A/HRC/39/25 addition, medical professionals did not know which drugs should be provided free of charge, and public awareness programmes had been ineffective owing to their lack of local engagement. Despite the adoption of a law in 2012 on measures to prevent neonatal and maternal deaths, its implementation had been limited owing to the lack of access of pregnant women and newborns to health care and services, public scepticism with regard to vaccines, low rates of birth registration, and challenges in the regulation of drug markets. 14. Helia Molina of the University of Santiago stated that, in the 1950s, awareness that the rate of infant mortality was problematically high began to grow, and national action was taken to reduce it. Even though per capita income in Chile was low, the targeted national efforts made had led to a massive reduction in the child mortality rate by 2014. Public expenditure on health was still among the lowest (3.4 per cent of GDP against an average of 6.5 per cent in countries that are members of the Organization for Economic Cooperation and Development), which showed that there was no direct correlation with expenditure. What was important was the focus on primary health-care issues and targeted, long-term policy planning implemented through comprehensive approaches. Success also relied upon strong political will and the development of human resources and capacity. 15. David Sanders from the University of Western Cape (South Africa) addressed the evidence, experience and regulatory challenges in ensuring access to essential child health interventions. In South Africa, rates of child mortality were, considering the country’s level of wealth and development, higher than they should be because of a lack of momentum, fragmentation, and inadequate resources. Immunization coverage for babies was also well below what it should be, given the country’s income level, owing to a shortage in vaccine stocks, the sheer distance to clinics and low degree of awareness among mothers. Interest in the role of community health workers had, however, been renewed, and community case management had been introduced to address pneumonia, a major cause of child mortality. All countries that had managed to attain the targets of Millennium Development Goal 4 on child mortality had community health workers; in South Africa, however, there was still only one community health worker for every 250 households. 16. Marcus Stahlhofer of WHO discussed addressing inappropriate marketing of breastmilk substitutes and other foods for infants and young children, including through human rights frameworks. Improved breastfeeding rates worldwide could save the lives of as many as 823,000 children under 5 years of age, result in economic gains of more than $300 billion annually due to increased productivity, and lead to a 6 per cent reduction in the risk of invasive breast cancer. Women, however, lacked support to initiate and sustain breastfeeding, and investments in this regard fell far short. Global annual sales of breastmilk substitutes totalled $44.8 billion, and were expected to rise to $70.6 billion by 2019. Even though the International Code of Marketing of Breast-milk Substitutes, adopted by WHO in 1981, was a major instrument in protecting mothers and babies from inappropriate marketing of breast-milk substitutes, its implementation at the national level remained low: only 35 States had comprehensive Code-related legislation, and only 32 States had a functional monitoring and enforcement system in place for implementation of laws. Manufacturers of breast-milk substitutes continued to interfere in both law-making and policy development, while lack of political will, data and coordination posed problems too. Moreover, legislation, monitoring and enforcement were inadequately resourced. Such action (and lack of action) constituted a violation of mothers’ and children’s rights. International human rights institutions should be part of the solution. 17. During the discussion, participants considered the importance of the availability, accessibility, acceptability and quality of health services. They noted that litigation could be a catalyst in this respect, but that its effectiveness could be reduced by corruption and clientelism. They discussed the reasons for the delays in the progress made in the fight against child mortality, which in some cases included the late booking of pregnancies, inadequate postnatal follow-up, lack of household visits from health workers and lack of data, including on deaths outside health facilities. Mental health issues and substance abuse, neglected in most countries, also exacerbated the situation of child mortality. Participants agreed that greater efforts were needed to support breastfeeding, including through civil action to strengthen a culture of breastfeeding. They proposed that violators of the WHO 6