“Midwives in Malta play a vital role in promoting healthy choices, including the importance of avoiding alcohol during pregnancy,” explains Maria Cutajar, Chief Midwifery Manager within the Nursing and Midwifery Services Directorate at the Ministry for Health and Active Ageing in Malta. “These conversations begin at preconception care and continue throughout antenatal and postnatal care.”
In the WHO European Region, alcohol use during pregnancy remains a serious public health concern because it can lead to a range of negative outcomes for both mother and baby. It increases the risk of miscarriage, stillbirth and lifelong physical, cognitive and behavioural problems in children, collectively known as fetal alcohol spectrum disorders (FASD).
Europe has the highest prevalence of alcohol use during pregnancy in the world and, consequently, the highest rates of FASD and fetal alcohol syndrome – the most severe form of the disorder.
Early identification and supportive conversations are critical tools in reducing harm for both mothers and their babies.
Specific societal challenges
Screening for alcohol consumption is a routine part of midwifery care in Malta. Midwives ask about alcohol use as part of a broader health assessment when booking visits and during postnatal check-ups. This gives them an opportunity to educate patients about the health risks of alcohol consumption. Short, structured conversations are also used to motivate patients to reduce or stop drinking and are proven to be effective, low-cost interventions that are easy to deliver.
“Alcohol consumption in Malta is deeply embedded in cultural traditions. It’s commonly associated with social events and hospitality,” Maria notes. “I would say it’s the elephant in the room – clearly there but often not talked about. This presents challenges when communicating the risks – particularly with vulnerable groups like pregnant women.”
Despite the lack of reported cases of FASD in Malta, Maria believes that drinking during pregnancy may be underacknowledged due to stigma or fear of judgment. However, she adds that public awareness around the issue is growing due to national strategies, health campaigns and the ongoing efforts of midwives and other health professionals.
Using motivational interviewing
“Best practices in screening and brief interventions begin with early, routine and tactful questioning,” says Maria. “We use open-ended, non-stigmatizing language and our tone is always empathetic. The goal is to create a safe space where women feel heard and supported, not criticized or judged.”
When someone shares that they have indeed been consuming alcohol during pregnancy, Maltese midwives employ brief interventions grounded in motivational interviewing – a technique that empowers women to explore their own motivations and confidence to change.
“Motivational interviewing encourages open, empathetic conversations that respect women’s autonomy,” explains Maria. “It helps them to identify their own reasons for change, which is far more effective than imposing judgment or directives.”
This non-confrontational approach is crucial. It builds trust and increases the chances that women will disclose behaviours they might otherwise hide. How these conversations are conducted is just as important as what is asked, which is why midwives in Malta receive education and training to support them throughout their career.
Creating healthier futures
In cases where additional support is needed, midwives in Malta refer women to multidisciplinary health-care services. This ensures that they receive holistic care tailored to their individual needs.
“Our role is to support by being consistent and non-judgmental. We aim to create an environment of trust, where women can make informed decisions that prioritize their health and their baby’s well-being.”
As International Day of the Midwife approaches, it’s a timely reminder of the wide-ranging impact midwives have – as public health advocates, educators and early interventionists.
By integrating screening and brief interventions into everyday practice with empathy and care, Malta’s midwives are not only improving pregnancy outcomes – they’re laying the groundwork for healthier futures.