The draft National Breastfeeding Policy launched for public consultation three months ago has proven to be controversial. Caroline Muscat spoke to different stakeholders about the issue.

Women should continue breastfeeding till the age of six months, according to the Health Parliamentary Secretary, but only 38 per cent of Maltese women do so.

Inadequate knowledge, feeling embarrassed about doing it in public, negative perceptions and society’s attitude are among the factors that discouraged mothers from breastfeeding.

The consultation document – the proposed policy is meant to cover the period 2014 to 2020 – aims to build on the target set in the 2000 National Breastfeeding Policy of securing 90 per cent exclusive breastfeeding on discharge from hospital and 80 per cent at four months old.

The policy has been welcomed by many, but it was also described as “fascist” by some who believe it would relegate women back to just feeding their babies and abandoning their careers.

But Health Parliamentary Secretary Chris Fearne says the policy addresses major challenges faced by mothers coping with today’s pace of life.

Many women, especially those pursuing a career, believe they should not breastfeed because it gives them more independence.

But it is these obstacles that the policy aims to address.

“What we are saying is that statistics show that mothers who choose to breastfeed are giving up because there are obstacles, and we need to address that. We need to remove the obstacles that do not allow mothers to breastfeed for as long as they wish,” Dr Fearne tells The Sunday Times of Malta.

The major obstacles are faced by those women who choose to return to work because usually there are no facilities in the workplace.

“We are asking employers to provide a breastfeeding-friendly environment in the workplace, as far as possible,” he adds.

But Dr Fearne makes it clear that no such imposition would be made on employers.

“We are not thinking of legislation that will bind employers, but we would like employers to make it easier for mothers who want to breastfeed. We would be happy to discuss on a one-on-one basis with anyone who could make it easier for mothers to do so. We are willing to help them... we are here to help, not to impose,” he says.

This could help dispel fears that forcing workplaces to provide facilities for breastfeeding mothers would encourage further discrimination of women in the labour market as employers would avoid recruiting women of childbearing age to avoid the expense.

Still, such a breastfeeding policy that stresses ‘breast is best’ may create unnecessary psychological and social pressures on women who choose alternatives such as formula milk.

But Dr Fearne dispels such thoughts saying the intention of the government is to promote what is best.

“Every mother is free to choose whether to breastfeed or not. That is not something in which I, the health department and certainly not the government, will interfere. But what we are saying is that the health department should be in a position to offer support to mothers who choose to breastfeed their babies. That is the whole point of the policy,” says Dr Fearne.

He makes it clear that those mothers who choose not to breastfeed will be offered support in terms of health services. But he also makes it clear the government has a duty to inform the public on the best possible options.

Dr Fearne stresses there is undeniable scientific evidence that breastfeeding is the best nutrition and is best for both baby and mother.

In children, it decreases the risk of infection and allergies such as asthma, and decreases the risk of chronic disease.

It also decreases the risk of diabetes, obesity and cardiovascular disease.

What we are saying is statistics show mothers who choose to breastfeed are giving up because there are obstacles, and we need to address that

He also refers to the fact that there is evidence that breastfeeding is medically beneficial to the mother by decreasing the risk of breast and ovarian cancer and bone disease.

“There is no doubt that breastfeeding is beneficial for everyone so we need to provide the resources and environment that makes it easier for mothers to do so,” he says.

The World Health Organisation and UNICEF recommend breastfeeding up to at least six months.

The three pillars of the policy, according to Dr Fearne, are education, training and support, saying the government is not considering legislation at this point in time. The aims would be achieved through cooperation.

One of the main controversies that erupted in the consultation process on this policy is Dr Fearne’s statement that, if necessary, the government would consider deploying wardens to private clinics to stop the advertisements of formula milk.

He clarifies that this was not the government’s intention.

He also says the measure would not be needed since the pharmaceutical industry is cooperating with the government to give a consistent message.

The Parliamentary Secretary’s main aim is to dispel the idea that bottle-fed babies are somehow healthier.

