The Relation between Several Factors That Influence the Inhibition

of Exclusive Breastfeeding in Glugur Darat Healthcare

Sarma Nursani Lumbanraja

, Roulina Ratih Suci Panggabean

Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Medical Student, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Nonexclusive Breastfeeding, Exclusive Breastfeeding

Abstract: Background. Exclusive breastfeeding is not to give baby food or other drinks, including water. Exclusive

breastfeeding will help inadequate growth in the first 6 months to get good nutritional status. The several

factors that influence the inhibition of breastfeeding are educational factors, occupational factors, knowledge

factors, maternal and child's health factors information factors, socio-cultural effect factors. Purpose. The

purpose of this study was to examine the relationship between several factors related to non-exclusive

breastfeeding Method. The research design used was analytic using cross-sectional.The population in this

study were all mothers who gave and did not give exclusive breastfeeding. The sample in the study was 166

mothers in consecutive sampling. The research instrument was a questionnaire. Data analysis with univariate,

bivariate, and multivariate analysis with logistic regression test.

1 INTRODUCTION

Exclusive breastfeeding according to the World

Health Organization (WHO) is not to give babies

food or other drinks, including water, other than

breastfeeding (except drugs and drops of vitamins or

minerals; milk is also permitted). Breast milk is the

best and most appropriate food for babies.

Breastfeeding the baby will prevent malnutrition

because the nutrients contained in breast milk meet

the needs of babies in an appropriate and efficient

way to protect the baby against infection, therefore

the immune substances contained in breast milk will

be very useful to protect the baby (IDAI, 2013 The

United Nation Children's Fund (UNICEF) and the

World Health Organization (WHO) recommend that

children should only be given breast milk (ASI) for at

least 6 months, this aims to reduce morbidity and

mortality in children (Indonesia Ministry of Health,

2018).

In Indonesia in 2010, the percentage of

exclusive breastfeeding patterns in 0-month-old

infants was 39.8% and the percentage of 1-month-old

infants was 32.5%. The percentage decreases with

increasing age groups of babies. However, the

percentage of exclusive breastfeeding has a

significant increase from 2012 to 2013, is from 42%

to 54.3%, with the highest percentage being in West

Nusa Tenggara Province at 79.7%. However, the

percentage such as in Papua is 31.5% and in Maluku

is 25.2%. Efforts are needed to increase the coverage

of exclusive breastfeeding because based on the

report above, there is no even distribution of

percentage figures between provinces (Indonesia

Ministry of Health, 2014).

Based on the 2016 Indonesia Health Profile

Report, the percentage of infants aged 0-5 months

who received exclusive breastfeeding was 54%,

referring to the 2016 strategic plan target of 42%.

Nationally, the coverage of exclusive breastfeeding

for babies under the age of 6 months was 54%

reaching the target. However, the percentage of

infants receiving exclusive breastfeeding up to 6

months is still low at 29.5% (Sumatera Utara Dept of

Health, 2016). Data from the Profile of the North

Sumatra Health Office in 2015 stated that the

percentage of coverage of exclusive breastfeeding

from 2011-2015 tended to show a substantial increase

from 26.67% to 44.59%. In 2015 experienced a

significant increase of around 10% compared to 2014,

from 34.56% to 44.59%. However, a report from the

Profile of the North Sumatra Provincial Health Office

in 2016 saw a sharp decline compared to 2015 and did

not reach the national target of less than 40%, a

percentage of 29.6% (Sumatera Utara Dept of Health,

2015).

Lumbanraja, S. and Panggabean, R.

The Relation between Several Factors That Inﬂuence the Inhibition of Exclusive Breastfeeding in Glugur Darat Healthcare.

DOI: 10.5220/0009862701710176

In Proceedings of the 2nd International Conference on Tropical Medicine and Infectious Disease (ICTROMI 2019), pages 171-176

ISBN: 978-989-758-469-5

171

The purpose of this study was to determine the

factors that influence exclusive breastfeeding at

Glugur Darat Health Center, East Medan. The benefit

of this research is to become a source of information

and increase the insight of breastfeeding mothers

about the benefits of breastfeeding so that they can

change the way the application of breastfeeding that

is still not right.

