Congo Brazzaville: Low Breastfeeding and High Infant Mortality Rates

The Republic of Congo Brazzaville 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 government delegation was composed of 12 members and one of them was representing the Ministry of Health. The head of the delegation was the Minister of Social Affairs Humanitarian Action and Solidarity, Ms Emilienne Raoul, who directly responded to most of the questions from the Committee on the Rights of the Child (CRC Committee).

IBFAN presented an alternative report to inform the CRC Committee on Congo’s situation of infant and young child feeding.

General overview of breastfeeding in Congo Brazzaville

The alternative report shows that breastfeeding rates are still insufficient: for the period 2007-2010, only 19% of infants were exclusively breastfed during the first 6 months and only 21% of the children were still breastfed at the age of 2. Early initiation of breastfeeding is also worryingly low (39%) while at least one child out of three is fed with other food than human milk during the 3 first days of their life. These bad figures are the result of a lack of adequate information and inadequate traditional practices on infant and young child feeding. The alternative report highlights the crucial role of health workers for dissemination of correct information, and calls for adequate training of these professionals. Currently, none of the hospitals of the country meets the requirements of the Baby-friendly Hospital Initiative (BFHI).

Inadequate infant and young child feeding practices contribute to the very high child and maternal mortality rates in Congo, where 61 children out of 1000 born die before their first year of age. Stunting is another main concern: it increases considerably after the first 6 months to reach 21% at the age of 9-11 months with a peak of 37% at the age of 18-23 months, coinciding with the time breastfeeding is stopped and replaced with other foods.

No measures have been taken so far from the government to regulate the marketing of breastmilk substitutes. Although Congo has adopted the Global Strategy on Infant and Young Child Feeding Breastfeeding, the International Code of Marketing of Breastmilk Substitutes  has not been implemented through a national legislation. A national law has been drafted to this end in the 1990’s and since then it’s still waiting to be considered by the government.

Maternity protection at work is also a challenge for Congo, where maternity leave is as short as 15 weeks, 9 of which should be taken after birth. Moreover, a very small fraction of active women are employed in the formal sector, while a large majority of them are working in the informal sector and therefore does not benefit from the maternity leave legislation.

Discussion on infant and young child feeding

During the interactive dialogue between the CRC Committee and the Congolese delegation, the issue of breastfeeding was addressed in the context of health care. Committee members asked whether a programme to promote good nutrition and breastfeeding has been implemented. Details concerning the number of hospitals that meet the requirements of the BFHI criteria have been requested. Finally, the question of the monitoring of marketing of breastmilk substitutes has been asked.

On these points, the head of Congolese delegation asserted that more than 90% of Congolese mothers breastfeed since birth, but the rate decreases to 36% after 6 months. She pointed to a Knowledge, Attitudes and Practice (KAP) study that has been realised in order to identify the causes and determinants of the health situation observed in the population. Identification of these determinants is crucial to develop a strategy to improve the health practices, including breastfeeding.

Unfortunately, issues related to the implementation of the International Code, the need to improve the knowledge of health workers, to promote early and exclusive breastfeeding as well as appropriate complementary feeding, maternity protection for women employed in all sectors were not addressed by the government delegation.

Other issues debated at the session included a wide range of topics: child adoption and alternative care, juvenile justice and incarcerated children, respect of the child’s rights by transnational companies, birth registration, violence and sexual abuses against children, female genital mutilations, child labour, children in street situation, children refugees, education, child marriage, children with disabilities, etc…

The Committee welcomed the progress that have been made by Congo so far, while being well aware of Congo shortcomings in realizing children’s rights in the country; however it stressed that many improvements are still to be made in order to ensure that the rights of the child are fully respected, promoted and protected.

CRC Committee's Concluding Observations

In its Concluding Observations, the CRC Committee directly addressed the issue of breastfeeding (para 59; 67), as well as the relation between child rights and the business sector (para 27), data collection (para 19) and mother-to-child HIV/AIDS transmission (para 61).

