61st CRC COMMITTEE RECOMMENDS GOVERNMENTS TO MONITOR THE INTERNATIONAL CODE AND SANCTION ITS VIOLATIONS

The 61^st session of the Committee on the Rights of the Child (CRC Committee) took place from 17 September to 5 October 2012 in Geneva. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 7 countries: Albania, Andorra, Austria, Bosnia & Herzegovina, Canada, Liberia and Namibia.

IBFAN presented alternative reports on the situation of infant and young child feeding for 6 of the countries under review. In 4 cases these reports were written in collaboration with IBFAN groups in the countries and IBFAN Regional Offices (Austria, Bosnia & Herzegovina, Canada, Liberia and Namibia). The report on the situation of infant and young child feeding in Albania was written by the Geneva Infant Feeding Association (IBFAN-GIFA).

In its concluding observations, the CRC Committee referred specifically to breastfeeding in 6 out of the 7 countries. With the exception of Andorra, all the other countries received concluding observations on infant and child nutrition and breastfeeding in particular.  The 6 countries concerned were reminded by the Committee of the importance of promoting exclusive breastfeeding for the baby’s first 6 months of age.

The Committee recommended the strengthening of awareness-raising campaigns on the importance of breastfeeding, among the public generally and new mothers in particular (Albania, Austria and Namibia). Namibia was also recommended to train health professionals and to develop educational programmes for parents.

A particular emphasis was put on the importance of the enforcement of the International Code of Marketing of Breastmilk Substitutes and especially on its thorough monitoring and the sanctioning of violations (Austria, Bosnia & Herzegovina, Canada, Liberia and Namibia). The Committee considered important for Austria and Bosnia & Herzegovina to strengthen the Baby Friendly Hospital Initiative and recommended the governments to allocate more funds to it and increase the number of certified hospitals.

The fight against malnutrition has been stressed as a priority for some countries and nutrition education and nutrition programs have been proposed as useful strategies (Albania, Liberia and Namibia).

On health more generally, the CRC Committee has focused on the need to ensure equal access to health care services (Albania, Namibia) and to improve the quality of the maternal health care system, with a focus on primary health care, by allocating more resources, ameliorating the infrastructure and its availability and accessibility (Albania, Liberia, Namibia).

Other issues of concern refer to establishing a countrywide system for monitoring children’s health status (Austria), strengthening  vaccination and iron supplementation programmes (Bosnia & Herzegovina), addressing the incidence of obesity in children by inter alia ensuring greater regulatory controls over the production and advertisement of fast food and unhealthy foods (Canada), ensuring effective implementation by companies of international and national environmental and health standards, and monitoring, sanctioning and providing remedies when violations occur (Namibia).

