Charmaine Gauci, director, Health Promotion and Disease Prevention Directorate, believes breastfeeding provides the ideal nourishment for babies and a special bonding experience with the mother, besides long-term benefits for both.

The decision whether to breastfeed or formula- feed the baby is one of the first decisions expectant parents will make. The decision and the ability to carry this out depends on a series of complex and often interrelated factors, including the parents’ knowledge and previous experiences, various lifestyle factors and the influence of those around you and the environment.

The quality of feeding in childhood is a major determinant of the future health of the individual. Breastfeeding provides ideal nourishment and a special bonding experience that many nursing mothers cherish.

Research shows that exclusive breastfeeding provides immediate health benefits to the infant. It reduces the rate of respiratory tract infections, otitis media, diarrhoea, as well as deaths due to these diseases, especially during the first six months of life.

Although it is the best feeding choice for babies and mothers, some mothers may share some concerns

The World Health Organisation has published evidence on the long-term effects of breastfeeding. These include lower blood pressure, lower total cholesterol, higher performance in intelligence tests and a reduced incidence in obesity/overweight and type-2 diabetes mellitus were found in babies who were breastfed. The magnitude of these effects was compared to other public health interventions, and it was found that especially for cholesterol levels and obesity, breastfeeding was similar to, if not more effective than, dietary education and physical activity in later life.

The initiation of breastfeeding has some immediate and short-term effects on the mother by stimulating the release of oxytocin which reduces the chance of postpartum haemorrhage through various pathways, while also delaying the return of ovulation, reducing the risks associated with having another pregnancy shortly after a previous one.

In the longer term, breastfeeding has been shown to help protect the mother from premenopausal breast cancer and ovarian cancer, osteoporosis and coronary heart disease. In addition, mothers who breastfeed also show an earlier return to pre-pregnancy weight.

The optimal duration of exclusive breastfeeding is six months, while the WHO recommends that thereafter infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond if desired.

Breastfeeding is a choice that everyone should respect and protect. Although it is the best feeding choice for babies and mothers, some mothers may share some concerns. Mothers should not be obliged to breastfeed, as putting undue pressure on them to do so is as unacceptable as is putting them undue pressure to opt for formula feeding.

The most recent data we have for Malta on exclusive breastfeeding at discharge from hospital shows a rate of around 55 per cent. It is obvious that there is still much room for improvement.

To achieve optimal infant and young child feeding, there needs to be support for all mothers who decide to breastfeed in initiating breastfeeding, breastfeeding exclusively for the first six months and continuing breastfeeding with appropriate complementary foods until two years and beyond, or as long as the mother and baby wish.

National policy on breastfeeding

Malta adopted its first national policy on breastfeeding in 2000. This was based on Unicef’s Innocenti Declaration of 1990 which appealed to world governments to support, protect and promote breastfeeding.. In June 2014, an updated policy was issued for consultation with five priority areas for action.

• Enact legislation controlling the marketing of breast milk substitutes. All health, social and allied workers and institutions caring for mothers, infants and young children should fully comply with all the provisions of the International Code of Marketing of Breastmilk Substitutes issued by the World Health Organisation. To this effect, the Health Promotion and Disease Prevention Directorate outlined a legal notice which was issued for wide consultation in order to regulate the marketing of such substitutes so mothers can be protected from such marketing.

• Enforce a breastfeeding policy in maternity hospitals based on the principles of the Baby Friendly Hospital Initiative (BFHI). All hospitals, maternity units and primary healthcare facilities should adopt and implement effective strategies for the protection, promotion and support of breastfeeding.

•Train healthcare professionals in the promotion and management of breastfeeding. All health, social and allied workers caring for mothers, infants and young children should get the education, training and skill development required to implement this policy.

• Develop strategies for the promotion and support of breastfeeding in the community at various levels including antenatal, during birth, postnatal period, in the workplace and in the community. One particular initiative is to encourage breastfeeding-friendly policies and facilities in workplaces and public service/amenity areas. At present, local councils, shopping areas and workplaces are being encouraged to set up such facilities. Support and guidance is available from the directorate.

• Set targets, implement and monitor this policy. These are crucial to ensure that this policy is in fact implemented and that initiatives are evaluated.

This policy requires a coordinated multi-sectoral approach in order to change culture and achieve behaviour change. It will direct national efforts until the year 2020, and aims to substantially increase exclusive breastfeeding rates for the first six months of life and for a longer period according to the wishes of the mother and child.