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Breastfeeding support in Lithuania
– Reported, June 14, 2013
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Unfit implementation of the Convention on the Rights of the Child. Article 24 of the Convention of the Rights of the Child establishes that a child has the right to access the best health care. On the basis of recommendations offered by the World Health Organization (hereinafter WHO) and the United Nations Childrens Fund (hereinafter UNICEF), all progressive world countries unanimously agree that breastfeeding is the most appropriate and the least expensive method for health strengthening among newborns, infants and small children as it has a positive long-lasting effect on health for the entire duration of human life. Item e) of the Part 2 of the Article 24 provides that the states parties to the Convention shall inform all groups of the public with a special focus on parents regarding benefits of nursing as well as undertake developing related education. Inpatient maternity institutions and primary health care facilities of Lithuania provide parents with small children with no appropriate information regarding breastfeeding; and consulting physicians do not encourage mothers to breastfeed due to subjective beliefs or a lack of required knowledge. As the provision of the aforementioned international piece of legislation is inappropriately implemented while no mechanisms exist for control of its implementation, a comparatively large number of mothers continue refraining from or choose especially short periods of breastfeeding. Consequently, the right of children to access the best health care, which is established in the Convention on the Rights of the Child are constantly violated.
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Wasting the Lithuanian health care funds. Progressive countries are economically interested in promotion of breastfeeding as date of clinical researches conducted around the world have proven that bottle-feeding of newborns and infants has a negative impact on physical and mental health of children while mothers refraining from breastfeeding are more susceptible to various chronic diseases. Thus, responsible state bodies that do not take action to encourage mothers to feed infants in a natural way, fail implementing public health strengthening actions based on disease prevention, which results in increased personal health care costs and sickness benefits, i.e. wasting of funds of the health system and the entire state.
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Defective system of qualifications for health care specialists. Part 1 of the Article 10 of the Law on the Medical Practice of the Republic of Lithuania as well as Part 3 of the Article 13 and Part 3 of the Article 14 of the Law on Nursing and Obstetric Practices of the Republic of Lithuania obligate medical doctors, general practice nurses and obstetricians to upgrade their professional qualifications as per procedure established by the Minister of Health. Currently, no substantial actions are taken to upgrade breastfeeding-related qualifications of paediatricians, neonatologists, family doctors and other medical professionals involved in health care of infants, children and mothers. Certain seminars on nutrition of infants and children for health care specialists are supported and organised by companies distributing breastmilk substitutes (formulas). Subsequently, inaccurate information is provided as well as arguments based on interpretations of subjective researches. Furthermore, free means to encourage bottle-feeding are distributed. This violates the International Code of Marketing of Breastmilk Substitutes and Item 2 of the Order No V-612 of the Minister of Health on Requirements of the International Code of Marketing of Breastmilk Substitutes in health care institutions of 27 August 2004 (hereinafter Requirements on the Marketing Code). In case of health care professionals working with infants and children, the Ministry of Health of the Republic of Lithuania should establish the procedure and content of the mandatory breastfeeding and lactation management training that corresponds to contemporary research literature, recommendations of the WHO and the European Communities as well as the Requirements of the Marketing Code.
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Violations of patient rights. Consultations of health care specialists provided to mothers on issues of breastfeeding and/or other types of feeding are to be regarded as personal health care services that aim to strengthen health of children and prevention of diseases. As per Part 1 of Article 3 of the Law on the Rights of Patients and Compensation of Damages to their Health of the Republic of Lithuania, a patient has the right to high-quality health care services; and Part 3 of the Article 5 of the Law establishes that the patient (in this case the representative of the patient, i.e. the mother) has the right to receive full information. The content of information provided to mothers regarding breastfeeding of children is established by Item 5 of the Requirements on the Marketing Code. However, neither medical doctors nor other health specialists observe this provision in practice. As health care institutions provide incorrect or partial information regarding breastfeeding and alternative infant feeding methods, patient (childrens) rights to access high quality services are violated and the rights of patient representatives (mothers) to receive information are breeched. Control mechanisms should be established to avoid such violations, such as monitoring of indicators on breastfeeding initiations and complications at maternity institutions, changes in numbers of breastfeeding mothers, distribution of exclusive breastfeeding and mixed feeding; identification of influencing factors; analysis and continuous development of improvement measures. Furthermore, it is essential to ensure implementation of the Item 10 of the Requirements of the Marketing Code establishing the prohibition for health care professional and their family members to accept any material reward from producers or distributors of milk substitutes.
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Failure to ensure health care accessibility. Health of newborns is entrusted to neonatologists and paediatricians, while health of infants to paediatricians and family doctors. However, in need of breastfeeding-related help, breastfeeding mothers are forced to address yet another specialist. Management of lactation is neither the field of neonatology, nor paediatric care or general practice. A breastfeeding woman cannot address a mammology specialist either as breastfeeding is not a breast diseases. In Lithuania, inpatient maternity institutions do not consult women post labour or discharged breastfeeding mothers. This indicates that accessibility of personal health care services for breastfeeding women is not sufficiently communicated and organised. Breastfeeding mothers have to be provided with a possibility to be referred to a breastfeeding and lactation management specialist. According to evidence-based recommendations, one qualified breastfeeding and lactation specialist should be available per one thousand of post-labour women. However, such speciality of medical practice and/or nursing is not provided for in legal documents. Subsequent to approval by the Minister of Health of curricula and respective medical norm that would be drafted and agreed with higher education institutions that would train such specialists and/or a respective professional association the list of types of professional qualifications of medical practice or the list of specialised fields of nursing could be supplemented with an a new area of medical practice or nursing . Therefore, higher education institutions that train health care specialists should design new breastfeeding and lactation management curricula that would ensure an integrated and specialised evidence-based training. Draft curricula and medical norms should be submitted for approval of the Ministry of Health.
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Patient discrimination on the grounds of the place of residence. According to Item 3 of Part 2 of the Article 1 of the Law on the Rights of Patients and Compensation of Damages to their Health of the Republic of Lithuania, discrimination is prohibited on any grounds. The majority of inpatient health care institutions having newborn-friendly status (hereinafter NFS) are located in Kaunas, which has three such health care institutions; , Pasvalys and Vilkavikis have only one each; meanwhile Klaipda and iauliai as well as other cities of Lithuanian have no such institutions. Consequently, in other health care institutions mothers and newborns are provided with lower quality services or receive no services that ensure successful breastfeeding. Limited by time and distance, a birth-giving mother cannot freely choose a health care institution. Mothers and newborns experience discrimination as they end up in a hospital without the NFS status.
CREDITS.
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