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

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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.

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.