2 METHOD

This research was conducted with analytical survey

methods, with analytic cross-sectional design,

namely observing or measuring variables at one time

to determine the relationship of independent variables

(factors of education, occupation, knowledge,

maternal and child health, education, information,

socio-culture effects) on the dependent variable

(inhibition of breastfeeding) in the work area of

Glugur Darat Health Center, East Medan. This study

uses primary data by measuring questionnaires and by

measuring interviews.

The study was conducted in March to December

which included the submission of titles, library

searches, reading of proposals, data collection and

processing, and reading of results. The research was

conducted in the working area of the Glugur Darat

Public Health Center. A population is a large number

of subjects that have certain characteristics.

The population in this study were all mothers,

who gave exclusive breastfeeding and mothers who

did not exclusively breastfeed in the work area of

Glugur Darat Health Center, East Medan. The sample

is part of the population chosen in a certain way until

it is considered to represent the population. The

sample in this study was taken using the Slovin

formula in this case with five independent variables,

the sample that is used in this study was 166 people.

Inclusion criteria are the general characteristics

of the research subjects in the target population and

in the affordable population. The sample inclusion

criteria in this study were mothers who gave

exclusive breastfeeding and who did not exclusively

breastfeed, were in good health and could understand

the questions well. Exclusion criteria were some

subjects who met the inclusion criteria and had to be

excluded from the study for various reasons. The

exclusion criteria for this study were mothers who

were not willing to become respondents.

Sampling in this study used the Consecutive

Sampling method, that is, all subjects who came in

sequence and fulfilled the selection criteria were

included in the study until the required number of

subjects was fulfilled.

Data collection is done by collecting primary data

by giving questionnaires to sample subjects in the

work area of Glugur Darat Health Center, East

Medan. The questionnaire is a technique of data

collection carried out by giving respondents a set of

written questions to answer.

This study uses univariate, bivariate, and

multivariate analysis methods. Univariate, namely by

collecting the frequency data of the independent

variable on the dependent variable. Bivariate, that is

by finding the relationship of each independent

variable with the dependent variable, using the chi-

square hypothesis test. Multivariate, which is a

method of analyzing data that involves more than one

independent variable and one or more dependent

variables. Hypothesis testing is logistic regression

test because the independent variables (factors of

education, occupation, knowledge, maternal and

child health, education, maternal and child health,

information, socio-culture effects) and dependent

variables (inhibition of breastfeeding) are nominal.

3 RESULTS AND DISCUSSION

3.1 Univariate and Bivariate Analysis

The univariate analysis aims to systematically

describe the actual and accurate facts of a population

or field. Variable frequency of distribution data can

be seen in Table 1.

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Table 1: Frequency Distribution of Univariate and Bivariate Analysis.

Variable

Measurement results

Breastfeeding

Non-exclusive breastfeeding

exclusive breastfeeding

P value

Education

Elementary

0.564

Secondary

College

Occupation

Unemployed

0.003

Employed

Knowledge

Well

0.329

Enough

Less

Maternal and children health

Well

Enough

Less

Information

Well

Enough

Less

Socio-culture effect

Well

Enough

Less

The bivariate analysis aims to determine the

relationship between independent variables and

dependent variables, using the chi-square test. This

analysis was also the first step in the selection of

variables included in multivariate analysis. The

relationship between risk factors and the inhibition of

exclusive breastfeeding is indicated by the value of p

< 0,05. Based on table 1, it was known that out of the

six independent variables tested with the chi-square

test, four variables were related (p < 0,05) and two

variables that were not significantly related (p > 0,25)

with the dependent variable were education variables

and knowledge variable.

The Relation between Several Factors That Inﬂuence the Inhibition of Exclusive Breastfeeding in Glugur Darat Healthcare

173

Table 2: Effect Between Independent Variables and Dependent Variables Using Logistic Regression Test (Enter Method).

Independent

variable

Wald

Sig

Exp (B)

95% CI for EXP (B)

Lower

Upper

Education

0.366

1,121

0.290

0.714

0.383

1,331

Occupation

0.948

8,481

0.004

0.388

0.205

0.734

Knowledge

0.033

0.020

0.888

1,033

0.655

1,629

Maternal And

children health

3,740

43,003

0,000

42,083

13,762

128,682

Information

1,844

29,146

0,000

6,233

3,237

12,351

Socio-Culture Effect

2,234

38,734

0,000

10.214

4,913

21,233

3.2 Multivariate Analysis

Before multivariate analysis, the independent

variables were tested first one by one with the enter

logistic regression test method to get the variables

that were significantly related to the dependent

variable and continued to multivariate analysis. The

requirement for this variable selection is if the p-

value obtained from the one-by-one variable test is

obtained> 0.25.

