International Baby Food Action Network
Red internacional de grupos pro alimentación infantil
Réseau international des groupes d’action pour l’alimentation infantile
1998 RECIPIENT OF THE RIGHT LIVELIHOOD AWARD
Submission to the OHCHR in view of the preparation of the
Technical guidance on the reduction and elimination
of preventable mortality and morbidity of children
under 5 years of age (HCR Resolution 24/11)
International Baby Food Action Network (IBFAN)
www.ibfan.org
February 2014
About the International Baby Food Action Network (IBFAN)
A world-wide network. IBFAN is a 35-year old coalition of more than 273 not-for-profit nongovernmental organizations in more than 168 developing and industrialised nations. The
network works for better child health and nutrition through the protection, promotion and
support of breastfeeding and the elimination of irresponsible marketing of breastmilk
substitutes.
Our commitment. IBFAN is committed to the Global Strategy on Infant and Young Child
Feeding (2002) – and thus to assisting governments in implementation of the International
Code of Marketing of Breastmilk Substitutes (International Code) and its relevant resolutions
of the World Health Assembly (WHA) to the fullest extent, and to ensuring that corporations
are held accountable for their International Code violations. In 1998, IBFAN received the
alternative Nobel Prize, called the Right Livelihood Award, “for its committed and effective
campaigning for the rights of mothers to choose to breastfeed their babies, in the full
knowledge of the health benefits of breastmilk, and free from commercial pressure and
misinformation with which companies promote breastmilk substitutes”.
A crucial underlying determinant to prevent child mortality and morbidity
Breastfeeding, the most effective intervention to save children lives. Breastfeeding is a
key element to combat mortality and morbidity of children under 5 years of age; it is the
single most effective intervention for saving lives.1 Optimal breastfeeding practices, including
exclusive breastfeeding for the 6 first months, have proven to reduce infant and child
mortality while sub-optimal breastfeeding practices significantly increase sanitary risks for the
child, including infections, diarrhoea and pneumonia, the three major killers of infants and
1
Bhutta et al., What works? Interventions for maternal and child undernutrition and survival, The Lancet, 2008,
371 (9610) : 417-440. http://www.who.int/nutrition/topics/Lancetseries_Undernutrition3.pdf.
children.2 Colostrum, the mother’s milk during the first post-partum days, provides protective
antibodies and indispensable nutrients, essentially acting as a first immunisation for
newborns, strengthening their immune system and reducing the chances of death in the
neonatal period. Breastmilk alone is the ideal nourishment for infants for the first six months
of life, providing them all of the nutrients they need, which means that no other liquid or food
is required. Furthermore, continued breastfeeding beyond six months, accompanied by
adequate complementary foods, ensures growing children a good nutritional status and
protects them against illnesses.3 In addition, breastmilk is a low-cost, high quality and locally
produced food and thus, ensures food security from the start of the life.4 Therefore, the World
Health Organisation (WHO) recommends exclusive breastfeeding until 6 months of age and
then, complementary breastfeeding until 2 years of age or further. Despite these
recommendations, approximately 1.4 million children under five die each year because they
haven’t been properly breastfed, 830 000 of which could have been prevented if the infant
had been breastfed within the first hour after birth.5
Early cessation of breastfeeding and the impact of infant formula on child health.
While the crucial role of breastfeeding in fighting child mortality and morbidity is widely
recognised, early cessation of breastfeeding in favour of industrial breastmilk substitutes as
well as needless supplementation and poorly timed introduction of complementary foods are
far too common. Currently, only 39% of the 134.6 million infants born worldwide are
exclusively breastfed in the first 6 months. This leaves almost 85 million of babies whose
right to health, adequate food and nutrition is compromised by early cessation of
breastfeeding. Moreover, only 58% of children are still breastfed at 2 years.6 These low
breastfeeding rates are due to several combined factors related to the lack of integrated
programmes at scale for the protection, promotion and support of optimal infant and young
child feeding, including lack of protection from unethical marketing of breastmilk substitutes,
bottles and teats, lack of promotion and support in the health care system and lack of support
for breastfeeding women in their workplace.7 As a result, numbers of babies are fed with
breastmilk substitutes, what denies the child the positive effects of breastfeeding highlighted
2 Arifeen
S. et al., Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants
in Dhaka slums. Pediatrics, 2001, 108(4): 67.
