Relationship between Mother’s Knowledge and Attitude towards Formula

Milk Advertisement with Exclusive Breastfeeding

at Baitussalam Health Center, Aceh Besar

Husnah

Liza Salawati

Emi Pus

ita Sari

Department of Nutrition,

aculty of Medicine, Syiah Kuala University,

ceh, Indonesia

Public Health Department, Faculty of Medicine, Syiah Kuala University, Aceh, Indonesia

Faculty of Medicine, Syiah Kuala University, Aceh, Indonesia

Keywords: Exclusive Breastfeeding, Knowledge, Attitude, Infant Formula Advertising Promotion

Abstract: Exclusive breastfeeding given as soon as possible after the babies birth, without any schedule and no

complementary food of breastfeeding until 6 months but the number of exclusive breastfeeding in Indonesia

is still low (54,3%). The purpose of this study was to find out the correlation between knowledge mother’s

attitude and infant formula advertising promotion to giving exclusive breastfeeding in Baitussalam Aceh

Besar primary health care. The methods of study used was analytical observational with cross sectional

design and samples were taken by accidental sampling from 16 February to 17 March 2015, and the

respondents are 31 mothers. Data were collected through questionnaire with interview techniques. The

result of this study indicated that mothers who gave exclusive breastfeeding is 51,6% and non exclusive

breastfeeding is 48,4%. The good knowledge is 48,4% and bad knowledge is 51,6%. The positive attitude is

74,2% and negative attitude is 25,8%. Infant formula advertising promotion is 42,5% and there isn’t infant

formula advertising promotion 54,8%. From Chi-Square, there was correlation between the mother’s

knowledge (p=0,019), mother’s attitude (p=0,015), and infant formula advertising promotion (p=0,020) with

exclusive breastfeeding. The conclusions were there is correlation between knowledge, mother’s attitude

and infant formula advertising promotion to giving exclusive breastfeeding.

1 INTRODUCTION

Early breastfeeding has a positive impact on both the

mother and the baby. For babies, breastfeeding has an

important role to support the growth, health, and survival

of babies because breast milk is rich in nutrients and

antibodies. As for the mother, breastfeeding can reduce

morbidity and mortality due to breast feeding will

stimulate uterine contractions, so that reducing the

postpartum hemorrhage (postpartum) (Riskesdas,2018)

The low level of exclusive breastfeeding in Indonesia is

caused by two factors, namely internal factors including

the low knowledge and attitude of the mother. External

factors include a lack of support from the families,

communities, health workers and the government,

incessant promotion of formula milk in several media,

socio-cultural factors and the lack of availability of

maternal and child health care facilities (Prasetyono D

2016).

Data from the 2012 Center for Disease Control (CDC)

Survey, showed 14% of infants in the United States get

breast milk excretively for up to 6 months. Year 2013

exclusive breastfeeding until the age of 6 months reaches

16%. Exclusive breastfeeding until the age of 6 months on

2013 remain about 18% (Center for Disease Control

2014). The Basic Health Research (Riskesdas) in 2013,

In Indonesia the percentage of exclusive breastfeeding is

higher for infants 0-1 months (52,7%), ages 2-3 months

(46%), ages 4-5 years old (41,9%), and ages 6 months

(40,2%). Breastfeeding is less than an hour after

birth (44,5%). The highest is in West Nusa Tenggara

(52,9%) and the lowest in West Papua (21.7%). The

breastfeeding process 1-6 hours after the baby born is

(35,2%) but (13,7%) of the breastfeeding process

is carried out after 48 hours (Riset Kesehatan Dasar

2018)

(Center for Disease Control 2014).

The percentage of exclusive breastfeeding for infants

0-6 months in Indonesia in 2013 was (54,3%), a slight

increase compared to 2012 which was (48,6%). The

highest percentage of exclusive breastfeeding was in West

Nusa Tenggara at (79,74%), South Sumatra at (74,49%),

and East Nusa Tenggara at (74,37%).