Based on table 2, it was known that of the six

independent variables tested by entering method

logistic regression, there were four related variables

(sig <0.25) and two variables that were not

significantly related (sig > 0.25) with the dependent

variable namely the education variable and

knowledge variable.

There are four independent variables related to the

dependent variable, namely the variable Occupation,

Maternal and Children Health, Information, and the

Socio-Culture effect which are jointly included in the

calculation of the enter logistic regression test

method.

Table 3: Independent Variables Tested by the Logistic Regression Test (Enter Method).

Independent variable

Wald

Sig

Exp (B)

95% CI for EXP (B)

Lower

Upper

Occupation

1,462

5,353

0.021

0.232

0.067

0800

The health of both

mother and child

2,955

22,110

0,000

19,192

5,601

65,762

Information

1.411

10.323

0.001

4.102

1,734

9,703

Effect of Socio-Culture

1977

14.258

0,000

7.223

2,588

20.158

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In the employment variable, the p-value of the

employment variable is 0.021 (p <0.05), and Exp (B)

is 0.232, this means that mothers who work 0.232

times more influence the inhibition of exclusive

breastfeeding. This is due to the busy life of the

mother and lack of knowledge of the mother to give

milk. This is in accordance with the theory proposed

by Prasetyono that for working mothers, efforts to

give exclusive breastfeeding often experience

obstacles due to the short period of maternity and

childbirth working holiday. Before exclusive

breastfeeding ends perfectly she must return to work.

The activities or work of the mother is often used as

an excuse not to give exclusive breastfeeding,

especially those who live in urban areas. As a result,

if the mother is required to return to full employment

before the infant becomes six months old, this

exclusive breastfeeding does not work as it should,

then followed by physical and mental conditions of

tired of having to work all day and adding an

inadequate diet will result in non-fluency of

breastmilk production. Working holidays regulation

after delivery was only last for 3 months which makes

many mothers have to prepare their babies with

breastmilk supplementary food before the cut-out

period is finished, so exclusive breastfeeding is not

successful.

On maternal and children health variables, the p-

value of maternal and children health variables is

0,0001 ( p <0.05) and Exp (B) of 19,192, which

means that maternal and children health problems

will affect 19,192 times greater inhibition of

breastfeeding. exclusive. The condition of the

mother's breast has a role in the success of

breastfeeding such as drowning, flattening or putting

too large nipples can interfere with the breastfeeding

process. In another study, almost all mothers did not

experience breast abnormalities but began to be able

to breastfeed after the second or third day. More milk

production is determined by the frequency of suction,

the stronger the suction power of the baby, the more

milk is produced. Mothers will not be deficient in

breastmilk, because breastmilk will continue to be

produced, provided the baby continues to suck

(Lumbanraja, 2015).

In the information variable, the p-value of the

information variable is 0.001 (p <0.05) and Exp (B)

