Correspondent: Emah Rohemah
Email:
[email protected]
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INTRODUCTION
Mother's Milk is the best life fluid, containing
various substances babies need (Rahmanisa
& Aulianova, 2016). Breast milk is good for the growth
and development of babies and according to their needs (Reniker et al.,
2023). In addition, breast milk also
protects babies from all infections by increasing their immunity (Aldy
et al., 2016). According to the World Health
Organization (WHO, 2017), Mother's Milk is given to newborns for up to 6 months
without food and other drinks, except vitamins, drugs recommended by health
workers for medical reasons is called exclusive breastfeeding (Reniker et al.,
2023); (Wijaya,
2019).
Based on research conducted in the United States, the
results showed that babies who were exclusively breastfed for six months had a
72% lower risk of experiencing respiratory tract infections (ARI), a 30% lower
risk of developing diabetes, and a 50% lower risk of experiencing otitis media
(1).
Sihombing, 2022). In addition, breastfeeding can also
reduce the risk of sudden infant death syndrome (SIDS) by 36% (Stalley
et al., 2022). Recognizing the many benefits of
exclusive breastfeeding, the United Nations Children Fund (UNICEF) and the
World Health Organization (WHO) recommend that children only be breastfed for
at least six months. In Indonesia, the government has also established
regulations regarding the importance of exclusive breastfeeding, which are
listed in the Decree of the Minister of Health Number 450/MENKES/SK/IV/2004 and
Government Regulation (PP) Number 33 of 2012 (Windari et al., 2017).
According to monitoring data on nutritional status in
Indonesia in 2017, mothers' coverage of exclusive breastfeeding for the first
six months of their babies is still shallow, namely 35.7%. This means that 65%
of babies do not get exclusive breastfeeding during the first six months of
birth. This figure still needs to be closer to the target of exclusive
breastfeeding coverage in 2019 set by WHO and the Ministry of Health, which is
80% (RI,
2018).
Based on the West Java Province Health Profile in
2017, the coverage of exclusive breastfeeding in West Java was 53.0%. Whereas
for Cirebon District, the percentage of babies who get exclusive breastfeeding
for babies aged 0-6 months is 32.79%. The exclusive breastfeeding rate is still
low because the target coverage for exclusive breastfeeding in infants 0-6
months is 80% (Mamonto,
2015).
Based on the results of a preliminary study conducted
at the Jamblang Health Center, it was found that the coverage of exclusive
breastfeeding. The Jamblang Community Health Center 2019 has reached the target of
exclusive breastfeeding, which is 40%. However, it has yet to reach the target
set by WHO and the Ministry of Health of 80%, where the coverage of exclusive
breastfeeding for the Jamblang Health Center in 2019 is 46.3%.
Based on the results of interviews conducted by researchers
with employees of the Nutrition Coordinator (Nutritionist) of the Jamblang
Health Center, Cirebon Regency, it is known that the coverage of exclusive
breastfeeding in 2019 has decreased from the previous year of 7.9%, wherein
2018 it was 54.2%, and in 2019 it was 46.3%. She also mentioned that there are
still very few mothers who breastfeed exclusively. The opinion of mothers so
far is that complementary foods for breastfeeding can make babies healthier and
less fussy and also cultural and traditional factors that cause low levels of
exclusive breastfeeding. Mothers also believe these foods can make babies
complete, get fat quickly, and not get sick easily.
Various factors that influence the success of
exclusive breastfeeding include the mother's knowledge, psychological factors,
mother's physical factors, sociocultural factors, health worker support
factors, and family support factors (Fadlliyyah,
2019). The support factor of health
workers, especially midwives, dramatically influences the success of exclusive
breastfeeding (Sipayung,
2022). This follows Government Regulation
(PP) Number 33 of 2012, which states that midwives are responsible for
providing education about exclusive breastfeeding and supporting breastfeeding
mothers starting from the process of pregnancy, the first time the mother
breastfeeds until the mother is breastfeeding (Sugianti,
2019). The midwives' support can also
increase the mother's self-confidence to continue breastfeeding her baby exclusively
(Alianmoghaddam et al., 2017).
METHODS
This
research is a qualitative descriptive survey using a cross-sectional approach
where observations of the independent and dependent variables are carried out
simultaneously. This research was conducted in the working area of the Jamblang
Health Center, Kab. Cirebon will be held on 10-12 February 2020.
In
this study, the population was mothers with babies aged 7 - 24 months in the Jamblang Health Center working area, with as many
as 1,036 people. The inclusion criteria of this study are Mothers who live in the working area of the Jamblang Health
Center, are willing to be
respondents, and with health
conditions both physically and mentally,
and the baby is in good health. The
exclusion criteria in this study were Mothers
with pathological conditions who cannot breastfeed their babies, such as breast
cancer or HIV, and mothers with babies with pathological conditions, such as
congenital disorders or digestive disorders.