Summary of concluding observations on IYCF: CRC Session 61 - 2012

Country		IBFAN report	Summary of specific recommendations on IYCF
1	Albania	Yes	Direct (Para 60-61): strengthen its efforts to address child malnutrition, focusing primarily on the most disadvantaged categories of children and on nutrition education and access to quality food; Strengthen its efforts to promote exclusive breastfeeding until 6 months of age by raising the awareness of health personnel and the public of the importance of exclusive breastfeeding; Indirect (Para 61): prioritize the allocation of financial and human resources to the health sector with a special emphasis on primary health care in order to ensure equal access to quality health services by all children, including children living in remote areas and Roma children; strengthen the link between maternal and child health services, including pediatric institutions and the collaboration of these services and the early childhood care institutions;
2	Andorra	No	No
3	Austria	Yes	Direct (Para 48-49): strengthen awareness-raising efforts on the importance of breastfeeding and promote exclusive breastfeeding of children up to the age of 6 months; strengthen the monitoring of existing marketing regulations relating to breast-milk substitutes and ensure that such regulations are monitored on a regular basis and action is taken against those who violate these regulations; increase the number of maternity hospitals that meet the required standards and are certified as baby-friendly under the Baby-Friendly Hospital Initiative (BFHI). Indirect (Para 47): establish a countrywide system for monitoring children’s health status.
4	Bosnia & Herzegovina	Yes	Direct (Para 54-55): reinstate its Breastfeeding Promotion Programme; provide funding for the Baby-Friendly Hospital Initiative; enforce the International Code of Marketing of Breastmilk Substitutes at a national level with effective monitoring mechanisms and commensurate sanctions for violations Indirect (Para 55): strengthen vaccination and iron supplementation programme
5	Canada	Yes	Direct (Para 62): establish a programme to promote and enable all mothers to successfully exclusively breastfeed for the first 6 months of the infant’s life and sustain breastfeeding for 2 years or more as recommended by the Global strategy for Infant and Young Child Feeding; enforce the International Code of Marketing of Breastmilk Substitutes, and undertake appropriate action to investigate and sanction violations. Indirect (Para 64): address the incidence of obesity in children, by inter alia ensuring greater regulatory controls over the production and advertisement of fast food and unhealthy foods, especially those targeted at children.
6	Liberia	Yes	Direct (Para 64-65): strengthen the promotion of breastfeeding and enforce the International Code of Marketing of Breast-milk Substitutes, as a means of combating the high prevalence of infant malnutrition; prioritise work on the causes of maternal and child mortality and morbidity, including underlying factors such as acute and chronic under-nutrition and nutritional deficiencies; develop nutrition programmes as a matter of urgency to reduce stunting and other forms of malnutrition; implement the Essential Nutrition Package in all health facilities; Indirect (Para 28, 62, 63): improve access to basic health care services for all children and pregnant women; devise and implement a strong primary health care system; strengthen health education and promote positive attitudes and healthy behaviours that may contribute to reduce the prevalence of maternal and child mortality; develop an accessible ante-natal care system provided by trained caregivers at home or in clinics, including care at delivery and for new-born babies; encourage pregnant women to seek antenatal care and deliver babies at hospitals; strengthen cooperation with civil society.
7	Namibia	Yes	Direct (Para 61-62): strengthen the promotion of exclusive breastfeeding up to the age of 6 months, by extending maternity leave without negatively affecting other labour rights; create a national monitoring system to monitor compliance with the IC; train health professionals, including professionals working in maternity units and communities on optimal breastfeeding practices and the importance of avoiding breastmilk substitutes, and ensure that they provide appropriate support to new mothers; initiate country-wide programmes to facilitate the early initiation of breastfeeding in all maternity centers; strengthen awareness-raising campaigns, particularly among new mothers. Strengthen efforts to address the high rates of malnutrition of children, and develop educational programmes, including campaigns to inform parents about basic child health and nutrition. Indirect (Para 27, 54): ensure effective implementation by companies of international and national environmental and health standards, and that the implementation is monitored, and appropriately sanctioned and remedies provided when violations occur, and that appropriate international certification is sought; undertake measures to ensure that all children enjoy the same access to and quality of health services; improve access to maternal care services by improving health infrastructure and increasing the availability and accessibility to Emergency Obstetric and Neonatal Care and skilled birth attendants.

Recent Publications from IBFAN

Few recent publications which may be of itnerest to you:

IBFAN-GIFA Newsletter 1- click here

International Code Documentation Center (ICDC) Legal Update July 2012 - click here

ICDC Press Release "USA interferes with national legislation" - click here

WHA Resolution Tackles Conflicts of Interest

The 65^th World Health Assembly (WHA) took place in Geneva in May and discussed an Implementation plan on infant and young child feeding. 

Proposed by Canada, UK, Swaziland and Mexico, the WHA adopted a new resolution WHA 65.6 on Maternal, infant and young child nutrition . 

It calls on governments to strengthen controls on the marketing of breastmilk substitutes and to establish “adequate mechanisms” to deal with conflicts of interest. 

The Resolution will be especially important in relation to the new partnerships and “multi-stakeholder” arrangements that are springing up to tackle poor nutrition - many of which are pushing fortified processed baby foods and fuelling the multi-billion “business of malnutrition”.

WHA 65.6 also mandates WHO "to provide clarification and guidance on the inappropriate promotion of foods for infants and young children".

More on this on IBFAN website

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.

JUNE 2012

 

IBFAN Calendar 2012

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.

The 60th Session of the CRC: 29 May - 15 June

The 60th Session of the CRC Committee has officially started on 29th May 2012. 

The calendar of the country reviews is the following:

• Cyprus : 30 May - 10am to 1pm and 3pm to 6pm
• Vietnam : 31 May - 10am to 1pm and 3pm to 6pm
• Turkey : 1 June - 10am to 1pm and 3pm to 6pm
• Australia : 4 June - 3pm to 6pm; 5 June - 10am to 1pm and 3pm to 6pm
• Greece : 6 June - 10am to 1pm and 3pm to 6pm; 7 June - 10am to 6pm
• Algeria: 8 June - 10am to 1pm and 3pm to 6pm

It is possible to watch the sessions through the a live webcast at the following link: http://www.treatybodywebcast.org/ ; please note that the times provided refer to the local Geneva timezone. Also, we will try to provide continuous updates from the discussions on this blog. 

IBFAN alternative reports have been provided to the CRC Committee for all the countries under review. .

You can find these reports on IBFAN's website: http://www.ibfan.org/fact-convention-reports.html 

On the 7th of June, IBFAN-GIFA will organize a briefing between the Special Rapporteur on the Right to Food and the CRC Committee: http://www.ibfan.org/news-2012-0302.html#rapporter20120302 

Become familiar with the work of a 32 year old network, which strives to protect, promote and support breastfeeding worldwide

 ----
IBFAN: International Baby Food Action Network

 

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.