is 4.102, this means that information will have an

effect of 4.102 times greater on the inhibition of

exclusive breastfeeding. In the results of interviews,

mothers who gave exclusive breastfeeding received

information about exclusive breastfeeding and how to

breastfeed through health workers at the health center

when conducting pregnancy control, while mothers

who were well informed but did not give exclusive

breastfeeding due to health reasons or mothers who

work. While some newborns were given formula

milk by midwives or hospitals because mother's milk

did not come out on the first day, then followed by the

tendency of mothers to buy formula milk because

promotion or advertising of formula milk looked

attractive. Increased efforts by milk factory to

promote formula milk interfere with the success of

exclusive breastfeeding. This is in accordance with

Rahmawati's research which showed that there was a

significant influence between the support of health

workers and exclusive breastfeeding. Health workers

are the main components that play a role and will

make a very important contribution to the success of

efforts to promote and promote breastfeeding, these

health workers have a big contribution in efforts to

increase the use of breast milk in addition to the

factors that exist in society. Strong commitment from

health workers or health providers (doctors,

midwives, nurses, hospital management, etc.) in

breastfeeding information or promotion is very

necessary because those who can directly contact

the community and have many opportunities to

provide explanations and counseling about breast

milk. Thus, health workers play a key role in this

matter, especially in the case of exclusive

breastfeeding in hospitals or maternity homes

(Rahmawati, 2010). The results of this study were

also supported by the results of Lumbanraja's study

which said that the place of birth had an influence on

exclusive breastfeeding for infants because it was the

starting point for mothers to choose whether to

continue giving their babies exclusive breastfeeding

or giving formula milk provided by health or non-

health workers before Mother's milk is called out

(Lumbanraja, 2015) .

In the socio-cultural effect variable, the p-

value of the socio-cultural effect variable is 0,000 ( p

<0,05) and Exp (B) is 7,223, this means that the socio-

cultural effect is 7,223 times greater than the

inhibition of exclusive breastfeeding. On the results

of interviews in collecting samples, mothers believe

that exclusive breastfeeding can change breast shape

and can increase body weight, and mothers believe

that newborns can be given honey. The hereditary

tradition is a factor that supports the emergence of the

assumption that breast milk alone is not enough for

infant food, as a result, the mothers provide other

forms of liquid or soft food such as formula milk,

pulverized bananas, pulverized rice as

complementary food before the infant reaches the age

of 6 months. This is consistent with the observation

of Alfan et al., that during the study there were still

The Relation between Several Factors That Inﬂuence the Inhibition of Exclusive Breastfeeding in Glugur Darat Healthcare

175

many mothers who had good knowledge who should

give ASI to their infants, this might be due to

hereditary habits of providing food or drink to infants

under 6 months with bananas, eel, honey, and coconut

water. Some mothers consider a weak baby suction

makes the mother afraid that the baby is not full if

only breastfed is given, and modernization such as the

use of formula milk and the assumption that formula

milk is better and more practical than da ASI (Alfan,

Astuti & Bangsawan, 2014).

4 CONCLUSIONS

Based on the results of this study, the conclusion

is that there is a relationship between maternal

employment status, maternal and children health,

information, socio-cultural effect with the inhibition

of breastfeeding. There is no significant relationship

between knowledge and education with the inhibition

of exclusive breastfeeding. In this study, maternal

and children health was the most significant

variable influencing the inhibition of exclusive

breastfeeding at the Puskesmas Glugur Darat.

REFERENCES

Alfan, W., Astuti, T., Bangsawan, M. 2014, ‘Pendidikan

Dan Pengetahuan Pada Ibu Yang Mempunyai Bayi

Usia 6-12 Bulan Dengan Pemberian Asi Eksklusif’,

Jurnal Keperawatan, VOL 10, NO.1

IDAI 2013. ASI sebagai Pencegah Malnutrisi pada Bayi,

Accessed 02 april 2018, Available at

http://www.idai.or.id/artikel/klinik/asi/asi-sebagai-

pencegah-malnutrisi-pada-bayi

Indonesia Ministry of Health. 2018. Berikan ASI Eksklusif

agar Anak Sehat dan Cerdas, accessed 02 April 2018.

Available at http://www.depkes.go.id/article/view/

16080800002/berikan-asi-ekslusif-agar-anak-sehat-

dan-cerdas.html

Indonesia Ministry of Health. 2014. Pusat Data dan

Informasi Situasi dan Analisis ASI Eksklusif.

Kementrian Kesehatan Replubik Indonesia’, p. 5.

Lumbanraja, S. 2015. ASI dan Aspek Klinisnya. USU

PRESS. Medan

Rahmawati, M.D. 2010. ‘Faktor-Faktor Yang

Memengaruhi Pemberian ASI Eksklusif Pada Ibu

Menyusui di Kelurahan Pedalangan Kecamatan

Bayumanik Kota Semarang’, Jurnal KesMaDaSka, vol

1, no 1, pp 8-17

Sumatera Utara Dept of Health. 2016. Profil Kesehatan

Sumatera Utara 2016. Dinas Kesehatan Provinsi

Sumatera Utara. Medan

Sumatera Utara Dept of Health. 2015. Profil Kesehatan

Sumatera Utara 2015. Dinas Kesehatan Provinsi

Sumatera Utara. Medan

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