Sampling
in this study, because the total population is more than 100, the number of
samples taken is 10% of the total population. They have already obtained
several samples in this study, as many as 104 respondents. The variables in
this study include the dependent variable, namely midwife support, and the
independent variable, exclusive breastfeeding. The type of data in this study
uses primary data, namely breastfeeding mothers who have babies aged 7-24
months in the working area of the Jamblang Health Center. Respondent data was
collected by distributing questionnaires directly to 104 mothers with babies
aged 7-24 months in the Jamblang Health Center working area regarding midwife
support and exclusive breastfeeding.
RESULTS AND DISCUSSION
Jamblang Health Center is one of 57 Health Centers in
Cirebon Regency. The Jamblang Health Center is at Jalan Mohammad Ramdhan No. 56
Wangunharja Village, Jamblang District, Cirebon Regency. The working area of
the Jamblang Health Center covers eight sub-districts in Jamblang District,
namely Jamblang Sub-District, Sitiwinangun Sub-District, Wangunharja
Sub-District, Bojong Wetan Sub-District, Bojong Lor Sub-District, Orimalang
Sub-District, Bakung Kidul Sub-District and Bakung Lor Sub-District. The
working area of the Jamblang Health Center is 1,947,501 Ha. The Jamblang
Community Health Center area is a lowland. The boundaries of the working area
of the Jamblang Health Center: to the north, it borders the UPTD Work Area of
the Suranenggala Health Center; to the south, it borders the UPTD Work Area to
the Waruroyom Health Center; to the west, it borders the UPTD Work Area to the
Klangenan Health Center, to the east it borders the UPTD Work Area to the
Plumbon Health Center.
Essential health services at the Jamblang Health
Center include maternal and infant health, preschool and school-age children's
health services, family planning services, immunization services, treatment and
care services, and elderly health services.
Univariate analysis
Table 1. Frequency Distribution of
Midwives' Support for Delivery Exclusive
breastfeeding in the Work Area of the Jamblang Health Center, Cirebon Regency,
in 2020
|
Midwife Support
|
F
|
%
|
|
Support
|
57
|
54,8
|
|
Less Support
|
47
|
45,2
|
|
Total
|
104
|
100
|
Based on Table 1 above regarding the frequency
distribution of midwives' support for exclusive breastfeeding, the number of
respondents who received midwives' support for exclusive breastfeeding was
54.8% (57 respondents) more than respondents who did not receive midwives'
support for exclusive breastfeeding, namely 45 .2% (47 respondents).
This study's results follow previous
research, which said that
the factors of health workers, especially midwives, greatly influence the
success of exclusive breastfeeding (Alianmoghaddam et al., 2017). Where midwives are responsible for providing
education about exclusive breastfeeding and supporting breastfeeding mothers
starting during the pregnancy process, the first time the mother breastfeeds
until the mother is breastfeeding. In addition, midwife support can also give
mothers the confidence to continue giving exclusive breastfeeding to their
babies (Alianmoghaddam
et al., 2017).
According to Government Regulation Number 33 of 2012
Article 13, midwives
are required to provide mothers with exclusive
breastfeeding information and education (Sugianti, 2019). Midwives' support in disseminating exclusive
breastfeeding can be started from prenatal care until the period of exclusive
breastfeeding. The information and education provided include the advantages
and advantages of breastfeeding, maternal nutrition, and preparation and maintenance
of breastfeeding.
The Gambling Community Health Center, Cirebon Regency,
has conducted various exclusive breastfeeding programs, including counseling on
exclusive breastfeeding at Posyandu and during pregnancy checks. The Jamblang
Community Health Center also put up posters regarding exclusive breastfeeding
in several rooms, including the room for pregnancy checks, the nutrition room,
and the patient waiting room. In addition, a breastfeeding room is also
provided at the Puskesmas.
All midwives support exclusive breastfeeding. Where in this case, the
role of midwives as educators and as executors has been carried out to support
breastfeeding mothers. As educators, Midwives provide health education and
counseling to individuals and families, groups, and communities. Even though,
in reality, the phenomenon that occurs in the field when midwives provide
counseling, sometimes mothers do not focus on counseling. Because usually, the
mother's focus is diverted to her baby, who is sometimes fussy or uncomfortable
in crowds.
Table 2. Frequency Distribution of Exclusive
Breastfeeding in Working Areas
Jamblang Community
Health Center, Cirebon Regency, (2020).
|
Exclusive Breastfeeding
|
F
|
%
|
|
Exclusive Breastfeeding
|
47
|
45,2
|
|
Not Exclusive Breastfeeding
|
57
|
54,8
|
|
Total
|
104
|
100
|
Based on Table 2 above regarding the frequency
distribution of exclusive breastfeeding, the number of respondents who did not
give exclusive breastfeeding was 54.8% (57 respondents) more than those who
gave exclusive breastfeeding, namely 45.2% (47 respondents).
Even though the number of respondents who did not give
exclusive breastfeeding was more than the number of respondents who gave
exclusive breastfeeding, this did not affect the activity of this study. One
factor that influences exclusive breastfeeding is the support of health
workers, especially midwives. Midwives are health workers who are closest to
women. Midwife support will determine exclusive breastfeeding behavior
(Ariwati, 2014).
