The Relation between Pregnant Women Characteristics and Their

Perceptions towards Early Breastfeed Initiation (EBI) in Mataram

City

Wahdana Kusuma Sari

, Ardyan Pradana Putra

and Melinda Restu Pertiwi

Magister of Forensic Science, Postgraduate School, Universitas Airlangga, Surabaya

Magister of Nursing Science, Faculty of Nursing, Universitas Airlangga, Surabaya

Keyword: Infant Mortality Rate, pregnant women, perception, Early Breastfeed Initiation (EBI).

Abstract: Infant Mortality Rate is one of the indicators to determine the level of public health. The government

launched the Early Breastfeeding Initiation (EBI) program to reduce infant mortality rate, yet, this program

is not optimally implemented. Citing from Health Profile of NTB in 2010, Mataram city ranked the lowest

in term of EBI program implementation with the percentage of 19.70%. This research aimed to determine

the relation between the characteristics of pregnant women including age, education, occupation, parity,

pregnancy age, birth history and their perceptions about EBI. The research design used analytical

descriptive with cross sectional approach. The sample of this research were 92 pregnant women in 4 public

health centers in Mataram city with accidental sampling technique. The research instrument was

questionnaire, and for statistical analysis, Phi & Chamer’s V test (α = 0.05) was performed. The results

showed that the relation between pregnant women characteristics and their perception about Early

Breastfeed Initiation (EBI) are age (ρ = 0.009), education (ρ = 0.019), parity (ρ = 0.005), occupation (ρ =

0.344), pregnancy age (ρ = 0.637) and birth history (ρ = 0.013). Thus, reproductive age, education, parity

and birth history affects the understanding and perception about EBI. Occupation and pregnancy age do not

affect their perception to EBI.

1 INTRODUCTION

The success of health improvement has a significant

role in improving human resources quality. This is in

line with the Law concerning Health Number 36

Year 2009 Article 3 “Health improvement is

purposed to improve awareness, willingness, and

survivability for every person to achieve the highest

public health degree, as an investment for socially

and economically productive human resources

development.” The Highest degree of public health

can be achieved through the development of health

for people living in the healthy environment justly

and equitably throughout Indonesia.

One indicator of high quality health is the

decrease of Infant Mortality Rate (IMR). According

to the Health Profile of NTB in 2015, Infant

Mortality Rate (IMR) is a number to indicate the rate

of death of 0-year-old age infant per 1000 live births

in a given year or the probability for the infants to

die before reaching the age of one year (expressed as

per one thousand births). Based on ASEAN's annual

statistics book, Brunei Darussalam, Malaysia,

Singapore, Vietnam and Thailand are rated low at

IMR with infant mortality under 20 per 1000 births,

while IMR of Indonesia is 32 per 1000 births. It is

ranked below the Philippines, whose IMR is 26 per

1000 births. Related to the Millennium Development

Goals (MDGs) 2015, Indonesia targets to reduce

infant mortality rate to 23 per 1000 births

(Prasetyawaty, 2012).

One of the government programs to decrease

IMR is Early Breastfeeding Initiation (EBI). Early

Breastfeeding Initiation (EBI) is a program to

promote breastfeeding immediately after the baby is

born. The baby should be put on its mother's chest,

and the baby itself with all its efforts to find the

nipple for immediate breastfeeding (Yuliarti, 2010 in

Wildfire, 2015). The benefit of EBI for the baby is

the quality and quantity of breast milk produced is in

accordance with the needs of the baby. Provide a

baby with passive immune health immediately to the

baby. Starting breastfeeding early will reduce 22%

of infant mortality 0-28 days. EBI enhances

Sari, W., Putra, A. and Putra, M.

The Relation between Pregnant Women Characteristics and Their Perceptions towards Early Breastfeed Initiation (EBI) in Mataram City.

DOI: 10.5220/0007545404790483

In Proceedings of the 2nd International Conference Postgraduate School (ICPS 2018), pages 479-483

ISBN: 978-989-758-348-3

479

exclusive breastfeeding and breastfeeding for up to

two years, thereby reducing overall child mortality

(Roesli, 2012).

Early breastfeeding initiation and exclusive

breastfeeding program in Mataram City, West Nusa

Tenggara has been implemented since 2010. This

program was initiated to response mothers’

unawareness to provide exclusive breastfeeding

around 2010. With the percentage of 19.70%,

Mataram city ranked the lowest percentage of all

provinces in West Nusa Tenggara concerning infants

which received EBI and exclusive breastfeeding.

(Health Profile of NTB, 2010).

