Breastfeeding rates have nearly doubled in 10 years but while this is encouraging, Malta still scores second lowest in Europe.

The rate, however, falls significantly in the first weeks when new mothers return home, Parent Craft Services coordinator Louise Bugeja said.

With about 60 per cent of mothers breastfeeding newborns on discharge from hospital, Malta is wedged between Ireland, which has the lowest breastfeeding rate of 39 per cent, and the UK with 69 per cent.

"A woman is most vulnerable after giving birth and there are too many disheartening factors - from familial pressures to a lack of support services in the community.

"Many mothers give up shortly after being discharged and, whenever we have reunion groups three to four months later, only a mere 25 per cent are still breastfeeding," Ms Bugeja said.

As World Breastfeeding Week is marked between August 1-7, health professionals are working hard to attain the goal of 90 per cent, established in Malta's Breastfeeding Policy in 2000.

Maria Ellul, the Health Promotion Department's principal scientific officer (nutrition), is keen on promoting breastfeeding since children who are not exclusively breastfed for six months are more likely to become overweight or obese.

"We have to look at the advantages of breastfeeding in the light of escalating childhood obesity. From a public health perspective it has undisputed nutritional value," she said.

Ms Ellul lamented the lack of baby-friendly public places that hampered a woman's decision to breastfeed.

She said mothers had a tendency to wean babies on formula milk earlier by adding food, such as biscuits, to the bottle for the baby to sleep soundly.

Breastfeeding is shrouded in too many myths and women have to be well equipped with the facts to empower them to stick by their decision.

"Nobody should be forced and whatever a woman decides should be respected. Our duty is to make sure they are well informed," she said.

The World Health Organisation recommends exclusive breastfeeding for the first six months, followed by continued breastfeeding, together with nutritious complementary foods for two years.

The benefits are multiple for both mother and baby. Breast milk provides everything the baby needs and reduces the child's risk of gastro-enteritis, respiratory, urinary tract and ear infections, eczema, childhood diabetes and obesity.

A mother who breastfeeds will have a lower risk of pre-menopausal breast and ovarian cancer, and also gain her figure much quicker - when a woman's body is making breast milk it burns about 500 calories a day, an incentive to get back in shape.

According to a 1999 study, artificially fed infants consume 30,000 more calories than breastfed infants by eight months of age - the equivalent of 120 Mars bars (four a week).

The US Centre for Disease Control and Prevention considers there are only two potential, cost-effective interventions that can be put in place immediately to deal with the childhood obesity epidemic: decreased television viewing and breastfeeding promotion.

Ms Ellul stressed the importance of allowing the baby to breastfeed soon after birth. She pointed out that in countries such as Norway and Sweden, where breastfeeding rates were over 90 per cent, the baby was handed to the mother 30 minutes after birth.

The need for post-natal classes was also highlighted, something Ms Bugeja really wishes to introduce, but lacks the human resources.

She also spoke of the need for pre-conceptual classes to discuss diet, health and fitness with the mother-to-be.

"We need to create a proper support system from the hospital to the home. The most common reason why women don't breastfeed is because they are convinced the baby is not getting enough food. The trick is patience and persistence."

Ten steps to successful breastfeeding

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.

2. Train health care staff in skills necessary to implement this policy.

3. Inform pregnant women about the benefits and management of breastfeeding.

4. Help mothers initiate breastfeeding within half an hour from birth.

5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.

6. Give newborn infants no food and drink other than breast milk, unless medically indicated.

7. Practise rooming-in - allow mothers and infants to remain together 24 hours a day.

8. Encourage breastfeeding on demand.

9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Source: World Health Organisation

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