The CRC 2013 General Comment N° 15 on the right of the child to the enjoyment of the highest attainable standard of health (art. 24) explicitly recognizes the importance of breastfeeding for the achievement of the right of the child to health. It urges States, in the effort of diminishing infant and child mortality, to devote particular attention to neonatal mortality and suggests, inter alia, to “pay particular attention to ensuring full protection and promotion of breastfeeding practices”. Moreover, “exclusive breastfeeding for infants up to 6 months should be protected and promoted and breastfeeding should continue together with appropriate complementary foods preferably until two years of age as feasible. States’ obligations in this area are defined in the “protect, promote and support framework”, adopted unanimously by the World Health Assembly in its 2002 Global Strategy for Infant and Young Child Feeding". Regarding Health and health services, the Committee urged Congo to pay "attention to its general comment No. 15 [...]. It recalls its recommendation to the State party to overcome the constraints preventing the implementation of existing strategies including, inter alia, by: (a) Ensuring the provision of primary health care services for all pregnant women and children, focusing on the development of accessible health care services with trained health care providers, interventions to reduce preventable and other diseases, particularly diarrhoeas, acute respiratory infections, and undernutrition. Health services should include access to sanitation and clean drinking water; (b) Strengthen and expand access to preventive health care, and therapeutic services for all pregnant women and children, particularly infants and children under five years old. These should include universal immunization services, oral rehydration therapy, treatment for acute respiratory infections, promotion of infant and young child feeding practices, particularly breast milk and infant food based on local foods, and prevention of malaria through use of impregnated bed nets. This must also include the effective implementation of the WHO/UNICEF International Code on the Marketing and Distribution of Artificial Infant Formula and a monitoring system to ensure the enforcement of regulations; (c) Increasing efforts to implement the strategies seeking to reduce maternal mortality throughout the country, including for trained care at home, in maternal and child health clinics, and emergency obstetric care; [...] (e) Continuing the dissemination of health information and promotion of health education, particularly on the use of latrines and hand washing to all segments of the society, and provide safe water to all segments of society; (f) Increasing the quality and coverage of training to staff at socio-health units and ensuring that these units are adequately staffed and have the essential facilities, including obstetric supplies and emergency medicines for children and pregnant women".

The CRC Committee, in its 2013 General Comment N° 16 on State obligations regarding the impact of the business sector on children’s rights, specifically calls on States “to implement and enforce internationally agreed standards concerning children’s rights, health and business including the [...] International Code of Marketing of Breast-milk Substitutes and relevant subsequent World Health Assembly resolutions”. In the section Children's right and the business sector, the Committee draws Congo's "attention to its general comment No. 16 [and] recommends that the State party establish and implement regulations to ensure that the business sector complies with international and national human rights, labour, environment and other standards, particularly with regard to children’s rights [...]. In particular, it recommends that the State party: (a) Establish a clear regulatory framework for the industries operating in the State party to ensure that their activities do not negatively affect human rights or endanger environmental and other standards, especially those relating to children’s and women’s rights; (b) Ensure effective implementation by companies, especially industrial companies, of international and national environmental 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; [...] (f) Be guided by the United Nations “Protect, Respect and Remedy” Framework, accepted unanimously in 2008 by the Human Rights Council, while implementing these recommendations."

The CRC Committee also urged Congo to improve its data collection system. The data should be disaggregated, among other criteria, by age, sex and socioeconomic background. These data could then be used to monitor breastfeeding rates in the country, providing thus an important tool to improve breastfeeding policies and practices.

In addition, Congo is requested to "adopt a holistic early childhood development (ECD) strategy and invest in the training of ECD teachers and provision of integrated formal and community-based programmes involving parents and covering healthcare, nutrition and breastfeeding, early stimulation and early learning for children from birth to the first year of school". Finally, the CRC Committee recommended to "ensure the implementation of effective HIV/AIDS preventive measures", including measures to prevent-mother-to-child transmission (like early diagnosis and immediate initiation of treatment).

News from IBFAN's Global Liaison Office

The Newsletter of IBFAN - GIFA (June-December 2013)

In this issue you will find:
§ Country review by the Committee on the Rights of the Child § Capacity building: breastfeeding as a right § Global Network for the Right to Food and Nutrition § Vienna +20 CSO Conference § Human rights and extraterritorial obligations § Update on WHO Reform § What do we know about safety of powdered formulas?	Publications: § Breastfeeding briefs #55 § Investing in babies News from Switzerland: § World Breastfeeding Week § Orientating Pharmacists on Breastfeeding § Miam La Vie – Geneva breastfeeding promotion project § Switzerland to adopt the ILO Maternity Protection Convention

For the full Newsletter please click here

General Comments on the right to health and on business and child rights

The CRC Committee issued two new General Comments in April 2013: General Comment No. 15 on ‘the right of the child to the enjoyment of the highest attainable standard of health (art. 24)’ and General Comment No. 16 on ‘State obligations regarding the impact of the business sector on children’s rights’. These are two very important documents which frame the importance of breastfeeding within the right of the child to health and to adequate food and nutrition as well as to survival, growth and development identifying both Sates’ obligations but also business sector’s responsibilities.

General Comment 15 urges States, in the effort of diminishing infant and child mortality, to devote particular attention to neonatal mortality and are suggested, inter alia, to “pay particular attention to ensuring full protection and promotion of breastfeeding practices”. Moreover, “Exclusive breastfeeding for infants up to 6 months should be protected and promoted and breastfeeding should continue together with appropriate complementary foods preferably until two years of age as feasible. States’ obligations in this area are defined in the “protect, promote and support framework”, adopted unanimously by the World Health Assembly” in the Global Strategy for Infant and Young Child Feeding.