http://pediatrics.aappublications.org/content/108/4/e67.full?sid=832a7273-16cf-4a41-a87d-bda69505da92.;
Chantry C.J. et al., Full Breastfeeding Duration and Associated Decrease in Respiratory Tract Infection in US
Children. Pediatrics, 2006, 117( 2) : 425 -432. http://pediatrics.aappublications.org/content/117/2/425.full.;
Duijts L. et al., Prolonged and Exclusive Breastfeeding Reduces the Risk of Infectious Diseases in Infancy.
Pediatrics, 2010, 126 (1) : 18 -25. http://pediatrics.aappublications.org/content/126/1/e18.full.
UNICEF, Pneumonia and diarrhoea : How to tackle the deadliest diseases for world’s poorest children. June
2012. http://www.unicef.org/media/files/UNICEF_P_D_complete_0604.pdf.
3
Singh K. and Srivastava P, The effect of colostrums on infant mortality: urban rural differentials. Health and
Population, 1992, 15(3&4): 94-100. http://nihfw.org/Publications/material/J294.pdf.
4
IBFAN, Food and nutrition security from the start of the life, Submission to the E-Consultation on Hunger, Food
and Nutrition Security.
http://www.fao.org/fsnforum/post2015/sites/post2015/files/resources/post%202015_08%2001%202012_IBFAN%
20input%20(2).pdf.
Save the Children, Superfood for babies: How overcoming barriers to breastfeeding will save children’s lives,
2013. http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0df91d2eba74a%7D/SUPERFOOD%20FOR%20BABIES%20ASIA%20LOW%20RES%282%29.PDF.
5
6
Childinfo / UNICEF, Child nutrition – Statistics by area : Infant and young child feeding.
http://www.childinfo.org/breastfeeding_iycf.php. (accessed 7 February 2014)
7
UNICEF / IBFAN, Challenges to Breastfeeding and State Parties’ Obligations, Oral Presentation to the CRC
Committee, 21st January 2014, Geneva.
above and increases the risks of exposing the child to pathogenic organisms and
substances. The harmful pathogens that may contaminate the powdered formulas can cause
serious illnesses and even lead to death.8 Lastly, the presence of bisphenol A, a chemical
component of most plastic bottles and teats, may present danger for child health and
therefore, increase the risks associated with artificial feeding.9
IBFAN’s action to reduce under-five child mortality and morbidity by advocating for
breastfeeding with regard to human rights standards and principles
Breastfeeding and the baby food industry. The misconduct of baby food companies
continues to be a key cause for poor breastfeeding practices, as these companies reap
profits from promotion of their products which directly compete with breastfeeding. They too
often undermine breastfeeding by making unethical and unfounded claims about their
products and by marketing them in deceptive ways. These commercial malpractices have a
negative impact on the realisation of the right of children to health and to adequate food and
nutrition, and thus affect directly child mortality and morbidity rates. Indeed, studies have
shown that promotion of breastmilk substitutes has a negative influence on breastfeeding
rates.10 Besides, the increasing undue influence of companies, including baby food
companies, on policy-makers and key institutions constitutes a threat to the independence of
public health institutions. Therefore, it risks affecting their ability to work in the public interest
in a transparent and accountable way. For these reasons, IBFAN promotes the
accountability of the business sector by engaging in a critical debate about the role and the
human rights obligations of commercial actors. Therefore, we work towards the
implementation of the Maastricht Principles on Extraterritorial Obligations of States in the
area of Economic, Social and Cultural Rights11. In addition, IBFAN advocates for the
adoption of legal safeguards against the impact of conflicts of interest within the process of
policy-making at both international and national levels, for example within the framework of
the WHO reform.
8
FAO / WHO, Enterobacter sakazakii and other microorganisms in powdered infant formula, Meeting Report,
WHO Microbiological Risk Assessment Series, 2004, 6. http://www.fao.org/docrep/007/y5502e/y5502e00.htm.
