Women Experiences of Exclusive Breastfeeding
in Aceh, Indonesia
Aida Fitri
1,2
, Budi Wahyuni
2
, Elsi Dwi Hapsari
2
, and Darmawati
1
1
Department of Maternal Health Nursing, Faculty of Nursing, Syiah Kuala University, Banda Aceh, Indonesia
2
Master Program of Nursing Science, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
Keywords: Experience, Exclusive breastfeeding, Women in Aceh.
Abstract: Exclusive breastfeeding is the most ideal meal for infants aged 0 - 6 months and provides substantial
benefits for the baby and the mother. Although there are many studies and publications on the benefits of
breastfeeding, but the number of exclusive breastfeeding in global coverage has not increased significantly.
Myths and erroneous beliefs about breastfeeding is still developing in some areas in Indonesia as well as in
Aceh. This study aim to describe the meaning of exclusive breastfeeding experience of women in Aceh.
This qualitative research with phenomenological approach. There were 9 participants participated in the
study consist of six mothers who have succeed exclusive breastfeeding and three additional participants.
Data collection was using semi-structured and in-depth interviews.
The study’s themes are consist of being
a mother, breastfeeding resilient for sake of the baby, knowledge is the key to successful, and cultural
practices is not a mistake. Mothers should be able to modify cultural practices to decrease the chance of
disturbance or even fail the process of exclusive breastfeeding.
Exclusive breastfeeding is believed to be the
best choice for children and mother and described as a success of mothers in carrying out their role.
1 INTRODUCTION
Children is a next generation of human resources to
continue our future development. Conducive
development should be provided in order the
children can grow and develop optimally, healthy,
intelligent and has a character in accordance with the
values of the Indonesian nation. The most basic
effort to ensure the achievement of the quality in
children development as well as fulfilling the rights
of children is to provide the best food for children
from birth until two years (DEPKES, 2011).
Breastfeeding and exclusive breastfeeding
provide substantial benefits both for the baby and for
the mother. Breast milk is the most complete
nutrition for baby. According to Burns, et al (2010)
although there have been various studies and
publications on the benefits of breast milk, but there
is a decline in breastfeeding rate globally, there are
many mother in the world who do not breastfeeding,
breastfeeding with a short duration or late in starting
breastfeeding.
WHO (2010) estimates that 85% of mothers in
the world do not provide optimal breastfeeding. Data
from Disease Control and Preventive (CDC)
National Immunization Survey (2009) in
Lowdermilk, et al (2012) indicated that the rate of
breastfeeding in the United States has increased
from 60% in 2005 to 70% in 2007. Data on
breastfeeding in some other countries in 2010,
coverage of exclusive breastfeeding in India has
reached 46%, Philippines 34%, Vietnam 27% and
24% in Myanmar (WHO, 2010).
According Gizikia (2014) coverage of exclusive
breastfeeding in Indonesia in infants up to 6 months
increased from 33.6% in 2010 to 38.5% in 2011.
However, this rate is decreased from 63.4% in 2012
to 54, 3% in 2013. This rate is far away of
expectations and signalled only a little Indonesian
children obtain sufficient nutrients from breast milk.
In fact, breast milk is a important role in the process
of physical and mental growth of children with long-
term effects (Riskesdas, 2013).
Health profile Aceh 2012 shows the coverage of
exclusive breastfeeding in Aceh is only 27% and
Aceh ranks in number 9 from the lowest of all the
provinces in Indonesia (SDKI, 2012). As for
exclusive breastfeeding coverage in Aceh Besar
amounted to 33.7% (health profile Aceh, 2012).
Results of a preliminary study on February 9, 2015
Fitri, A., Wahyuni, B., Hapsari, E. and Darmawati, .
Women Experiences of Exclusive Breastfeeding in Aceh, Indonesia.
