PHNOM PENH: On January 31, 2023, The Ministry of Health, Council for Agricultural and Rural Development, Ministry of Labor and Vocational Training, in collaboration with Hepten Keller International, supported by the MUSEFO project of GIZ and Helen Keller Intl-ARCH, organized a consultative workshop on improving infants and young child feeding and maternity leave for working women in Cambodia at the Phnom Penh Hotel.
Globally, the scaling up of breastfeeding to a near-universal level could prevent 823,000 annual deaths in children younger than 5 years and 20,000 annual deaths from breast cancer. These preventable deaths, combined with cognitive losses and health system costs, lead to over US$340 billion in economic losses annually. The data calls for immediate scaling up of the financing and implementation of policies, programs, and interventions to meet the World Health Assembly’s breastfeeding target of increasing the rate of exclusive breastfeeding in the first 6 months up to at least 50% by 2025.
In Cambodia, almost 2,000 children’s lives could be saved each year if optimal breastfeeding was practiced and inadequate breastfeeding results in approximately half a million avoidable cases of childhood diarrhea and pneumonia each year. In addition, some 5,000 children become obese annually. The country stands to lose US$137.7 million annually due to inadequate breastfeeding (combined health system, mortality, and cognitive losses).
The Royal Government of Cambodia is committed to increasing the rate of exclusive breastfeeding practices to 85% by 2030. In the past, Cambodia was very successful in the promotion of breastfeeding practices, sadly the rate of exclusive breastfeeding for children aged 0-5 months has decreased significantly – from 74% in 2010 to 65% in 2014 and 51% in 2021-2022. The deterioration is particularly marked in urban areas, which experienced a drop from 64% to 34% between 2010 and 2014. This drop in exclusive and continued breastfeeding, especially in urban areas, has been partially attributed to increased use of breast-milk substitutes (BMS) and mothers returning to work following maternity leave.
Additionally, preliminary baseline results (conducted between February and March 2022 among 308 women employees with children younger than 12 months of age) from the GIZ-MUSEFO funded Workplace and Infant and Young Child Feeding (IYCF) Support Project, currently being implemented by Helen Keller Intl (Helen Keller), found that only 9% of infants were exclusively breastfed to six months among working mothers. Almost two-thirds (61%) of infants had received breast milk substitutes (BMS) on the day preceding the data collection. The average cessation of breastfeeding was 3 months, with half (51%) of mothers ceasing breastfeeding at or before 3 months postpartum. This was assumed to be because of the short duration of maternity leave. Of the mothers who stopped breastfeeding, almost half (49%) stated that they stopped breastfeeding due to returning to work.
The International Labor Organization (ILO) estimates that as many as 93% of workers in Cambodia are informal workers, of which estimated three-quarters (77%) of employed women are working in the informal sector. With more women entering the workforce each year and evidence showing the numerous barriers working mothers face to achieving optimal breastfeeding, there is a need for the government to strengthen maternity entitlement laws and policies to help protect, promote, and support breastfeeding.
According to the Cambodia Labour Law, Section 8, ‘Child Labor – Women Labor’, Section C. Women Work – Articles 182-183, women are entitled to a maternity leave of ninety days (12.9 weeks) at half of their wage, including their prerequisites, paid by the employer. However, the wage benefits as specified are granted only to women having a minimum of one year of uninterrupted service in the enterprise.
Cambodia’s labor law does not meet the minimum 14 weeks of maternity leave or minimum pay of two-thirds of the woman’s earnings prior to taking leave currently recommended in the ILO’s Maternity Protection Convention (No. 183). The limited duration of maternity leave also presents significant challenges for working women to meet the WHO/UNICEF recommendations for exclusive breastfeeding in the first 6 months of life.
Cambodia’s present maternity entitlements reforms have been limited compared to neighbouring countries. Many countries in the region have expanded or made selective amendments to their maternity leave entitlements. In Vietnam, the length of maternity leave has been increased from 16 to 26 weeks, in Laos PDR increased from 12 to 15 weeks, in the Philippines from 8½ to 15 weeks, and in Malaysia from 8½ weeks to 13 weeks. In Bangladesh, the combined maternity and postnatal leave are 6 months, and they have recently increased entitlements for female workers in the education and financial sectors, and in Myanmar, expanded provisions were given during the COVID-19 pandemic. Since extending maternity leave to 6 months in Vietnam, the rate of exclusive breastfeeding has increased from 22% to 45.4%.
But optimal breastfeeding alone is not enough and limited dietary adequacy during the complementary feeding period contributes to an increased prevalence of growth faltering, anaemia, and zinc deficiency among young children. The diet quality indicator, Minimum Diet Diversity (MDD) for children 6-24 months, has increased by only 3 percentage points since 2014, resulting in half (51%) of these children consuming 5 out of 8 food groups in the last 24 hours.
Less than one-third (30%) of Cambodian children aged 6–23 months received a minimum acceptable diet. The efforts to promote age-appropriate infant and young child’s diets and feeding practices are insufficient, particularly among socio-economically disadvantaged groups and hard-to-reach households. In addition, a recent study undertaken by the MOH and Helen Keller found that sugar-sweetened beverages and unhealthy food consumption were highly prevalent among young children. Furthermore, there are currently no Cambodian regulations/standards that specifically and comprehensively govern the composition, nutrient content and labelling (including appropriate nutrient content claims) of commercially produced complementary feed products for children 6-24 months.
Photo by: Helen Keller International-Cambodia
