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| The Video of Speech |
I would like however to welcome very much this invitation, particularly the work of the International Baby Food Action Network Asia that has been instrumental in organizing this event. And may we take as departure point the recent adoption in June of this year by the Vietnam National assembly of two very important legislative measures. On 18th of June the National Assembly in Vietnam approved the extension of paid maternity leave from 4 months as it was in the past to 6 months. A few days later on 24th of June, it voted to ban the advertising of Breast Milk Substitutes for infants from 6 to 24 months, aligning the country more closely with the 1981 International Code on Breastmilk Substitutes on the marketing of breast milk substitute and subsequent World Health Assembly resolutions. I think this episode, very important for Vietnam, illustrates number of facts that I would like to underline.
First of all, it is very important I think to realize that for Breastfeeding, exclusive breastfeeding for 6 months and continued breastfeeding until the second birthday of the child, it is very important that we move beyond promotional campaigns and education. Promotional Campaigns and education are extremely important, they are necessary and they are useful and indeed education about nutrition and the benefits of breastfeeding in schools, I believe should be supported. The media should be sending the right messages and it is worry that today we have a relatively low number of countries that are serious about the enforcing the International Code on the Marketing of Breast-milk Substitute. In fact, the count, the World Health Organization made in December 2011, shows that out of a total of 165 states about which we had information on how they were implementing this Code, about 103 states had some regulatory measure in place, 37 States relied only on the voluntary commitments of the infant formula manufacturers and 25 States had taken no action. Perhaps more telling and more worrying is that out of these 103 States that have adopted legislative instruments in order to implement the International Code on the Marketing of Breastmilk Substitute, in fact a bit less than 50% of them had actual provisions on enforcement and only 37 States did the World Health Organization consider that they were serious enforcement of these provisions. So, much more should be done on this front. We should ensure that the mothers are given the right message and that the efforts of government to promote breastfeeding are not nullified and made fruitless by the selling of infant formula by these manufactures and the International Code of 1981 is absolutely vital in this respect. But my point is, that though necessary & vital is not enough and we must also ensure that the employers facilitate breastfeeding, for example, By
having childcare facilities in the work place and that maternity leaves allow women not to have to choose between remaining in employment and providing adequate breastfeeding to the child. This I believe should also be true for public works programmes and we often forget that important part of social protection measures adopted in developing countries. Let me take as an example of this, since we are in Delhi, the Mahatma Gandhi National Rural Employment Guarantee Act since 2006 in India and now in the totality of the country guaranties a 100 days paid employment to poor rural families. Now the Mahatma Gandhi National Rural Employment Guarantee Act is an amiable programme, it’s been extremely effective, it now benefits 52 million households at least that was the figure for 2010 and it has quarters reserved for women to ensure that they participate in large numbers in the programme. The National Rural Employment Guarantee Act also has a provision according to which, I quote, “In the event that there are atleast 5 children under the age of 6 at the work site, one of female worker should be deputed to look after them and she should be paid the same wage as the other National Rural Employment Guarantee Act Workers.” So this public works programmes in which women and men are given employment on public projects in order to allow them to have minimum wage at least 100 days per year is one that in principle should facilitate the ability for women to join the programme while still continuing to breastfeed their very young children. However, it turns out from a survey of 2008 that about 70% of the women had no access to child care facilities on the work site in fact and that 65% of the women were not aware of the right that they had under the cited provisions of the Mahatma Gandhi National Rural Employment Guarantee Act. So, more needs to be done also in public works programmes to ensure that the women should not have to choose between having access to employment and breastfeeding her child. Required is really a cross sectoral effort involving health, education, social affairs, employment and industry departments in order to have all these department to work together in a co-ordinated fashion to promote adequate breastfeeding practices.
The second point I would like to make based on this development in Vietnam I began with is that breastfeeding obviously should be supported by strengthening women’s rights and women’s education. There was a very impressive study published in 2000 by Smith & Haddad showing that based on a cross country study, covering 25 years from 1970 to 1995 Smith & Haddad showed that 43% of the reduction of hunger in developing countries during those 25 years were attributable to improved women’s education and this is almost as much as the increase in food availability 26% and the improvements in health services 19% together. Infact if we add that 12% of the improvements to the reduction of hunger and malnutrition during this period are attributable to better life expectations for women, we write a conclusion that 55% of the gains against hunger, malnutrition during this period were attributable to women’s education or a longer life expectancy for women, this is quite remarkable. And the reason for this is well known it’s because we realize the importance of adequate care of the children during the first few years of life in order to have adequate nutritional and health outcomes. UNICEF in particular has proven has demonstrated that food intake alone would not ensure adequate health & nutritional outcomes if not combined with adequate care, if not combined with adequate access to water and sanitation services and health services, so all this together can ensure that young children develop well physically and mentally and that the mortality of the children under five is reduced. Better education for girls and women is absolutely vital to achieve this. Now better education for women and girls means of course more economic opportunities and more chances of employment outside the household and this of course poses questions. Some studies in Thailand, in Iran in the 1990s have attempted to show that in some cases more work for the women outside the home means reduced times for children care and thus reduced nutritional outcomes. In fact however, major study done in the Philippines in the last decade has shown that there was no such an inverse relationship between the quality of the care given to the child and the ability for the women to fetch employment outside the household. In fact, this study in the Philippines shows that women that are economically active outside the household that have access to incomes from their work outside the house hold and very often provide better care to the child than without these economic opportunities. The income effects are such that the child ultimately benefits & women that are more economically active and more economically independent can make better use of their time make the right choices, for example to visit health facilities and to have the child adequately taken care of.
My third remark is that we must, to promote breastfeeding better and more effectively, we must build on breastfeeding as a human right both for the women and for the infant. This imposes certain obligations on governments particularly to adapt the world of employment to the need to support breastfeeding as I have mentioned earlier and to seriously implement the International Code of Marketing of Breastmilk Substitutes. Only by emphasizing that breastfeeding is a human right can we oblige to a government to take effective action and can we justify imposing that the actions of government in this respect are monitored by independent bodies who can impose a high political cost on governments for not doing enough in this respect. The report I presented to the United Nations Human Rights Council, a little bit than a year ago on this issue tries to highlight this point and to ground adequate nutrition on human rights in order to show that it can be made more enforceable in this way.
With these remarks I would like to close and thank again the International Baby Food Action Network of Asia and the other organizers of this extremely important world conference on breastfeeding for their hospitality and wish you all the best in your very important work.
Thank you very much indeed.
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