In order to prevent negative impact of marketing on children’s right to health, survival and development, States are required adopt preventive measures including appropriate and effective regulation and monitoring of advertising and marketing industries. The General Comment 16 specifically calls on States “to implement and enforce internationally agreed standards concerning children’s rights, health and business including the [...] International Code of Marketing of Breast-milk Substitutes and relevant subsequent World Health Assembly resolutions”.

Read the full General Comments here.

Human rights recommendations on breastfeeding by the Committee on the Rights of the Child (64th session)

The 64^th session of the Committee on the Rights of the Child (CRC Committee) took place in Geneva from 16 September to 4 October 2013. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 7 countries: China, Kuwait, Lithuania, Luxembourg, Monaco Sao Tome and Principe and Tuvalu.

IBFAN submitted 4 alternative reports on the situation of infant and young child feeding for China, Kuwait, Lithuania and Luxembourg. The reports were written in collaboration with IBFAN groups in the countries.

We regret to see that in its concluding observations, the CRC Committee referred specifically to breastfeeding in only 2 out of the 7 countries (China and Tuvalu). In the case of Luxembourg, even if breastfeeding was largely mentioned in the discussion between the CRC Committee and the government delegation, Luxembourg did not receive any recommendation concerning breastfeeding.

Some of the recommendations on health care and on the business sector and its impact on child rights are of relevance for infant and young child feeding and are reported below.

The CRC Committee recommended China and Tuvalu to promote exclusive breastfeeding. It has also stressed the need to establish Baby-Friendly Hospitals (China) and to adopt the International Code of Marketing of Breastmilk Substitutes and resolutions (China, Tuvalu). It also urged Tuvalu to provide training to all health workers about breastfeeding.

The Committee particularly addressed the issue of children affected by contaminated formula in China and recommended the government to strengthen its legislative framework on food and health standard and ensure sanctions and remedies in cases of violation.

An Emphasis has been put on the importance of respecting the right of the child to the enjoyment of the highest standard of health (China, Lithuania, Monaco, Sao Tome and Principe). Countries have been reminded to pay attention to the 2013 General Comment 15 on the right of the child to health, which explicitly recognizes the importance of breastfeeding for the achievement of the right of the child to health. It urges States, in the effort of diminishing infant and child mortality, to devote particular attention to neonatal mortality and suggests, inter alia, to “pay particular attention to ensuring full protection and promotion of breastfeeding practices”. Moreover, “Exclusive breastfeeding for infants up to 6 months should be protected and promoted and breastfeeding should continue together with appropriate complementary foods preferably until two years of age as feasible. States’ obligations in this area are defined in the “protect, promote and support framework”, adopted unanimously by the World Health Assembly” in the Global Strategy for Infant and Young Child Feeding.

Some of the countries are recommended to provide quality training for the health care personnel (and to increase the budget for health programs in general. China is urged to improve health infrastructure as well as availability and accessibility to emergency obstetric and neonatal care, especially in rural and poor areas, in order to prevent child and maternal mortality. Sao Tome and Principe is recommended to undertake surveys in order to understand the causes of maternal mortality and to intensify its efforts to improve access to safe drinking water and sanitation. Lithuania is demanded to ensure maternal care for women who choose to deliver at home and finally, it recommended Monaco to ensure that all children, including non-nationals, enjoy the same access and quality to health services.

A great focus was placed on the need to regulate the impact of the business sector on children’s rights. The CRC Committee drew attention to the 2013 General Comment 16, which specifically calls on States “to implement and enforce internationally agreed standards concerning children’s rights, health and business including the [...] International Code of Marketing of Breast-milk Substitutes and relevant subsequent World Health Assembly resolutions”.

 Countries are recommended to ensure the implementation by companies of both international and national environment and health standards and ensure appropriate sanctions in cases of violations. Countries are also recommended to require companies to undertake assessments of the environmental health-related and human rights impact of their business activities The CRC Committee also focused on the need to prevent mother-to-child HIV/AIDS transmission by improving access to treatment, follow-up treatments and by ensuring early diagnosis, as well as early initiation of treatment.

Direct link to our website: http://ibfan.org/reports-on-the-un-committee-on-the-rights-of-the-child/118

Monaco at the Committee on the Rights of the Child

Monaco presented its consolidated 2^nd and 3^rd periodic report on the situation of the implementation of the Convention on the Rights of the Child in the country. The consolidated 4^th to 6^th periodic report is expected by January 2019.

IBFAN did not present any report.

Discussion on infant and young child feeding

The issue of breastfeeding has not been addressed by the CRC Committee during its dialogue with the government delegation. The delegation instead mentioned health care issues and claimed that the Government has established prevention and information programmes to ensure the healthy upbringing of children. Pregnant women receive a medical follow-up and enjoy a special regime at work.