DOI: 10.5220/0008396300002442
In Proceedings of the Aceh International Nursing Conference (AINC 2018), pages 193-198
ISBN: 978-989-758-413-8
Copyright
c
 2022 by SCITEPRESS – Science and Technology Publications, Lda. All r ights reserved
193

found the number of breastfeeding mothers with
babies aged in 0-24 months in Puskesmas Kuto Baro
amounted to 241 people and the exclusive
breastfeeding amounted to 109 people. Many things
can affect the exclusive breastfeeding among them
such as influence of the older in family members,
the influence of social learning, and the influence of
religion (Demirtas, et al, 2011), socio-economic
status, occupation and mother's education, ethnicity,
shifting neighbourhood, mimic western lifestyle,
influence health personnel and the availability of
formula (Burns, et al, 2010) and culture (Chen, et al,
2013).
The lowest achievements of exclusive
breastfeeding in Aceh is much influenced by the
culture of giving food and drinks too early to infants,
this is because of lack of family knowledge,
incessant propaganda formula, especially in urban
and maternal behaviour towards breastfeeding
(health profile of Aceh, 2012). Acehnese who firmly
attached to the customs and cultures that affect in
their daily lives, including in the process of
breastfeeding.
Acehnese people assume that breastfeeding for
infants should be in two years, it is because of a
religious order and the child is a mandate from Allah
SWT that must be treated as well as possible.
However, from the results of a preliminary study
conducted by researchers by interviewing midwives
and health workers at health centre district of Kuta
Baro said there are still many mothers in Aceh who
stopped breastfeeding before the 2 years with the
reason of the milk production slightly, the behaviour
of mothers who use of formula feeding in infants
under 6 months and the additional of supplementary
food such as rice mixed with mashed banana at an
early age, worker mother, spacing pregnancies too
close to focus attention with order baby, knowledge
and lack of family support.
The myths associated with the practice of
breastfeeding is still evolving, as considered
colostrum is stale milk that are not well provided for
baby, postpartum mothers must undergo restrictions
to eat and not to eat / drink in large portions / lot,
myths breastfeeding can affect the shape of the
body, also believe that the formula for growth and
intelligence of babies.
2 METHODS
This study is a qualitative research with
phenomenological approach. Technique of
determining the participants by using purposive
sampling to determine criterian inclusion and
exclusion. Criterian inclusion of mothers with
infants aged > 6 months to 12 months and managed
exclusively breastfed their babies, Acehnese, the age
range of mothers 20 to 35 years, women with
minimal education in high school, able to
communicate well, and willing to be Participants in
the study. While exclusion criteria: infants with low
birth weight (LBW) and pregnant mother.
The number of participants in this study were 9
people. Data collected by using a semi-structured
interview or in-depth interviews and field note. The
study was conducted in the district of Kuta Baro,
Aceh Besar district. Data collection took place from
June - August 2015.
3 FINDINGS
Based on the selected participants, participant
characteristics obtained consisting of age, infants
age, parity, number of children, place of birth, type
of delivery, duration of breastfeeding, duration of
exclusive breastfeeding, education, occupation,
ethnicity and family members who live together
participants. Below is the themes of the study:
3.1 Being a Mother
3.1.1 Proud as a Mother
The pride of being a mother when the mother can
give life to her baby by giving exclusive
breastfeeding, proud of her success in the midst of
other mothers who complain about breastfeeding,
proud to be able to prove to parents that mothers can
successfully breast-feed, proud though babies only
given only breast milk for 6 months but remain
healthy baby. As expressions of the following
participants:
Proud if you succeed in providing exclusive
breastfeeding for children, the meant
successfully becoming a mother if she had
given exclusive breast milk. (P1)
3.1.2 Breast Milk is the Gift of God
Breastfeeding is a grace and favor of God that is
irreplaceable and must be grateful, exclusive
breastfeeding for 6 months is one way in which the
mother to give favors, such as the expression of one
of the following participants:
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It is a gift from God and cannot be replaced
by another. (P1)
3.2 Test Stand, for the Sake of the
Baby Breast Milk
3.2.1 Efforts to Power
Mother made great efforts in maintaining the
exclusiveness of breastfeeding, the mother carried
them to learn and seek information about exclusive
breastfeeding, perform management problems
during breastfeeding, preparation especiall before
childbirth, foster goodwill and strong motivation.