“We believe there is the goodwill from the pharmaceutical industry that import breast milk substitutes – and this is reflected in initial discussions – that we need to give the message that ‘breast milk is best’ for the baby.

“The message cannot be that bottle-fed babies are healthier. We have discussed this with them and they agree that the message should be so,” he says.

This was confirmed by two major formula milk importers who spoke to The Sunday Times of Malta. They said the message is in line with their operations as they are obliged by their mother companies in Europe to follow WHO recommendations.

They also told the newspaper that such a move by the government would in fact help create a level playing field because small distributors not bound by such restrictions were handing out promotional packages to mothers in clinics against recommendations by health authorities.

But if the breastfeeding policy reaches its aim, Malta may still have an obesity problem – an issue touted as one of the main reasons behind the policy.

Questioned why the government chose this starting point rather than addressing other obvious problems leading to obesity, such as the overconsumption of soft drinks and fast food, Dr Fearne makes it clear the breastfeeding policy is only one small step in tackling the obesity problem.

“We started by tackling obesity from birth, and we will work our way up in the next couple of years,” he says.

A national food consumption survey will be carried out with the help of WHO to understand exactly what the Maltese are eating. Once those results are in, a campaign would follow to recommend healthier eating.

Policy initiatives

• Enforce a breastfeeding policy in maternity hospitals

• Control the marketing of breast milk substitutes

• Train health care professionals in the promotion and management of breastfeeding

• Monitoring and research

• Develop strategies for the promotion and support of breastfeeding:

- Antenatal
- Postnatal
- In the community
- Support groups
- At the workplace

Lorraine Spiteri

Chairwoman, Malta Confederation of Women’s Organisations

Is the policy a step forward or backward in terms of women’s rights?

“Personally, I am in favour of the policy, but it is a very sensitive issue with some women being very much in favour and others very much against.

“I went through the experience of breastfeeding. I have to say it was a sacrifice but nonetheless a unique experience. I don’t regret it. And I wish that other mothers would succeed in doing this.

“But at the end of the day, people have different lifestyles. A mother can find herself in a situation where for different reasons she decides that she won’t breastfeed and that does not mean she loves her child any less than the mother who decides to breastfeed.

“We have to also acknowledge that some mothers who want to breastfeed are forced to give up because of factors and structures that are not in place.

“It’s true that children raised on formula milk are fine, but it doesn’t mean that breastfeeding isn’t a better option. If the mother’s milk is the best option for the child, the government should do its best to promote the healthier option.

“We also have to keep in mind that a holistic approach to a healthy lifestyle is important. If breastfeeding is then followed by a diet of soft drinks, carbohydrates and fast food, and a lack of sports and exercise, then the problem remains.”

Joseph Farrugia

Director General, Malta Employers Association

Does the breastfeeding policy present new challenges to employers?

“We support a policy that promotes breastfeeding but places of work are what they are. That’s why we are looking into exactly what the recommendations are proposing. One has to look at the limitations that exist. These are things that cannot be ignored because reality is what it is.

“We need to look into the details and see in practice how these recommendations can be implemented.

“I wouldn’t like to give the message that we are against the concept of breastfeeding, or that we want to make it more difficult for women to work.

“But obviously, everyone will then be making their calculations and we need to be sure that we do not create laws that are not practical, that cannot be implemented, which then creates fear leading employers to refrain from employing women. We have to be careful that when we draft policy, even though this is not necessarily binding on employers, it reflects the reality of the workplace.”

Dr Anna Borg

Lecturer, Centre for Labour Studies, University of Malta

Would measures to enable breastfeeding at work increase discrimination against women in the labour market?

“The issue is extremely complex. There are no straight answers. It depends on the size of the organisation, the job, the locality, where the mother works and where she’s leaving the baby. It needs looking into in greater detail.

“You’re also putting more pressure on the employer, especially the smaller ones. It depends on the work and it merits a lot more thought than we have given it at the moment.

“But it does need solutions, and if discussed on a case-by-case basis. perhaps we can find solutions that work out for both employer and employee. This is for the common good after all. We’re talking about the future of our children.”