IBFAN, Infant and Young Child Feeding and Chemical Residues, 2013. http://ibfan.org/ips/IBFAN-Statement-onInfant-and-Young-Child-Feeding-and-Chemical-Residues.pdf.
9
Braun J.M. and Hauser R., Bisphenol A and children's health. Current Opininion in Pediatrics, 2011, 23 (2): 233239. http://www.ncbi.nlm.nih.gov/pubmed/21293273.
Braun J.M. et al., Impact of Early-Life Bisphenol A Exposure on Behavior and Executive Function in Children.
Pediatrics, 2011, 24: 873-882. http://pediatrics.aappublications.org/content/126/1/e18.full.pdf+html.
Donna S. et al., Bisphenol A and Chronic Disease Risk Factors in US Children. Pediatrics, 2013, 19: e637-e645.
http://pediatrics.aappublications.org/content/early/2013/08/13/peds.2013-0106.full.pdf+html.
10
US Government Accountability Office, Some Strategies Used to Market Infant Formula May Discourage
Breastfeeding; State Contracts Should Better Protect against Misuse of WIC Name, February 2006.
http://www.gao.gov/new.items/d06282.pdf.
Foss K.A. and Southwell B.G., Infant feeding and the media: the relationship betweenParents' Magazine content
and breastfeeding, 1972–2000. International Breastfeeding Journal, 2006 (1): 10.
http://www.internationalbreastfeedingjournal.com/content/pdf/1746-4358-1-10.pdf.
11
Maastricht Principles on Extraterritorial Obligations of States in the area of Economic, Social and Cultural
Rights. http://www.etoconsortium.org/nc/en/library/maastricht-principles/?tx_drblob_pi1[downloadUid]=23.
The International Code of Marketing of Breast-milk Substitutes. IBFAN is committed to
the Global Strategy on Infant and Young Child Feeding, adopted by WHO in 2002.12 Hence,
we are assisting governments in implementation of the International Code of Marketing of
Breastmilk Substitutes and its subsequent WHA resolutions to the fullest extent, and
ensuring that corporations are held accountable for their International Code violations.
Companies have an obligation to comply with the International Code regardless of any
government action, yet monitoring by civil society shows that none of the large multinational
companies live up to this obligation. A crucial contribution of IBFAN is the preparation of
global monitoring reports that continuously show the extent to which the baby food industry
violates the International Code. The latest 2014 report details global marketing trends by
baby food manufacturers and exposes violations of the International Code and its
subsequent resolutions.13 IBFAN has also been assisting governments since 1981 with their
implementation of the International Code; much of the success to date can be attributed to
our efforts and those of UNICEF (and to some degree WHO). However, the level of progress
in International Code implementation cannot be regarded as satisfactory. The grossly
inadequate resources invested in breastfeeding and optimal infant and young child feeding,
particularly in the International Code implementation and monitoring, are one of the causes.
The Convention on the Rights of the Child. Since 1989, the Convention on the Rights of
the Child (CRC) has placed breastfeeding on the child rights agenda, particularly in regard to
its Article 24, which enshrines the right of the child to the enjoyment of the highest attainable
standard of health. The CRC Committee, in its General Comments 15 and 16, further
elaborated on government and non-state actors’ obligations to ensure that the International
Code is implemented and enforced, and that optimal breastfeeding practices of are
adequately protected, promoted and supported by States Parties. Moreover, the CRC
Committee recognises that implementation of the International Code by States Parties as a
concrete measure towards the realisation of parents’ right to objective information on the
advantages of breastfeeding and thus, to fulfilling the obligations of the Article 24 of the
Convention.14 It has also regularly recommended governments to adopt additional policies,
programmes and initiatives to protect, promote and support breastfeeding.15 Since 1998,
IBFAN collaborates with the CRC Committee and submits alternative reports on the state of
infant and young child feeding, including breastfeeding practices, in the reviewed countries.