I have started looking for information before
pregnancy through the internet (P3)
Although breastfeeding is easy and practical. But
the mother realized during breast feeding mothers
need extra effort to provide exclusive breastfeeding.
For example related to time maybe hmmm…
have to get up earlier that for...uh…dairy
ASI… it's saved… I mean hmm… Manage
the time for me ... to produce breast milk (P5)
3.2.2 Family and Social Support
Family and social investment is the mother obtained
the support of her husband, family, workplace,
environmental, social and health workers during
exclusive breastfeeding.
Given attention, asking if I have eaten or not,
remember to eat regularly. (P6)
Office mate reminded of breaks to go home
so I could breastfeeding. My boss also gave
attention by allowing me to go home early.
(P6)
Ee…posnatal visit to the age of the baby 40
days through visits KN1, KN2, KN3 (PP2)
3.2.3 Learning from Previous Experience
Results of the research showed that the three
participants had experienced a failure during
breastfeeding her first child, so that the experience is
a provision for the mother to be successful in
providing
exclusive breastfeeding her second child.
When I gave birth my second child, I was
determined to give exclusive breastfeeding
(emphasizing the tone of voice) want to see
how the difference with the first child. (P2)
3.3 Knowledge, the Key to Success
From these results the knowledge of exclusive
breastfeeding consists of understanding and
perception of exclusive breastfeeding, an
understanding of the benefits of exclusive
breastfeeding for the mother, an understanding of
the benefits of exclusive breastfeeding for infants,
previously a relative understanding and Religion and
breastfeeding.
All participants know about the definition of
exclusive breastfeeding. Most of them considered
breast milk as the source of immune system.
Exclusive breastfeeding is emmm ...
breastmilk is given for 6 months without the
aid of formula milk or complementary foods”
(P5)
Mothers also understood that breast milk is
beneficial for infant health, intelligence, endurance,
increase the baby's weigh.
Baby's immune system is stronger ...rarely
sick, and it’s good for the baby’s brain and
intelligent (P3)
In addition to the benefits for the baby, the
mother is also useful to know the breastfeeding
mother as well, such as for natural contraception
after giving birth, one of the methods to lose weight
mothers, improving mother-child emotional bond
and can prevent breast cancer.
Or natural diet and family planning
methods.... (P5), prevent cancer. (P2),
improve emotional connection with babies,
(P4)
The results showed that participants know that in
Islam also encourages breastfeeding. As a Muslim,
the participants understand that religion is always
good advice, so that breastfeeding is important.
In our religion it has been ordered to
breastfeed until the baby is 2 years old. (P2)
Women Experiences of Exclusive Breastfeeding in Aceh, Indonesia
195

3.4 Cultural Practices, There is No
Harm
Associated with cultural practices there are three
categories illustrates that not all cultural practices
can hinder the success of exclusive breastfeeding,
the categories are:
3.4.1 Traditional Rituals on the People of
Aceh
Results of analysis of the data shows that there are
two traditional rituals influence in exclusive
breastfeeding among peucicap and bie ie sira.
Participants stated that peucicap is a ritual performed
in infants which aims to introduce food to the baby
degan provide a wide variety of food at the time of
carrying out the ritual.
Provide an opportunity to taste food for
newborns. The peucicap uses egg yolks,
fruits and honey). (P3)
While bie sira ie this is a tradition of giving
sugar-salt water to babies who paid his first visit to
the home of relatives. If there is a baby who first
visited the house after the birth of the party host
should provide sugar-salt water as symbols of
welcome and glory given to the baby when the baby
is first visited.
