RE: 10 Year Anniversary of the Right to Food Guidelines

Carol Bartle New Zealand
09.05.2014

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). [1]  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. [2] 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.[3] 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 [4] 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 [5] 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

  • The College supports this document, and any future revised versions of this document, being situated within a framework of human rights with recognition of the importance of elimination of discrimination of any kind including discrimination related to race, colour, sex, gender, age, health status, and income. 
  • The special needs of women in relation to pregnancy, birth, breastfeeding and infant feeding support, and the postnatal period, need to be embedded within any documents related to health, well-being, nutrition, poverty, and food security.
  • In situations where there are humanitarian disasters, as a result of war, natural disaster or catastrophic events due to climate change, any operational guidance policies, or documents related to infant and young child feeding in emergencies, need to include the importance of supporting women to initiate and continue breastfeeding, protecting them and their families from misinformation and avoiding the distribution of donated supplies of breast-milk substitutes. The College has developed a consensus statement on infant feeding in natural disasters [6] and recommend that all organisations working with pregnant women, mothers, infants and young children consider developing similar statements. Feeding the mother so she is enabled to breastfeed her baby is to be recommended wherever possible.  

Theme 2: The Right to Food Guidelines

  • The College supports point 4.4 in that States should provide adequate protection to consumers against fraudulent marketing practices and misinformation. This includes ensuring the nutritional adequacy and safety of all foods marketed as being suitable for infants and young children and putting into place rigorous safety mechanisms. Regulation in regards to the International Code of Marketing Breast-Milk Substitutes and subsequent, relevant World Health Assembly resolutions needs to be strengthened in most if not all countries and this includes a commitment to education about the Code, monitoring, reporting and the provision of meaningful sanctions for industry violations of the Code.
  • The College supports point 7.4 in that States should strengthen domestic laws and policies to acknowledge the importance of recognising the contribution of women to poverty reduction and nutrition security. This includes maternity protection regulations and policies along with the protection, promotion and support of breastfeeding.
  • The College would also like to emphasise the importance of point 8.3 – the specific access problems of women and of vulnerable, marginalised and traditionally disadvantaged groups, including all persons affected by HIV/AIDS. The highest rates of illness and premature death are generally experienced by those who are worst off financially.[7] In New Zealand, Māori and Pacific households are disproportionally represented in the two lowest income quintiles. Māori and Pacific women are also reported to have the lowest breastfeeding rates in New Zealand. The importance of access to not only sufficient nutritious, culturally and socially acceptable food, but also to good, consistent, accessible, and timely support for breastfeeding women is critical. New Zealand has high initiation rates of exclusive breastfeeding but the New Zealand Breastfeeding Authority reports that continued breastfeeding rates in the community have shown little, or no improvement,[8] and for Māori and Pacific peoples rates have remained consistently lower. The Plunket Society data on infants around six months of age suggests exclusive breastfeeding rates of 9% for Maori and 12% for Pacific as opposed to 19% for ‘other’. [9]
  • The College suggests that point 10.6 is in need of strengthening, in that we consider States have an obligation to disseminate evidence based and up to date information on the feeding of infants and young children that is consistent and in line with current scientific knowledge and internationally accepted practices, and to take steps to counteract misinformation on infant feeding.

Theme 3: The Future

The College would like to recommend the following:

  1. That the calls for action from the 1990 and 2005 Innocenti Declarations should be recognised and revitalised and that urgent attention needs to be paid to these recommendations, for example:  
  • Establish or strengthen national infant and young child feeding and breastfeeding authorities, coordinating committees and oversight groups that are free from commercial influence and other conflicts of interest.
  • Revitalise the Baby Friendly Hospital Initiative (BFHI), maintaining the Global Criteria as theminimum requirement for all facilities, expanding the Initiative’s application to include maternity, neonatal and child health services and community based support for lactating women and caregivers of young children.
  • Implement all provisions of the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions in their entirety as a minimumrequirement and establish sustainable enforcement mechanisms to prevent and/or address non-compliance.
  • Adopt maternity protection legislation and other measures that facilitate six months of exclusive breastfeeding for women employed in all sectors, with urgent attention to the non-formal sector.
  • Identify and allocate sufficient resources to fully implement actions called for in the Global Strategy for Infant and Young Child Feeding.
  • Recognise that optimal breastfeeding and complementary feeding are essential to achieving the long-term physical, intellectual and emotional health of all populations and therefore the attainment of the Millennium Development Goals and other development initiatives and that inappropriate feeding practices and their consequences are major obstacles to poverty reduction and sustainable socioeconomic development.
  1. Issues related to the sustainability of global food systems and reduction of the negative effects of monocultures and dairy expansion on the global environment should be taken into account along with the goals of any rights to food and reduction of food insecurity initiatives.  Alongside the aim of provision of sufficient nutritious, culturally and socially acceptable food to support the health and well-being of all populations should be the urgent need to care for the planet, and protect its water supplies from pollution and exploitation. Breastfeeding represents the only sustainable means of providing nutrition and protecting and developing robust immune systems in infants and young children, and therefore the protection, promotion and support of breastfeeding women and the implementation of the International Code of Marketing Breast-milk Substitutes and subsequent, relevant, WHA resolutions are urgent priorities.

Thank you for the opportunity to participate in the global on-line discussion and consultation.

 

 

[1] 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.

[2] Rush, E. (2009). Food security for Pacific Peoples in New Zealand: A report for the Obesity Action Coalition. Obesity Action Coalition, Wellington, NZ.

[3] Bidwell, S. (2009) Food Security: A review and synthesis of themes from the literature. Canterbury District Health Board, Christchurch, NZ.

[4] 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.

[5] World Health Organisation. (2011). Country implementation of the International Code of Marketing Breast-Milk Substitutes: Status report 2011. Geneva, WHO.

[6] 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...

[7] 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.

[9] 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...

 

See the attachment: 
New Zealand College of Midwives