Factors that affect the implementation of EBI is

the knowledge of pregnant women about EBI. It

leads to positive or negative perceptions about the

EBI. According Notoatmodjo (2008), knowledge is

a very important domain for the formation of

perceptions, attitudes, and behavior of a person (over

behavior). Someone who has a positive perception

of something would also behave or show a more

positive participation on the matter. Mothers with

negative attitudes toward EBI have a greater chance

of not giving EBI to their babies, bundled with

positive attitude toward EBI (Yuwansyah, 2017).

Perceptions, attitudes and behaviors based on

awareness and knowledge result in a long-last or

attached behavior of the individual. Based on the

exposure, the researchers were interested to examine

the relation between the characteristics of pregnant

women with the perception of EBI in Mataram city.

2 METHODOLOGY

This is a descriptive analysis research which used

cross section approach. The population in this study

were all pregnant women who checked their

pregnancy at 4 public health centers in Mataram

city, i.e. Ampenan Public Health Center,

Cakranegara Public Health Center, Karang Taliwang

Public Health Center and Tanjung Karang Public

Health Center. The sample in this study were 92

pregnant women who checked their pregnancy at 4

public health centers between December 16, 2013

and January 9, 2014. Sampling was conducted by

using accidental sampling technique. The

participants were pregnant women who routinely

checked their pregnancy at Ampenan Public Health

Center, Cakranegara Public Health Center, Karang

Taliwang Public Health Center and Tanjung Karang

Public Health Center.

The research instrument was a questionnaire

which was adopted from the previous research and

has passed the validity and reliability test to know

the perception of pregnant woman about EBI

(Puspitasari, 2011). Data collection was performed

by giving letter of agreement to the respondents and

explaining the purpose of the research. Furthermore,

the researcher handed the questionnaire to the

respondents and explained the questions and how to

answer. The data obtained were in the form of

pregnant women's characteristics and their

perception about EBI.

Data analysis was performed to know the

relation between the independent variables and

dependent variables. More than 2 variables with

nominal data scale by using Phi & Cramer's V

coefficient test with significance level of 0.05. Data

processing was computerized by using SPSS 15.0

for Windows Evaluation Version.

3 RESULT AND DISCUSSION

3.1 Result

Table 1: Frequency Distribution of Pregnant Women

Characteristics in 4 Public Health Center of Mataram City

Characteristics

Category

Perception of EBI

p Value

Cramer’s V

Value

Positive

Negative

Age

< 20 years

20-35 years

> 35 years

4.3

69.6

7.6

5.4

10.9

2.2

0.009

0.321

Education

Elementary School

Junior High School

Senior High School

Collage

9.8

19.6

40.2

12.0

5.4

8.7

4.3

0.019

0.329

Occupation

Civil servant

Private employees

Entrepreneur

Housewife

8.7

4.3

15.2

53.3

2.2

14.1

0.344

0.190

Parity

Primigravida

Primipara &

Multipara

27.2

54.3

13.0

5.4

0.005

0.295

Pregnancy Age

Trimester 1

Trimester 2

Trimester 3

15.2

27.2

39.1

4.3

7.6

6.5

0.637

0.099

Birth History

Never

Normal

Section Caesarea

27.2

51.1

3.3

13.0

4.3

1.1

0.013

0.308

Table 3 shows all the characteristics of pregnant

women, i.e. age, education, occupation, number of

children, gestational age and birth history have

greater positive perceptions than negative

perceptions towards EBI. Maternal age influenced

perceptions about EBI (p value = 0.009) and

contributed 32.1% based on Cramer's V test. The

biggest positive perception was respondents with

productive age (20-35 years) of 69.6%.

With the value of p = 0.019 and contribution of

32.9% from Crame's test score, education level

affects the respondents’ perceptions towards EBI.

Greater positive perceptions of the EBI program

indicate adequate levels of education, i.e. Senior

High School (40.2%) and college (12%).

Parity and birth history have also been associated

with perceptions of the EBI program (p = 0.005 and

p = 0.013) in which parity contributed 29.5% and the

birth history contributed 30.8%. While employment

and gestational age have no relation with perceptions

about the EBI program with a p value of 0.344 and

0.637. Contribution from both criteria is also quite

low, i.e. 19% and 9.9%.

3.2 Discussion

Age, education, parity and birth history affect the

respondents’ perceptions towards EBI. It is

important to convey information about early

breastfeeding initiation to pregnant women so that

they can process the information obtained and be

able to understand the benefits of EBI for the health

of their babies as well as having a positive

perception towards EBI. This has been explained by

The Relation between Pregnant Women Characteristics and Their Perceptions towards Early Breastfeed Initiation (EBI) in Mataram City

481

Hardy and Reyes in Sobur (2011), information

coming from sensory organs, and it needs to be first

organized and interpreted before being understood;

and this process is called perception. In addition,

along with the information given by health

personnel, it will be able to improve the knowledge

of the mother about initiation of early breastfeeding

that they are expected to initiate breastfeeding early.