Based on the results of the study, it can be seen that
the majority of mothers who do not get support from midwives to provide
exclusive breastfeeding are as many as 45.2% (47 respondents).
Following Astutik's theory, Reni Yuli (2014) states
that the lack of support from health workers, especially midwives, causes
mothers to lack motivation to provide exclusive breastfeeding.
Bivariate Analysis
After univariate analysis, bivariate analysis was conducted
to see the relationship between the independent variable (midwife support) and
the dependent variable (exclusive breastfeeding) using the Chi-square test with
a significance level of 0.05.
The research results obtained data as
follows:
Table 3. The relationship between
midwife support for breastfeeding
Exclusive in Region Jamblang Health Center Work Cirebon Regency in 2020
|
|
Exclusive
breastfeeding
|
Total
|
|
|
|
|
|
Midwife Support
|
Exclusive breastfeeding
|
Not breast milk Exclusive
|
F
|
%
|
value
|
|
|
|
F
|
%
|
F
|
%
|
|
|
0.038
|
|
Support
|
31
|
29,8
|
26
|
25.0
|
57
|
54,8
|
|
Less Support
|
16
|
15,4
|
31
|
29,8
|
47
|
45,2
|
|
Total
|
47
|
45,2
|
57
|
54,8
|
104
|
100
|
Based on Table 3 above, the results of the analysis of
the relationship between midwives' support for exclusive breastfeeding in the
Jamblang Health Center Work Area, Cirebon Regency, in 2020, using the
Chi-square correlation method found that mothers who received support and gave
exclusive breastfeeding were as many as 29.8% (31 respondents), this percentage
is higher when compared to mothers who receive support and provide exclusive
breastfeeding, namely as much as 25.0% (26 respondents). Meanwhile,
the percentage of mothers who received less support and gave exclusive
breastfeeding, which was 15.4% (16 respondents), was lower compared to mothers
who received less support and did not provide exclusive breastfeeding, namely
29.8% (31 respondents).
Based on the
results of statistical tests using chi-square, the results obtained were p
value = 0.038. If the p-value is <0.05, then Ho is rejected, which means a
relationship exists between midwives' support for exclusive breastfeeding.
This shows
that the success of exclusive breastfeeding is also influenced by the support
of health workers, especially midwives. Mothers who get good support from
midwives will be more confident giving exclusive breastfeeding, but good
support from midwives also cannot fully influence mothers to give exclusive
breastfeeding. This is due to the counseling skills possessed by midwives both
in conveying information and educating mothers about exclusive breastfeeding.
Skills are one of the factors in achieving midwife competence in providing
support.
Good
counseling skills are essential for a midwife because this can foster community
trust in a midwife. In addition, skilled midwives will also feel that they have
good abilities to provide support (Aldianti & Sulistyoningtyas, 2017).
The results
of this study are also consistent with previous research, which stated that
there was a relationship between midwives' support in exclusive breastfeeding
with a p-value <0.05 of 0.037 (Fauziyah et al., 2022). These
results indicate that midwife support is an effort made by midwives to shape
mothers' behavior to provide exclusive breastfeeding.
Following the
theory states that behavior is influenced by the support of health workers
because by being given support by health workers as a reference group, a person
will be able to determine healthy behavior (SUSANTO, 2013).
In addition,
the results of this study are also in line with previous research, which stated
that breastfeeding mothers need more support and help when they start and
continue breastfeeding as their first step in needing assistance since
pregnancy and after delivery (Nuzulia, 2013 ).
Breastfeeding mothers need support for exclusive breastfeeding from midwives,
families, and the surrounding environment (Judistiani, 2016).
However,
midwife support cannot fully influence a mother in exclusive breastfeeding.
Even though midwives have received support from midwives in exclusive
breastfeeding, a small proportion of respondents do not give exclusive
breastfeeding, namely 25.0% (26 respondents). This is because there are several
influencing factors, such as breast milk that does not come out at the time of
delivery, so the baby is immediately given formula milk. Then another factor is
that the mother feels that the breast milk given is not enough for her baby, so
she provides other food besides breast milk before the baby is three months old.
Besides that, the reason for the failure of exclusive breastfeeding is the
culture of giving honey, water, and mashed bananas which are considered
suitable for babies (Husein et al., 2022).
CONCLUSION
Based on the results of
research conducted by researchers, it can be concluded that the percentage of
mothers who received midwife support for exclusive breastfeeding in the working
area of the Jamblang Health Center, Cirebon Regency, was 54.8% (57
respondents), the percentage of mothers who did not exclusively breastfeed was
54.8% ( 57 respondents). This figure still has not reached the national target
of exclusive breastfeeding coverage of 80%. The data was then tested
statistically using the chi-square test with a p-value = 0.038 (<0.05),
which means that Ho was rejected and Ha was
accepted. It can be concluded that there is a relationship between
midwives' support for exclusive breastfeeding in the working area of the
Jamblang Health Center, Cirebon Regency. With a positive contingency
coefficient value of 0.199, which means the level of closeness is meager.
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Received :
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