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Mike Brady reflects on what it means to say breastfeeding is a human right.

Human rights apply universally and it is the responsibility of governments to deliver and protect these rights.

The right to breastfeed is an interpretation of existing rights, such as the right to adequate food in the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights, and the Convention on the Rights of the Child, amongst others. 

Professor George Kent of the University of Hawaii wrote in a paper on Human Rights and Infant Nutrition prepared for the World Alliance for Breastfeeding Action Global Forum in 2002:

"The principles are based on the concept that mothers should not be legally obligated to breastfeed, but rather they should be supported in making their own informed choices as to how to feed their infants."

Protecting the right to breastfeed does not force mothers to continue breastfeeding if they want to stop. We have the right to free speech, but that does not mean we are forced to give an opinion on every subject under the sun; if we want to speak, that right is protected.

In the UK, 90% of women who stop breastfeeding before six weeks do so before they wish to (Bolling et al, 2007 cited in UNICEF, 2012 - full Infant Feeding Survey details available at http://www.ic.nhs.uk/pubs/ifs2005). If the Government had protected the right to breastfeed, might the situation have been different?

To protect breastfeeding and empower mothers, we need to provide an environment that makes breastfeeding possible. Many societies present obstacles to breastfeeding, rather than remove them. Maternity leave for working women needs to be sufficient, at least for the recommended period of 6 months exclusive breastfeeding (so those who wish to do so, can do so), and working conditions must be conducive to continued breastfeeding into the second year of life and beyond. Convention 183 (2000) of the International Labour Organisation states:

"A woman shall be provided with the right to one or more daily breaks or a daily reduction of hours of work to breastfeed her child... These breaks or the reduction of daily hours of work shall be counted as working time and remunerated accordingly."

Not all countries have ratified the Convention. The UK has not yet done so.

Mothers also need protection from aggressive marketing of breastmilk substitutes. Ensuring parents have the required information and support on breastfeeding as called for by the Convention of the Rights of the Child entails implementing the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions of the World Health Assembly, which also aims to protect mothers who use breastmilk substitutes, who also have a right to accurate, independent information.

The Committee on the Rights of the Child now routinely looks at how governments have implemented the International Code and Resolutions when assessing their progress in complying with the Convention. The Committee commented in 2008 on the UK: "it is concerned that implementation of the International Code of Marketing of Breastmilk Substitutes continues to be inadequate and that aggressive promotion of breastmilk substitutes remains common".

To promote breastfeeding and inspire mothers and their families may require investment in social marketing.

In the UK, the coalition government scrapped the Infant Feeding Coordinator posts at the Department of Health, even though these posts are called for in the Global Strategy on Infant and Young Child Feeding. 

It is also short sighted if the intention is to save money. UNICEF UK issued a report this year on the unnecessary illness that could be prevented and costs saved if breastfeeding rates increased, if the mothers who stopped breastfeeding earlier than they wanted were able to continue for longer.

The theme of the World Breastfeeding Conference was "Mom-made, not man-made". Perhaps "Mum-made, not manufactured" works better in our culture and helps us to highlight that the European Union prioritises trade and growth over health.

So we see the Irish Government’s Enterprise Ireland and Danone announcing investment of Euro 50 million in a baby milk factory to boost the economy by exporting formula around the world. According to Enterprise Ireland "98% of the output from [the] Macroom [facility] will be exported and commercialized in more than 60 countries worldwide". This will inevitably displace breastfeeding in other countries as well as its own. To benefit its economy, the Irish Government could instead invest in mothers, the "real milk" producers, in a country where less than half (47%) of mothers are breastfeeding on discharge from maternity services (NPRS, 2008 cited by the Health Service Executive).

To support breastfeeding requires provision of health care services, a supportive environment and counselling services, particularly in countries where breastfeeding is not entrenched and visible. 

As Prof. George Kent comments with regard to the right to adequate food :

"There is increasing recognition at the international level that good nutritional status is an outcome that depends not only on good food but also on good health services and good care. Health services consist of a broad range of measures for the prevention and control of disease, including the maintenance of a healthy environment."

In the UK we have the National Health Service, free at the point of use, and an increasing number of hospitals are entering the UNICEF Baby Friendly Initiative, which aims to ensure support is provided to pregnant women and mothers in hospital and in the community. However, there are growing concerns about the way health workers are being targeted in the UK and other countries by baby milk companies, including through funding training and other events. (See page 17).

Mother support groups provide counselling services in the UK and the Department of Health does provide a grant towards the National Breastfeeding Helpline operated by a coalition of them. This is one example of the Government acting on its human rights obligations. However, a coherent approach is needed as the failure to adequately regulate the baby food industry means companies encourage pregnant women and mothers to contact company-branded telephone "carelines" for support on infant feeding and to sign up to their mother and baby clubs for information. There is an intrinsic conflict of interest in baby milk companies with products to sell making direct and indirect contact with pregnant women and mothers, and this is prohibited by the Code. The fact this is a marketing strategy was demonstrated in Nov 2012 when Baby Milk Action won a case against Pfizer/Wyeth before the Advertising Standards Authority (ASA) over its illegal advertising of infant formula when ostensibly providing breastfeeding support. (See page 18).

A human rights approach requires action on many fronts. It helps us to think coherently and logically about what is required to protect and deliver the rights in question.

Further reading

Breastfeeding: A Human Rights Issue? Development, Vol. 44, No. 2 (June 2001), pp. 93-98. http://www2.hawaii.edu/~kent/breastfeedingrights.pdf

Global Obligations for the Right to Food, edited by Professor George Kent, with a chapter on Holding Corporations Accountable by Mike Brady.

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