Concluding Observations

In its Concluding Observations, the CRC Committee has made no specific recommendation on breastfeeding to the government delegation.

In par. 37 and 38 regarding health care and services, the Committee asked Monaco to pay attention to its General Comment no. 15 (2013), which insists on “the right of the child to the enjoyment of the highest attainable standard of health, and recommends that the State party undertake all necessary measures, including legislative measures, to ensure that all children, including non-nationals, enjoy the same access and quality of health services”.

Breastfeeding and child rights in Luxembourg

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

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

Discussion on infant and young child feeding

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

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

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

Concluding Observations

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

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

China to strengthen legislation on food safety and the International Code

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

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

Discussion on infant and young child feeding

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

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

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

Concluding Observations

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

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

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

The CRC Committee, in its General Comment 16 (2013), specifically calls on States “to implement and enforce internationally agreed standards concerning children’s rights, health and business including the [...] International Code of Marketing of Breast-milk Substitutes and relevant subsequent World Health Assembly resolutions”.

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

Lithuania's lack of support for breastfeeding programme implementation

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

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

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

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

Concluding Observations

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

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

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

Tuvalu and breastfeeding

Tuvalu presented its initial report on the situation of the implementation of the Convention on the Rights of the Child in the country. The 2^nd to 5^th periodic reports are expected by October 2017.

IBFAN did not present any report.

Discussion on infant and young child feeding

The Committee did not enlarge on the issue of breastfeeding. The delegation of Tuvalu simply mentioned the fact that breastfeeding was actively encouraged, especially among young mothers.

Concluding Observations

In its Concluding Observations, the CRC Committee made recommendations on promoting the implement of breastfeeding programmes.

Regarding breastfeeding, the CRC Committee recognized that Tuvalu has adopted national policy on breastfeeding and has designated Princess Margaret Hospital as a baby-friendly hospital. However, the Committee gave concern on the brief duration of breastfeeding. It therefore recommended Tuvalu to: “undertake specific measures to promote exclusive breastfeeding up to the age of 6 months, including by providing training to all health workers and introducing legal measures to control the marketing and promotion of artificial infant formula” (para 53-54).

Kuwait to regulate business activities in child rights

Kuwait presented its 2^nd periodic report on the situation of the implementation of the Convention on the Rights of the Child. The next consolidated 3^rd to 6^th periodic report is expected by November 2018. The Kuwaiti delegation was composed of 19 members headed by H.E. Dhara Abdul Razzak Razzooqi, Ambassador, Permanent Representative of the State of Kuwait in Geneva.

IBFAN presented an alternative report on the situation of infant and young child feeding in Kuwait. The report, prepared by IBFAN Kuwait, shows that there are very low exclusive breastfeeding rates. This is due to insufficient coverage and low quality of antenatal education about breastfeeding management, weak support for the baby-friendly hospital initiative (BFHI) as well as lack of timely follow-up and competent support for mothers after hospital discharge. Concerning maternity at work, the duration of maternity leave is shorter than the ILO recommendation of 18 weeks, and women working in the informal sector do not enjoy the same rights as those in the formal sector.

Discussion on health care

The delegation of Kuwait informed the CRC Committee that particular attention was being paid to the social and health aspects of the life of the child, which has led, among other things, to reduce mortality rate. The government allocated a considerable budget to health care.

The issue of breastfeeding and infant and young child feeding has not been directly addressed in the dialogue between the CRC Committee and the government delegation.

The Kuwaiti delegation also specified that specialized centres had been established for HIV and AIDS tests and other sexually transmitted diseases. To date, there is in Kuwait a very limited number of HIV-positive cases thank to the effective programme established by the Government.

Concluding Observations

Kuwait did not receive any direct recommendations on breastfeeding in the Concluding Observations of the CRC Committee.

However, the CRC Committee has addressed to Kuwait recommendations on the impact of the business sector on child rights.

The CRC Committee recalled Kuwait the content of the General Comment no. 16 (2013) on State obligations in regard to the importance of the impact of the business sector on child rights. It recommended to Kuwait to establish and implement regulations in order to ensure that the business sector respects the international and national human rights and complies with labour, environment and specifically with children’s rights.

The CRC Committee therefore recommended Kuwait to: “(a) Ensure effective implementation by companies, especially industrial companies, of international and national environment and health standards; set up effective monitoring of implementation of these standards and appropriate sanctioning and providing remedies when violations occur, as well as ensure that appropriate international certification is sought; (b) Require companies to undertake assessments, consultations, and full public disclosure of the environmental, health-related and child rights impacts of their business activities and their plans to address such impacts”.

The Committee also mentioned the importance of respecting the environment in order not to contaminate water. It urged Kuwait to: “(c) Take immediate measures to relocate all families and children subjected to pollution that endanger their life and health status; 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).

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).