According to Notoadmojo (2008) the factors that

influence knowledge are age. Age affects the

capability and mindset of a person. The older the

ability to process information and mindset are more

developed. Based on the above description, we

assume that pregnant women < 20 years old (high

risk age during pregnancy) have not been able to

capture and understand information about early

breastfeeding initiation because it is their first

pregnancy. This is the reason why age relates with

the perceptions about EBI.

A person's education level would greatly affect

the person's response to something that comes from

outside (Rusnita, 2008). Knowledge is closely

related to education. It is expected that someone

with higher education to be more knowledgeable.

Several studies have found that early breast-feeding

frequency is higher among educated people (Setegn,

et al., 2011). The 13 respondents with junior and

elementary school education level had negative

perceptions about the EBI. This is due to lack of

knowledge and ability in perceiving the information

obtained about early breastfeeding initiation. In

addition, there were some pregnant women who

claimed they have never received information about

EBI. In accordance with the opinion of Sunaryo

(2004), a person who has never obtained information

about an object, would have worse perception than

the individual who has obtained previous

information.

Parity also affects the perceptions of EBI.

Pregnant women with primiparous & multiparous

parity have a greater positive perception. This is due

to the experience of pregnant women with previous

deliveries. It is in line with Rakhmat’s (2007)

opinion that experience will affect one's perception,

Leathers in Sobur (2011) also proves that experience

would help a person improve perceptual ability.

Experience is not always obtained through formal

learning process, and experience increases through

sequence of events ever encountered. Mothers who

already have children can have a better perception of

early breastfeeding initiation than mothers who have

no children. This is related to the experience of

mothers who had given birth and breastfeeding the

baby before.

A significant positive perception was obtained

from respondents with a history of normal delivery,

in which Roesli (2012) stated that early

breastfeeding should be performed in all deliveries.

Especially in normal delivery and assisted by trained

health personnel. It is because in normal delivery, a

maternal mother does not have physical or

psychological problems so as not to deny the baby is

placed on her chest. The baby condition must be

healthy so as to be able to find the mother's nipple

actively and independently.

Meanwhile, initiation of early breastfeeding is

not given because to mothers with section caesarean

delivery considering that the baby will be handed to

the pediatrician for further treatment. Thus, the baby

will lose skin contact with its mother in a rather long

time until the examination conducted by the medical

personnel is complete. Once finished, the baby also

needs to wait the process of sewing surgical wound

completed. The cold operating room temperature

causes no early initiation of breastfeeding. To

anticipate, the baby is immediately blanketed and

taken to the nursery. This is supported by the results

of research Lebang. MT, 2009 in Priscilla, 2011 that

babies are born with drugs and postponed skin

contact with his mother.

The pregnancy age determines how often

pregnant women should visit a health center to

check up. According to the health department of

Indonesia, the examination of pregnancy is

conducted 4 times during 3 trimester of pregnancy

for normal pregnancy. Frequency of pregnancy

check-up can increase in trimester 2 and 3 trimester

to have early detection shall there are abnormalities

in the pregnancy. The increasing frequency of

pregnancy examination is expected that pregnant

women increasingly have positive perception to EBI

because more and more get information from health

officer. However, based on statistical calculations

performed in the study, gestational age does not

relate with the perception of pregnant women about

EBI.

Occupation is a factor that affects knowledge.

Assessed from the type of occupation which requires

extensive human interaction, it is found that they are

more knowledgeable compared to one whose

occupation does not require extensive human

interaction. The learning experience provides

professional knowledge and skills as well as the

decision making in accordance with scientific and

ethical reasoning (Sirajuddin, et al., 2013). Yet, the

calculation showed that the occupation of pregnant

women does not relate with the perception towards

EBI.

ICPS 2018 - 2nd International Conference Postgraduate School

482

4 CONCLUSION

Based on the results of this study it can be concluded

that there is a relation between several

characteristics of pregnant women to the perception

of EBI. Some of the characteristics associated are

the age, education, parity and birth history. There

were also two characteristics which have no relation

with the perception towards EBI which are

occupation and pregnancy age.

Each Public Health Center should provide more

extensive information about Early Breastfeeding

Initiation so that pregnant women are well-informed,

resulting in a positive perception towards EBI.

Counselling about EBI should also be given to

husbands and families of the pregnant women so

that in the implementation of EBI will tone support

from husband as well as the family. Thus, it is

expected that the implementation of EBI can

increase and well-implemented.

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