The lowest percentage of exclusive breastfeeding is in

Maluku (25,21%), West Java (33,65%) and North

Sulawesi (34,67%). Data on the health profile of the

Province of Aceh in 2013 the coverage of exclusive

breastfeeding was only (48,76%) (Kementerian

Kesehatan Republik Indonesia 2014).

Based on the 2013

Statistics Agency (BPS), the average percentage of

children 2-4 months who were breastfeed and

supplemented with food was (15%) and the average

percentage of children 2-4 months who were breastfeed

Husnah, ., Salawati, L. and Sari, E.

Relationship between Mother’s Knowledge and Attitude towards Formula Milk Advertisement with Exclusive Breastfeeding at Baitussalam Health Center, Aceh Besar.

DOI: 10.5220/0008789401170120

In Proceedings of the 2nd Syiah Kuala International Conference on Medicine and Health Sciences (SKIC-MHS 2018), pages 117-120

ISBN: 978-989-758-438-1

117

without additional food was (4,86%) (Badan Pusat

Statistik 2013).

Knowledge has a relationship with the level of health.

The better the knowledge, the easier it is to accept the

concept of healthy living, including giving exclusive

breastfeeding to infants (Notoadmodjo S 2014).

Attitude

is a reaction or closed response from someone to a

particular object. Attitudes obtained through experience

will have a direct influence on behaviour (Notoadmodjo S

2014) (Hidayanti L2011).

Promotion is a process that has

inputs and outputs. The increasing use of formula milk as

a substitute for breast milk is due to the incessant

marketing of formula (Notoadmodjo S 2014) (Hidayanti

L2011).

2 METHODOLOGY

Time and Place of Research

This research was held at the Baitussalam Aceh Besar

Health Center in February 2015.

Research Samples

Samples is a non-probability sampling, namely the

mothers who brought babies to the Baitussalam Aceh

Besar Health Center in 2015 were 31 people who were in

accordance with the inclusion criteria.

Research Procedure

a. PreparationThe researcher asked permission from the

head of the health center to carry out the research

and prepare the necessary tools.

b. Research flowProviding questionnaires to the mothers

who bring babies to obtain research data, data in 2013

at Baitussalam Health Center, the percentage

of exclusive breastfeeding was only (45.31%).

Measurement of mother knowledge, mother’s attitude, and

the promotion of infant formula advertising. Collect

questionnaires by the interviewing and analyzing data

using the Chi-Square test.

3. RESULTS AND DISCUSSION

Table 1. Frequency Distribution of Breastfeeding,

Mother's Knowledge and Attitudes and Promotion of

Formula Milk Advertisements

Variable Frequency (n) Percentage (%)

Breastfeeding

- Exclusive

- Not Exclusive

51,6

48,4

Knowledge

- Good

- Bad

48,4

51,6

Attitude

- Positive

- Negative

74,2

25,8

Promotion

- There is

45,2

- There is not

17 54,8

Total 31 100

Based on table 1, it was found that infants who were given

exclusive breastfeeding had 16 infants (51.6%) and were

not given exclusive breastfeeding 15 infants (48.4%).

Mother's knowledge about breastfeeding is still lacking in

16 people (51,6 %), mothers that have a positive attitude

to giving exclusive breastfeeding to 23 infants (74,2%).

There was an advertisement promotion for formula milk

for 14 people (45,2%).

Table 2. Relationship between knowledge of mothers and

exclusive breastfeeding

Breastfeeding

Knowledge

Total

Exclusive

Not Exclusive

value

% n

Good

73,3

26,7 15

100

0.019

Bad

31,3

68.8 16 100

Table 3. Relationship between Attitudes of Mothers and

Exclusive Breastfeeding.

