Environmental Factors on Infant Feeding Practices
in Lombok Island – Indonesia
C. S. P. Wekadigunawan
1
and Rahmah Moh Amin
2
1
Faculty of Health Sciences, Universitas Esa Unggul, Jakarta, Indonesia
2
Faculty of Medicine, Universiti Tuanku Zainal Abidin, Terengganu Malaysia, Malaysia
Keywords: Infant Feeding, Exclusive Breastfeeding, Indigenous People.
Abstract: Achieving the Sustainable Development Goals (SDGs) 2030 that related to health is very important to
improve the quality of life for all people, babies are included. The vision is ‘no one left behind’. Exclusive
breastfeeding is a smart investment for our baby. Thus, the World Health Organization recommends to all of
the health centers in the world to promote exclusive breastfeeding. However, the practice is not easy. In this
study, the researcher found out environmental factors on infant feeding practices. The factors are traditional
beliefs on infant feeding practices, family influence, and health care location. Methods: The sample of this
research were 700 mothers who have a baby age six months – twelve months. We used a questionnaire as a
tool to gather the data. The univariate and bivariate analysis was performed using the Chi-Square test.
Results: Factors traditional beliefs, family influence were associated with infant feeding practices with P-
Value < 0,05 and health care location was not associated with infant feeding practices with P-Value = 0.09.
1 INTRODUCTION
Infant feeding practices is vital for many health
workers to understand, either in the urban area or in
the rural area. Adequate nutrition during infancy is
very crucial for proper development and growth.
Many researchers have documented that the period
from birth to two years of age is identified as a
“critical window” for the promotion of optimal
growth, health, and development.
This is because the child is susceptible to growth
faltering, certain micronutrient deficiencies, and
acute infection during this period that could lead to
significant morbidity, mortality, and delayed mental
and motor development. Thus, the importance of
optimal feeding of infants and young children
becomes a priority to avoid long-term consequences
of malnutrition such as impaired mental
performance, low work capacity, and poor overall
health during adolescence and adulthood (Dewey,
2003).
Exclusive breastfeeding for the first six months
of an infant’s life is recommended worldwide. The
United Nations Children’s Fund (UNICEF, 2001)
recommended that exclusive breastfeeding should be
continued for six months. Therefore, World Health
Organization member states have been urged to
develop an appropriate social support system to
overcome and to adjust for factors associated with
breast milk substitutes.
Indonesia has the fifth number of stunted
children in the world, amounting to more than 7.6
million children (UNICEF, 2010). The number of
children who have been abandoned is 2.8 million,
and 3.8 million more are underweight. The United
Nations in December 2010 reported that Indonesia
faces a marked decrease in exclusive breastfeeding.
The United Nations has teamed up with government
and religious leaders to promote a practice that is
proven to protect newborns and infants from
diseases, illnesses, and impaired development.
Rates of exclusive breastfeeding in Indonesia
have fallen from 42% in 1997 to 40% in 2002, with
less than one-third of infants now being breastfed in
line with global standards in the first six months of
life. In 2007, exclusive breastfeeding rates fell to
32% (figure 1).
The introduction of early supplementation
feeding is the preferred practice in the rural
community, for example, in Lombok Island-
Indonesia. Lombok Island is in the eastern region of
Indonesia, adjacent to Bali Island as a world tourist
attraction. In Lombok, mothers practiced traditional
Wekadigunawan, C. and Amin, R.
Environmental Factors on Infant Feeding Practices in Lombok Island – Indonesia.
DOI: 10.5220/0009581101790183
In Proceedings of the 1st International Conference on Health (ICOH 2019), pages 179-183
ISBN: 978-989-758-454-1
Copyright
c
 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
179

infant feeding practices such as giving a day old
baby smooth banana and even giving her Nasi Papak
(a masticated rice that was chewed by her mother
first and then given to the baby on the day after).
These practices affected infant health seriously
because their gastrointestinal tract was not ready to
receive solid food.
Figure 1: Exclusive breastfeeding rates in Indonesia
(Indonesia Demographic & Health Survey 2008).
2 MATERIAL AND METHODS
2.1 Study Design
The research design was a community-based Cross-
sectional Study.
2.2 Setting and Respondents
The study was conducted at five districts in East
Lombok to cover 700 respondents. Keruak district
62 mothers, Terara district 83, Selong district 266,
Pringgabaya 197 and Sambalia district 92 mothers.
The respondents were mothers who had an infant
age 6 – 12 months old with exclusion criteria,
mothers whom infants who had specific problems
(for example, cleft lips and palate).
2.3 Research Tool and Data Collection
To obtain the data, the study used a questionnaire
that systematically covers several domains were (1)
traditional beliefs of mothers on infant feeding
practices (2) ease of access to the location of health
services (3) family influence (4) Nasi Papak (rice
that has been chewed by the mother and then
wrapped in banana leaves to be kept overnight, and
given to baby the next day.