In 2013 alone, a total of 17 countries were reviewed by the Committee on the Rights of the
Child (CRC Committee). IBFAN submitted alternative reports on the situation of IYCF for 13
of them: China, Kuwait, Lithuania, Luxembourg, Malta, Guinea, Niue, Armenia, Guinea
Bissau, Israel, Rwanda, Slovenia and Uzbekistan.16 In addition, IBFAN contributed to the
consultation processes on the right of the child to the enjoyment of the highest attainable
12
WHO, Global Strategy for Infant and Young Child Feeding, 2002.
http://whqlibdoc.who.int/publications/2003/9241562218.pdf?ua=1.
13
ICDC, Legal Update, January 2014. http://www.ibfan-icdc.org/files/Jan_2014.pdf.
14
UNICEF, Implementation Hanbook for the Convention on the Rights of the Child, 3rd edition, 2007 : 360.
http://www.unicef.org/publications/files/Implementation_Handbook_for_the_Convention_on_the_Rights_of_the_C
hild_Part_2_of_3.pdf.
15 In
2013, out of the 17 States Parties reviewed under the Convention, the CRC Committee made
recommendations on the implementation of the International Code to 9 countries and recommendations on the
protection, promotion and support of breastfeeding to 10 countries.
These reports can be found online on IBFAN’s website: http://ibfan.org/reports-on-the-un-committee-on-therights-of-the-child.
16
standard of health (Article 24),17 that lead to the adoption of CRC General Comment 15, and
on child rights and the business sector,18 that lead to the adoption of CRC General
Comment 16.
Women’s rights to reproductive health and maternity protection. Human rights for
women and children were largely developed separately within the human rights framework
and the complex inter-connectedness of mother and child in pregnancy, infancy and
breastfeeding has not yet been adequately addressed. Breastfeeding has not been properly
recognised by the international community as an essential part of human rights, including as
women's sexual and reproductive right, and it is constantly undervalued and threatened
because of misinformation and commercial pressures. Furthermore, the maternal practice is
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. Many countries, industrialised and
developing alike, lack adequate maternity protection in the workplace to protect
breastfeeding practices. Currently, there is no comprehensive framework or convention
tackling the rights, needs and capability of both mother and child during this critical period of
biological, emotional, social and legal interconnectedness. For this reason, in 2014, IBFAN
will advocate for women’s rights to reproductive health as well as maternity protection within
the framework of the Convention on the Elimination of Discrimination against Women
(CEDAW) by submitting regularly alternative reports to the CEDAW Committee and sharing
CRC Committee’s Concluding Observations to promote harmonisation of work of these two
treaty bodies.
Contribution to international consultation processes. IBFAN takes part in human rights
bodies’ topical discussion days, providing its expertise on issues such as the rights of
children of incarcerated parents,19 and attempts to raise the profile of safe food and adequate
nutrition for infants and young children, i.e. breastfeeding and optimal infant feeding
practices, in relevant international and national policies in the context of Post-2015
Millennium Development Goals agenda.20 In addition, IBFAN will take part in the upcoming
2nd International Conference on Nutrition.
17
IBFAN, Breastfeeding and the right of the child to the enjoyment of the highest attainable standard of health.
Contribution to the General Comment on the Child’s Right to Health.
http://www2.ohchr.org/english/bodies/crc/docs/CallSubmissions_Art24/InternationalBabyFoodActionNetwork.pdf.
18
IBFAN / FIAN, Submission to the General Comment on Child Rights and the Business Sector.
http://www2.ohchr.org/english/bodies/crc/docs/CallSubmissionBusinessSector/IBFAN_FIAN_JointSubmission.pdf.
19
IBFAN, Children of Incarcerated Parents: Considerations on Infant and Young Child Feeding, 2011.
http://ibfan.org/upload/files/children-inc_parents_IBFAN%20subsmission.pdf.
20
IBFAN, Food and nutrition security from the start of the life, Submission to the E-Consultation on Hunger, Food
and Nutrition Security.
http://www.fao.org/fsnforum/post2015/sites/post2015/files/resources/post%202015_08%2001%202012_IBFAN%
20input%20(2).pdf.