Breastfeeding

Monther’s

Attitude

Total

Exlusive No Exlusive Pval

n % n % n %

Positive 15 62.2 8 34.8 23 100

0.01

Negative 1 12.5 7 87.5 8 100

Table 4. Relationship between Promotion of Formula Milk

Ads and Exclusive Breastfeeding

Breastfeeding

Promotion of

Formula Milk

Total

Exlusive No Exlusive Pval

n % n % n %

There

4 28.6 10 71.4 14 100

0.02

There

is not

12 70.6 5 29.4 17 100

SKIC-MHS 2018 - The 2nd Syiah Kuala International Conference on Medicine and Health Sciences

118

4. CONCLUSION

The results showed exclusive breastfeeding was (51,6%),

not (48,4%). This study is in line with the study of

Ramadani (2009) at the Air Tawar Health Center in West

Sumatra that breastfeeding is still lower than the national

target (80%), (55.4%) were exclusive breastfeeding.

Sarbini's research results (2008) in Surakarta Exclusive

Breastfeeding coverage was (40%). This is caused by the

milk that has not come out so that the food or drink is

given before the milk comes out and the colostrum is

removed because it is considered dirty. High levels of

community education contribute indirectly to

breastfeeding coverage rates. Because someone with a

higher level of education usually has better knowledge

(Ramadani2010) ( Sarbini D 2008).

The study showed that exclusive breastfeeding with

good maternal knowledge was (73,3%) while in

respondents with less knowledge only (31,3%). Based on

the results of statistical tests obtained p value 0,019 < 0,05

means that there is a relationship between knowledge and

exclusive breastfeeding.

The results of this study are in line with the research of

Mariane (2013) in Manado City Health Center which

shows a relationship between the knowledge of mothers

with Exclusive Breastfeeding (Mariena 2013). Juliastuti

Research (2015) in Beijing Village, Trowulan District,

Mojokerto Regency that there is a relationship between

maternal knowledge and breastfeeding Exclusive

Knowledge of a mother can affect the mother in giving

exclusive breastfeeding. The better the mother's

knowledge about the benefits of breast milk, then a mother

will give exclusive breastfeeding to her child. Conversely,

the lower the mother's knowledge about the benefits of

exclusive breastfeeding, the less chance the mother gives

exclusive breastfeeding (Mariena 2013) (Rulina 2016).

Maternal knowledge is increasingly high due to the

increasing progress in developing science and technology

(Widiyanto S 2012).

The mother is not only informed by

health workers in Health Center directly, but with the

presence of media such as television, radio and magazines

it can be a source of information about the importance of

breastfeeding for children (Yuliarti N 2010).

Knowledge also has a relationship with the level of

health. The better the knowledge, the easier it is to accept

the concept of healthy living independently, creative and

continuous. A person's educational background is related

to the level of the knowledge, if the level of maternal

nutrition is good, the nutritional status of the mother and

her child is also good (Kementerian Kesehatan Republik

Indonesia 2014) (Devina E 2012).

According to the researchers assumptions, mothers'

knowledge about exclusive breastfeeding is still lacking.

Mothers do not know the benefits of breastfeeding and the

risk of providing other foods other than breast milk in

infants under the age of 6 months. Then there needs to be

counseling conducted by health workers to mothers about

the benefits of exclusive breastfeeding. Mothers with

knowledge lacking 2.5 times the risk of not giving

exclusive breastfeeding than mothers with good

knowledge (Mariena 2013) (Widiyanto S 2012).

The results showed exclusive breastfeeding with a

positive mother attitude of (65,2%) while the negative

maternal attitude was (12,5%) accoriding to Fisher's Exact

Results.

Test obtained p value 0.015 means that there is a

relationship between the attitude of the mother with

exclusive breastfeeding. Thus showing the more positive

attitude of the mother, the higher the percentage of

exclusive breastfeeding. The results of this study are in

line with the research of Mariane (2013) in Manado City

Shoulder Health Center which shows the relationship

between maternal attitudes and exclusive breastfeeding.