2.4 Data Analysis
For the quantitative method, the questionnaire sheets
were reviewed and coded after completion. The
researcher with a daily check of the quality of data
entry did the entry of the data to SPSS – Statistical
Package for Social Sciences and errors were
corrected immediately. The data had entered into
Microsoft Access Database and were analyzed using
SPSS 21 (SPPS Incorporation, Chicago, IL, USA).
Quantitative variables were normally distributed
after testing for normality measures of central
tendency, this histogram and Kolmogorov-Smirnov
test (p < 0.05).
Percentage, proportion, and contingency tables
were used for the description of the data.
3 RESULT AND DISCUSSION
3.1 Result
The descriptive reports show that respondents who
were up to 18 years old, only 3.3%, while 96.7%
were aged more than 18 years.
In the picture of the education level of
respondents, the researcher found that only 8.3% of
mothers who savor college or university level. While
mothers who reached secondary school level at
47,1%, the sad part was there were still 2.5% of
respondents who have never attended school at all.
In the description of the employment status of
the respondents, the researcher found that 72.1% of
mothers were no job. They mostly stay at home,
clean the house, cook, and take care of their
children. Some 27.9% of respondents had a work
status. Generally, they work in hotels or restaurants,
but there were also civil servants and private.
Some 73% of respondents had a family income
up to 289 Ringgit Malaysia (eight hundred and
ninety-five thousand rupiah). Only 27% of mothers
had a family income of more than 298 Ringgit (eight
hundred and ninety-five thousand rupiahs). Sasak
people were used to growing vegetables, yams,
cassavas, bananas, mangoes, and the like for their
daily meals. That is why the income of working out,
usually they used to buy other purposes than food.
For the religious, the Sasak people embraced Islam.
However, the traditional belief still exists hereditary
derived from animism, dynamism, and Hinduism a
thousand years ago. Lombok Island adjacent to Bali
Island is also known as the island of a thousand
pieces of the mosque.
ICOH 2019 - 1st International Conference on Health
180

Table 1: Socio-Demographic Characteristics of
Respondents (n = 700).
Characteristics of Respondents f %
Age Up to 18 years
More than 18 years
23
677
3.3
96.7
Religion Islam 700 100
Education Never attended
school
Up to primary
school
Up to 2ndary
school
Tertiary Education
17
295
330
58
2.5
42.1
47.1
8.3
Occupational
Status
Working
Not Working
195
505
27.9
72.1
Family
Income
Up to RM.298
More than RM.298
511
189
73.0
27.0
3.1.1 Traditional Beliefs Associated with
Good and Poor Infant Feeding
Practices
Among respondents who have a strong belief in
traditional beliefs, there were 42.9% of mothers who
did good infant feeding practices. Vice versa, the
respondents who have a weak belief in traditional
beliefs, there was 65.2% of mothers who did good
infant feeding practices, only some 34.8% who did
poor infant feeding practices. Through the cross-
tabulation test, the researcher found that P-value =
0.0001, which indicates there is a very strong
association between traditional beliefs and infant
feeding practices.
3.1.2 Family Influences Associated with
Good and Poor Infant Feeding
Practices
Among respondents who rated getting a strong
influence on the baby’s grandmother, found there
were 60.5% of mothers who did poor infant feeding
practices, while only 39.5% did good infant feeding
practices. In those who have a weak influence on the
baby’s grandmother, 58.0% did good infant feeding
practices, while the remaining 42.0% did poor infant
feeding practices. The analysis shows X
2
=24.02 (df
=1); p = 0.0001. This is the info that there is an
association truly significant, between family
influence with infant feeding.
Table 2: Association between Infant Feeding Practices and
environmental factors.
Factors Infant Feeding Practices X
2
p-
value
Good
Practices
Poor
Practices
n
(340)
% n
(360)
%
Traditional
Beliefs
Strong
Weak
224
116
42.9
65.2
298
62
57.1
34.8
26.32 0.001
Family
Influenced
Strong
Weak
141
199
39.5
58.0
216
144
60.5
42.0
24.02 0.001
Health
Care
Location
Difficult
Easy
75
265
49.3
48.4
77
283
50.7
51.6
0.05 0.001
3.1.3 Health Care Accessibility Associated
with Good and Poor Infant Feeding
Practices
In the group of respondents who have the perception
the health care location was easy to reach, there
were found to be 51.6% did poor infant feeding
practices, while the remaining 48.4% did good infant
feeding practices and vice versa. However, the test
result showed X
2
= 0.05 (df = 1); p = 0.85, this
means there is no association between the location
of health care with infant feeding practices
3.2 Discussion
3.2.1 Traditional Beliefs Associated with
Good and Poor Infant Feeding
Practices
In this study proved, significantly, those traditional
beliefs in society Lombok, most associated with
infant feeding practices. Mothers who have a strong
belief in local beliefs, it seems more likely to do
poor infant feeding practices, than in those who
believe in traditional beliefs.
That result consistent with a study in South
Easter Turkey that there was an association between
traditional cultures and beliefs with infant feeding
practices among mothers (Geckil et al., 2006).
