled for April. 

"Formula for disaster" - a documentary on the Philippines (2007)

This documentary by UNICEF produced in 2007, shows the difficulties of infant feeding in poor areas of the Philippines. Even if it was produced a few years back, it is a powerful documentary which reveals the contradiction of a reality where poor parents spend a significant amount of their salary to buy infant formula for their infants thinking that they are doing what's best for their children. They come to believe so because of what they are told by health care professionals - which are sponsored and materially supported by industry - or by the television advertisement. What these parents ignore is the very high risk to which they are exposing their infants by feeding them artificial milk, in a context with no clean water or proper hygenic conditions.

The documentary can be viewed in the link below:

www.youtube.com:80/results?search_query=unicef+philippines+formula