Widiyanto (2012) and Yuliarti (2010) research shows the

relationship between maternal attitudes and exclusive

breastfeeding.

This is because the influence of the environment will

affect someone to make the best decision.

Some respondents stated that the attitude of providing

additional food before the baby is 6 months old due to the

advice of the immediate family who took care of the baby

and some birth attendants also gave formula milk as soon

as the baby was born on the grounds that breast milk had

not produced much.

Another factor that encourages mothers to give breast

milk is the attitude of society towards health, tradition and

public trust in health. The value system adopted by the

community, culture, education level, socio-economic

level, availability of facilities and health facilities

(Ramadani2010) (Juliastuti 2015).

According to the researchers’ assumptions, the attitude

of mothers who provide other foods other than breast milk

in infants under 6 months is due to the influence of the

closest family. One of the most common examples at the

time of the study “Crying babies are considering hungry

and breast milk is insufficient so that the mother gives

water or bananas”. The support of the closest husband,

family and relatives greatly affects the attitude of the

mother in giving exclusive breastfeeding. Negative

attitude mothers have 2,5 times the risk of not giving

exclusive breastfeeding to mothers who have a positive

attitude.

The results showed that exclusive breastfeeding by

respondents with the promotion of formula milk

advertisement was (28,6%), respondents with no

promotion of (70,6%) formula milk advertising.

The Chi-Square test results obtained p value 0,02 <

0,05 means that there is a relationship between the

promotion of formula milk advertising with exclusive

breastfeeding. This result is in line with Devina’s (2012)

study at Seulimeum Health Center, where there was a

relationship between the advertising of formula milk and

exclusive breastfeeding. Researcher Saktila (2009) in

Tangkil Village, Sragen Subdistrict, there was a

relationship between promotion of formula milk and

exclusive breastfeeding (Devina E 2012) (Saktila 2009).

Many mothers give formula milk compared to

exclusive breastfeeding because mothers feel impatient

and provide food before 6 months old infants and

Relationship between Mother’s Knowledge and Attitude towards Formula Milk Advertisement with Exclusive Breastfeeding at Baitussalam

Health Center, Aceh Besar

119

increased promotion of formula milk. Promotion of

formula milk is very intense while promotion of Exclusive

Breastfeeding is very minimal. This causes mothers to

ignore the benefits of breast milk for the development of

their baby's life (Ramayah T. 2004) (WHO 2013).

Increasingly the promotion of formula milk and

complementary breastfeeding causes mothers to switch to

providing complementary breastfeeding food for infants

less than 6 months old on the grounds that breast milk is

not enough to fulfill infant nutrition (Saktila 2009) (WHO

2013).

Incessant promotion of formula milk among health

workers is also one of the factors that shape the attitude of

mothers in breastfeeding. In Malaysia, the baby food

market is said to be growing relatively fast. In 2000 the

overall growth rate of marketing for first and advanced

year formula milk was (2,5%) and (5,6%) (Ramayah T.

2004).

The WHO International Code of Marketing for Breast

Milk Substitutes Code recommends that there should be

no ads substitutes for mother's milk to the general public,

there should be no samples free or household appliances

for mothers, there must be no promotion of products to

health facilities and there should be no prizes for health

workers (WHO 2013).

According to the researcher’s assumptions the reason

mothers do not give breast milk to their children is

including busy work and fear of changes in body shape if

the breastfeed so that the mother does not give exclusive

breastfeeding to her child. Plus the incessant advertising of

formula milk and the crush of the family economy make

mothers to fulfill their daily needs. Mothers who received

milk ads promotion had a 2,4 times risk of not giving

exclusive breastfeeding than mothers who did not get

advertising promotion (Hidayanti L2011) (Riset

Kesehatan Dasar 2018).

5. SUGGESTION

There is a meaningful relationship between mothers

knowledge, mother’s attitude and promotion of

advertising formula milk with exclusive

breastfeeding at the Baitussalam Aceh Besar Health

Center

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