Acehnese people's habits when baby first
home visit relatives, given water containing
salt and sugar or honey. (P1)
These ritual gives significance of public
importance in Aceh
Bie ie sira is a symbol of Acehnese people to
glorify babies. Peucicap with sweet-salty,
meaning that everything in life has something
that is pleasant or unpleasant and both must
be lived). (PP3)
3.4.2 Do not Perform Traditional Rituals
Despite Knowing
Results of analysis of the data, although the
traditional rituals of the sacred meaning for the
people of Aceh, but the participants knew that
provide food / drink other than breast milk to the
baby can frustrate exclusive breastfeeding. So most
participants did not perform the rituals.
Provide knowledge to family members not to
provide food or drinks to babies when
visiting relatives' homes. (P6)
3.4.3 Respecting the Traditional Rituals
Participants maintain, preserve and respect the
customs and rituals can not avoid a series of
traditional rituals that must be followed in social life.
As expressions of the following participants:
Sometimes it is difficult to give
understanding, maybe someone is offended
or angry. (P3)
Participants chose to perform traditional rituals
in other ways but still does not derail exclusive
breastfeeding.
Giving water containing sugar and salt does
not interfere with exclusive breastfeeding,
because it applied only the baby's lips. (P1)
Peucicap and bie ie sira is a custom. Thus
generally do not have any impact for both mother
and baby, not not be a sin if abandoned.
No effect whatever it's just a custom not a
religious law. it's just the belief of old
people). (PP3)
4 DISCUSSION
Being a mother is a dream for every woman. The
role of a mother described as a duty to care for the
child and provide the best for children. From the
results of the study illustrate the success of
becoming a mother when someone managed to give
exclusive breastfeeding to their children. The
success of exclusive breastfeeding became the pride
and is a gift to be grateful mother.
Burn, et al (2009) which states that expectations
about breastfeeding woman is described as a natural
process that is best for babies and equated with
being a good mother. Stop breastfeeding is often
associated with guilt and failure as a mother.
Another study conducted by Britton and Britton
(2008) states that women who breastfeed exclusively
has a high self-concept, the form of satisfaction and
happiness in interrelation (Wattimena, et al, 2012).
Breastfeeding described as a fun thing that can not
be disclosed (Hall & Hauck, 2007), so it is a gift to
be grateful.
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The theme “hold the test, the milk for the sake of
the baby” general explained that breast milk is best
for babies and all women should do. Give the best
thing for a baby is a strong motivation for most
women to choose exclusive breastfeeding. But for
many people to give the best for the baby requires
new skills in the face of unforeseen challenges.
The results showed although breastfeeding is
described as natural, easy and practical for every
mother, but in fact the mother requires great effort to
remain mempertahanka exclusive breastfeeding. It is
also supported by research Burn, et al (2009) which
states that breastfeeding is not as easy as one might
imagine, in fact, the mother is required to have
perseverance, to be able to survive in a difficult
situation, and requires great sacrifice.
Put aside personal interests in order to move
towards the goal achieved. Prioritize. the needs of
the children themselves need to fulfill her
responsibilities as a mother. Mother willing to lose
his time and pleasure for the sake of children.
The theme “knowledge is the key to successful
explained about the breast feeding knowledge from
the participants. According Fikawati & Shafiq
(2009) which states that can be ascertained if the
mother does not know about exclusive
breastfeeding, mothers may not know the benefits of
exclusive breastfeeding. Maternal knowledge is the
basis for the mother to believe that exclusive
breastfeeding is the best option that is a mother for
the confidence anaknya.dengan mother needs to
survive to continue to provide the best for her baby.
The mother also understands that, as Muslims
believe breast-feeding mother is instructed in
religion. So the suggestion breastfeeding is
defined
as an obligation that must be fulfilled like doing
other acts of worship.
In the Qur'an Allah surah Al Baqarah verse 233,
Allah says which means "The mother let suckle their
children for two full years, that those who want to
enhance the breastfeeding (Al-Baqarah: 233).