Higgins (2000) stated that there was a correlation
between Puerto Rican cultural beliefs and their
infant feeding practices. Barbara Higgins conducted
her study in Western New York, United States. It
Environmental Factors on Infant Feeding Practices in Lombok Island – Indonesia
181

was because of the high incidence of anemia in the
Puerto Rican pediatric population in the United
States, as compared to the incidence in the general
pediatric low-income population, in The United
States, as compared to the incidence in the general
pediatric low-income population, including other
Hispanic (US Department of Health and Human
Service 1990).
3.2.2 Family Influences Associated with
Good and Poor Infant Feeding
Practices
In Indonesia especially outside big cities, a new
couple usually stays with their family. They live in
an extended family, which means in one house there
are grandmother, grandfather, sister, and brother. In
this study, we assessed the grandmother’s role in
their grandchild feeding. A newborn baby is a very
special gift for grandmothers. Therefore, the
grandmother usually takes the role without asking
permission or willingness from her daughter/
daughter in law.
Some research suggests that significant others
such as a woman’s partner and her mother and
mother in law are influential in decisions and
practices about infant feeding, but precisely how and
why this happens, need investigation (Aubel et al.,
2004; Grassley & Eschiti 2007).
This finding is consistent with findings in the
literature that the attitudes of the grandparents play
an important role in determining the initiation and
duration of breastfeeding practices (Wachs et al.
2005).
In some parts of Lombok Island, a paternal
grandmother is very influential. These women have
considerable influence over their sons’ marital
relationship. If a mother in law mother felt it
necessary, she could recommend divorce for her
sons. A mother in law could take a child away from
a mother if she felt the child was not being cared for
properly. Their powerful influence means that many
young mothers obey their mothers-in-law on child
feeding suggestion even if the midwife or doctor has
told them differently. It is revealed in the focus
group discussion, an informant said that if their
husband helped with childcare and feeding, their
mothers-in-law complained. That means, how
important is the role of grandmother, in various
decisions in the homes of their children. From a
public health perspective, it would be nice if they
were included in the promotional programs good
infant feeding practices.
3.2.3 Health Care Accessibility Associated
with Good and Poor Infant Feeding
Practices
Health care accessibility and its influence related to
infant feeding practices have been assessed in this
study. Access to a primary health care facility is
projected as a basic social right (United Nations,
2001). Indonesia Government tried committed with
that statement through provided the least midwife in
one village. Nevertheless, that is not enough,
because one village contains 3-5 Dusun (sub-
village). In addition, every sub-village has a wide
area. Fortunately, there are cadres (Kader) who have
the willingness to visit the household and give
simple health messages or suggestions.
For some women who were still choosing TBAs
as birth attendants in this study, sometimes even
though healthcare was accessible, they feel more
comfortable with TBAs than midwives do.
The distance separating patients and clients from
the nearest health facility has been remarked as an
important barrier to use, particularly in rural areas
(Government of Pakistan, 2000). The long-distance
has even been a disincentive to seek care especially
in the case of women who would need somebody to
accompany. As a result, the factors of distance have
strongly adhered to other factors such as the
availability of transport, the total cost of one round
trip and women’s restricted mobility.
Promotion of interest of breastfeeding infants, as
far as the researcher’s knowledge, also has not been
promoted in places where women work, such as in
government offices or private. The fact that the
mother in this research work is less able to do good
infant feeding practices, presumably of intervention
should be considered by decision-makers. Although
this study conducted only in East-Lombok, the
results are would useful for West Nusa Tenggara
Province Government.
This study shows that good infant feeding
practices influence the state of maternal employment
status, and the mother’s ability to face commands
the baby’s grandmother, refused to perform the
traditional beliefs that affect their health and their
infants and a good understanding of the pattern of
infant feeding.
4 CONCLUSIONS
Several conclusions emerge from this study. The
evidence presented indicates some factors that must
be considered to promote good infant feeding
ICOH 2019 - 1st International Conference on Health
182

practices among women in a rural area in Lombok
Island.
 More than half of the respondents in this study
did poor infant feeding practices, while 340
mothers (48.6%) did good infant feeding
practices.
 Working mothers are at risk of not able to
implement good infant feeding practices
compared with mothers who did not work
 The mothers who have low levels of education, it
seems, are easier to do good infant feeding
practices, compared with mothers who had a
high level of education.
 A mother who has good knowledge about infant
feeding practices, shows, better able to
implement good infant feeding practices,
compared to those who have poor knowledge
about infant feeding practices.
 Mothers with a weak belief in traditional beliefs
were predicted to have a high chance to do good
infant feeding practices than those who have a
strong belief that traditional things.
 The mothers who were less influenced by
grandmother showed higher chances to
implement good infant feeding practices,
compared to those who received a strong
influence of the grandmother.
 Women have many misconceptions about
breastfeeding and wearing. Therefore, they still
avoided colostrum and gave pre lacteal feedings
such as honey, sugar fluid or Zam-zam water.
 Giving rice Papak (masticated rice) is still
frequently practiced in the area of East Lombok.
The mother gave it even to an infant who aged
only a day old.
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