title: Incorrect advice: the most significant negative determinant on breast feeding in Malta.
abstract: OBJECTIVE
  this study reviewed breast-feeding rates in Malta for the first six months of life and identified reasons why mothers discontinue breast feeding in this small island state.
  
  
  METHODS
  a random sample of 405 new mothers who chose to breast feed in the only major state hospital were contacted by phone one week postnatally and again each month up to six months, and presented with a questionnaire relating to their feeding experience.
  
  
  RESULTS
  breast-feeding attrition rates were high with just 152 (38%) of 403 analysable babies still breast feeding at six months. The reasons for stopping breast feeding were categorised by: maternal choice; medical reasons; lack of information; social reasons, incorrect advice and no reason provided. 200 (50%) of the total cohort stopped breast feeding following incorrect advice from health professionals. Just 14 (3.5%) and 17 (4.2%) mothers stopped as a result of their own choice or a medical problem, respectively. Of the total of 403, 77 (19%) mothers introduced supplementary bottle feeds in hospital; of these, 70 (91%) stopped breast feeding altogether soon afterwards. This compared with just 180 (55%) of 326 women who did not introduce bottle feeds in hospital yet subsequently discontinued breast feeding (p<0.001).
  
  
  CONCLUSIONS
  many health professionals in Malta are not sufficiently committed to supporting breast-feeding mothers, and artificial feeds are widely recommended without any scientific-based rationale. Incorrect advice on breast feeding is often given early prior to discharge from hospital. As a result, many Maltese mothers introduce supplementary artificial milk feeds in hospital, and this is significantly associated with subsequent cessation of breast feeding within six months of discharge.
  
  
  CONCLUSIONS
  the introduction of a clear hospital breast-feeding policy and appropriate education for all health professionals involved in maternity care is strongly recommended.
authors: Department of Paediatrics, St. Luke's & Mater Dei Hospitals, Malta. simon.attard-montalto@gov.mt
authors: Simon
authors: S
authors: Attard Montalto
authors: Helen
authors: H
authors: Borg
authors: Mary
authors: M
authors: Buttigieg-Said
authors: Edward J
authors: EJ
authors: Clemmer
mesh_terms: D001291:Attitude of Health Personnel; D001942:Breast Feeding / Q000453:epidemiology*; D002755:Choice Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000706:statistics & numerical data; D007231:Infant, Newborn; D008319:Malta / Q000453:epidemiology; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D012056:Reinforcement, Social