Lessons clause contained in the book of the Holy
Quran, at least emphasizes that breastfeeding is very
important. Although there are still differences of
opinion about whether or not mandatory
breastfeeding, but should for a Muslim to respect the
verses of Allah. That verse firmly advocated to
enhance breastfeeding period is for 2 years.
According to Shaikh and Ahmed (2006) stated
that the Muslims formed by two main sources that
drive on the belief that Al-Qur'an and hadith as a
guide for the behavior of a Muslim. Likewise with
breastfeeding behavior. Mother believed that God
give as a breast milk production as a gift for the
baby and the mother has an obligation to God to
memmenuhi right baby. So most Muslim women
believe that they will be rewarded if it does not
fulfill this obligation.
Cultural values of the people of Aceh believe
breastfeeding is associated with the nature of the
task and the role of a mother. In this case it appears
that the values of the culture of breastfeeding is still
attached firmly and believed by most people in Aceh
positively.
Acehnese people undergo various traditional
rituals performed in welcoming the birth of the baby.
But there are two rituals are very striking that
influence breastfeeding practices of exclusion,
namely ritual peucicap and bie ie sira. Peucicap is a
ritual that is performed when the baby is 7 days old
or some are doing so at the age of infants 40 days all
the rituals of getting off the ground. Peucicap ritual
performed to introduce a wide variety of food to the
baby.
Bie ie sira is the provision of water mixed with
sugar and salt to the baby's first visit to the house of
relatives after the baby off the ground. Bie ie sira
done as a symbol of welcome and praise the baby
first came to the house of relatives.
A culture that believed in an area will affect the
behavior of the local community, as well as with the
behavior of breastfeeding. It is also stated by the
Yzer (2012) based integrative models of behavioral
prediction, namely that culture is the background
variables that indirectly affect the intention to
perform the behavior.
However, the results also showed some
mothers still perform traditional rituals such as
peucicap and bie ie sira to respect the rituals that
have been undertaken families and the surrounding
communities for generations. To keep the
exclusivity of breastfeeding mothers do both of these
traditional rituals symbolically, it is only by
smearing the lips of baby food / liquor. This will
make the baby still exclusively breastfed for food
and drinks was not until tertelah by infants.
This is done by the mother so as not to be a
new conflict between beliefs about exclusive
breastfeeding mother with family and community
understanding of the rituals associated with peucicap
and bie ie sira understood as a ritual and sacred.
Mother knows that knowledge of the family, the
local community or indigenous elders not fully
understand about exclusive breastfeeding, so that the
mother can make a leeway in rituals peucicap and
bie ie sira.
Women Experiences of Exclusive Breastfeeding in Aceh, Indonesia
197

5 CONCLUSIONS
From the results, the four themes that describe the
meaning of breastfeeding on the people of Aceh,
which became the mother, breastfeeding test stand
for the sake of the baby, the key to successful
knowledge and cultural practices would not hurt.
Being a mother is a pleasant thing to be thankful
for as well as pride. In breastfeeding mothers face
many obstacles so that the mother should have a
spirit and a high fighting spirit and a complete
knowledge to survive for the sake of fulfillment of
exclusive breastfeeding in infants. Besides the
cultural practices are often an obstacle to
maintaining the exclusiveness of breast milk, but the
mother is able to face and to modify cultural
practices that do not succeed exclusive
breastfeeding.
Based on the description above conclusion is
expected to families, communities, health workers
and the government can provide practical support to
mothers in exclusive breastfeeding. Provide positive
support and identify things that are needed by the
mother in maintaining the success of exclusive
breastfeeding.
ACKNOWLEDGEMENTS
The first author expressed her gratitude to Dr.
Christantie Effendy, S.Kp., M. Kes, Mrs Dr. Dra.
Sumarni DW., M. Kes,
Mrs Dr. Fitri Haryanti,
S.Kp., M. Kes as a mentor who has been providing
input, guidance and support in completing this
reserch.
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