The New Zealand College of Midwives
In response to the Ten Year Anniversary of the Right to Food Guidelines and the three themes provided as a vehicle for commentary, Theme 1: Right to Adequate Food - Past and Present; Theme 2: The Right to Food Guidelines; Theme 3: The Future, the New Zealand College of Midwives would like to submit the following as a contribution to this global consultation.
The New Zealand College of Midwives (The College) is the professional organisation of midwifery in New Zealand. The midwifery model of care focus is woman centred and as midwives work with women from early pregnancy and up to six weeks following the birth of their babies they are in a unique position to comment on food security and the right to food guidelines, specifically related to maternal and infant nutrition, health and well-being.
The College would like to reinforce the importance of protection against all aspects of discrimination for pregnant, birthing and breastfeeding women. To treat women differently or to create conditions that discriminate against them because of pregnancy, birth and breastfeeding is unacceptable. Pregnancy and childbirth are significant events in the lives of women, and their families and represent a time of great vulnerability. As midwives working in partnership with women, the College recognise the importance of gender equity and the work to protect women’s rights in pregnancy, childbirth and breastfeeding. Addressing issues of gender inequality and working towards improving the socioeconomic status of women are both key aspects in the work to improve health and access to breastfeeding and healthy, nutritious, culturally and socially acceptable food.
The College recognises that mother and baby health and well-being are innately linked and cannot be viewed in isolation from each other. The well-being of children is closely linked to the well-being of their mothers. Policies which support parents to be primary caregivers for their young children, such as flexible maternity protection, support for birthing women and breastfeeding, are recognized internationally as effective mechanisms to reduce the vulnerability of children but they are also linked to aspects of food security for infants and young children. Supporting women to breastfeed is a sound, evidence-based investment in infant and child health and food security. Practices that occur during pregnancy and around birth may have negative impacts on the initiation and establishment of breastfeeding and issues such as enabling women to have skin-to-skin contact with their infants immediately after birth and supporting an early start to breastfeeding are essential and need to be recognised in any policies or guidelines related to food security and nutrition. We note the absence of breastfeeding in many international and national documents concerned with poverty, nutrition and food security and recommend that this be given some urgent priority. One exception is a document published by the Pan American Health Organisation (2013).  This document emphasises how critical skin to skin care and early initiation of exclusive breastfeeding are. The four pillars of food security are availability, stability of supply, access and utilisation and these pillars are all upheld when mothers and infants are not separated, mothers are supported to breastfeed early and often, and where donor human milk is also available to be used when appropriate. The College recommends that adequate nutrition for pregnant and lactating women needs to be treated as a priority in all global food and nutrition security programmes.
The College recognises that food insecurity is an escalating problem in households with children.  Bidwell reports that there are links between lower rates of initiation and continuing breastfeeding in food-insecure households and that the relationship between food insecurity and poor health status is well documented. Bidwell also notes that “food insecurity is strongly linked to maternal depression which in turn has a flow on effect on mother-child interaction, attachment, neglect and abuse” (p. 5). This is also likely to have a negative impact on breastfeeding exclusivity and duration. Women make an enormous contribution in terms of their breastfeeding and child care endeavours and the Asian Development Bank highlighted how critical it is to recognise women’s unpaid work, including care work, as there is a “modest almost invisible reference to the immense contribution of care to the market economy” (p. 3).
As the World Health Organisation highlighted in 2013  more than two million children under five years of age die due to under-nutrition and many of these deaths are associated with inappropriate feeding practices. This highlights the ongoing issue of inappropriate marketing of formula and complementary foods for infants and young children. In a 2011 report the World Health Organisation  made a statement about the potential of breastfeeding to prevent about 800,000 deaths among children under five years of age, if all infants and young children between birth and twenty-three months were optimally breastfed. It was also noted in the same report that less than half of newly born infants are put to the breast within an hour of birth.
Further points related to the three themes; Theme 1: Right to Adequate Food - Past and Present; Theme 2: The Right to Food Guidelines; Theme 3: The Future.
Theme 1: Right to Adequate Food - Past and Present
Theme 2: The Right to Food Guidelines
Theme 3: The Future
The College would like to recommend the following:
Thank you for the opportunity to participate in the global on-line discussion and consultation.
 Pan American Health Organisation. (2013). Beyond Survival: Integrated delivery care practices for long-term maternal and infant nutrition, health and development. 2nd edition, Washington DC, PAHO.
 Rush, E. (2009). Food security for Pacific Peoples in New Zealand: A report for the Obesity Action Coalition. Obesity Action Coalition, Wellington, NZ.
 Bidwell, S. (2009) Food Security: A review and synthesis of themes from the literature. Canterbury District Health Board, Christchurch, NZ.
 World Health Organisation. (2013). First meeting of the WHO Scientific and Technical Advisory Group in inappropriate promotion of foods for infants and young children. Geneva, WHO.
 World Health Organisation. (2011). Country implementation of the International Code of Marketing Breast-Milk Substitutes: Status report 2011. Geneva, WHO.
 New Zealand College of Midwives. (2012). Infant Feeding in Natural Disasters. Consensus statement ratified at the 2012 NZCOM AGM. Access - http://www.midwife.org.nz/quality-practice/practice-guidance/nzcom-conse...
 Stevenson, S. (2013). Edible Impact: Food security Policy Literature Review. Whakatane, NZ, Toi Te Ora, Public Health Service, Bay of Plenty District Health Board, NZ.
 New Zealand Breastfeeding Authority website http://www.babyfriendly.org.nz/going-baby-friendly/breastfeeding-data/
 Royal New Zealand Plunket Society. (2010). Breastfeeding data: Analysis of 2004-2009 data. Access http://www.plunket.org.nz/assets/News--research/Plunket-Breastfeeding-Da...