Inhibitor Factors of Early Initiation of Breastfeeding

by Postpartum Mothers in Zainoel Abidin

General Hospital Banda Aceh

Wardiati

, Rosnila

and Basri Aramico

Faculty of Public Health, University Muhammadiyah Aceh, Jl.Kampus Unmuha, Banda Aceh, Indonesia

Keywords: Early initiation of breastfeeding, midwife’s role, maternal employment status, family support.

Abstract: Early Initiation of Breastfeeding (EIB) is a program by the Health Ministry of the Republic of Indonesia.

Various studies had confirmed the benefit of EIB implementation to maternal and newborns’ health. The

study aims to determine the inhibitor factors of EIB implementation in Zainoel Abidin General Hospital

Banda Aceh. The study uses Cross-sectional design. The population included mothers who underwent

normal delivery in Zainoel Abidin General Hospital in February 2018, totaling 231 people. Simple Random

Sampling method was used to determine the sample. The data were analyzed using bivariate and

multivariate analysis with Chi-square test and Multiple Logistic Regression. The results showed a

significant relation between maternal employment status, number of children, knowledge, family support,

and midwife’s role (p-value <0.05) and the EIB implementation. On Multivariate analysis, midwife’s role

(p-value: 0.001; OR: 10.92; CI: 2.88 - 38.09) was found as the main inhibitor factors of EIB

Implementation, meanwhile maternal employment status (p-value: 0.016; OR: 6,660; CI: 1,424 - 31.150)

comes next. In conclusion, less participation of midwives is the main inhibitor factors of EIB

implementation in Zainoel Abidin General Hospital Banda Aceh.

1 INTRODUCTION

Early Initiation of Breastfeeding (EIB) is an activity

of putting a newborn baby on the mother's chest to

begin the breastfeeding process, which is conducted

within the first hour of life (WHO, 2008). According

to UNICEF and WHO (2018), most newborns in the

world were not directly breastfed either because of

habit or medical reason. In 2017, it was estimated

that 78 million newborns did not accept the EIB

process in the first hour of life. Globally, only 42%

of newborns received the EIB process in the first

hour of life. The highest percentage of EIB

implementation in the world was discovered in East

and South Africa region. Meanwhile, the lowest was

in East Asia and the Pacific.

Every year, it is estimated that 9 out of 10

newborns in Burundi, Sri Lanka, and Vanuatu

received EIB Initiation. On the other hand, only 2

out of 10 newborns in Azerbaijan, Chad, and

Montenegro had it (UNICEF & WHO, 2018; WHO,

2018).

EIB is an effective method to prevent newborns

death, as well as giving long-term health benefit for

both baby and mother (UNICEF & WHO, 2018).

Numerous studies have shown the advantage of

breastfeeding process within the first hour of life.

For instance, it has proven to reduce the risk of

newborns death and prolong exclusive breastfeeding

process. On the contrary, breastfeeding after the first

hour of life could increase the risk of newborn death

(Edmond et al., 2006; Smith et al., 2017; Bisrat,

Kenzudine, & Bossena, 2017; Suparmi & Saptarini,

2016). Furthermore, the EIB process is beneficial for

maternal health. Mothers who implement EIB

directly after deliveries have lower rates of

postpartum depression compared to those who

postpone it. Moreover, the EIB process is important

for both baby and mother in term of psychological

and physical relationships (Pope & Mazmanian,

2016; Sharifi, Nouraei, & Shahverdi, 2016).

Various studies have revealed the contributing

factors for inhibiting EIB Process. First is maternal

factor, consisting of maternal age, education,

knowledge, attitudes, maternal employment status,

Wardiati, ., Rosnila, . and Aramico, B.

Inhibitor Factors of Early Initiation of Breastfeeding by Postpartum Mothers in Zainoel Abidin General Hospital Banda Aceh.

DOI: 10.5220/0008371900400043

In Proceedings of the 1st International Conference on Social Determinants of Health (ICSDH 2018), pages 40-43

ISBN: 978-989-758-362-9

and parity. Second is family factor that consists of

husband/family support and family income, place of

deliveries, health workers, and culture (Bisrat et al.,

2017; Elyas, Mekasha, Admasie, & Assefa, 2017;

Liben & Yesuf, 2016; Syam & Amiruddin, 2015).

According to the study, the inhibiting factors of

EIB implementation in Indonesia are varied,

depending on geographic and demographic

conditions. However, various studies have stated

that the main inhibiting factors of EIB are socio-

economic and cultural factors, type of delivery,

place of delivery, attitude, knowledge, family

support, and the health workers factors (Bernolian,

2017; Sirajuddin, Abdullah, & Lumula, 2013;

Suparmi & Saptarini, 2016).

According to the Regulation of the Minister of

Health No. 25 of 2014 and the Standard Operating

Procedure (SOP), Zainoel Abidin General Hospital

is required to implement EIB process to newborn

baby within the first hour after delivery. However, it

has not been implemented properly. Based on a

report of EIB implementation in Zainoel Abidin

General Hospital in 2017, the coverage was 53.7%

(RSUZA, 2018). The number increased slightly

compared to previous year, which was 52.1%. The

study was aimed to find out inhibiting factors of EIB

implementation in Zainoel Abidin General Hospital

Banda Aceh.

2 SUBJECTS AND METHODS

This research was carried out in Zainoel Abidin

General Hospital Banda Aceh in February 2018. The

population includes mothers who underwent normal

delivery in February, totaling 231 people. The

sample of 65 respondents was selected using Simple

Random Sampling method. This study used Cross-

sectional design. Data collection was done through

interview and questionnaire. The instruments

validity and reliability had been tested before they

were used. The interview was carried out after the

samples were transferred to the treatment room

(Arafah Room III). Univariate analysis was

performed to determine the frequency distribution of

each variable. Bivariate analysis using Chi-Square

test was employed to identify the relationship among

variables, while multivariate analysis using Multiple

Logistic Regression tests with Backward

Conditional method was used to identify the

inhibitor factors of EIB implementation in Zainoel

Abidin General Hospital.

3 RESULT

Most of the respondents participated in this study

were 20-35 years old (87.7%). As much as 61.5% of

respondents completed high school and 23.2%

completed Diploma/Bachelor Degree. Based on the

result, 67.7% of the respondents did not perform

EIB in the first hour after the delivery.

Table 1. Bivariate analysis.

Bivariate analysis showed a significant relation

between maternal employment status and the EIB

implementation (p-value: 0.014). Most of the

working mothers choose not to implement EIB. In

addition, the number of children is related to the

implementation of EIB. The mothers who have more

than two children prefer not to implement the EIB.

Family support is related to implementation of EIB

(p-value: 0.005). Mothers who received less family

support chose to not implement EIB. Furthermore,

this study found a relation between midwife’s

treatment and EIB implementation (p-value: 0.001).

Those who were less assisted by midwives chose not

to perform EIB compared. However, this study did

not confirm the significant relation among mother’s

knowledge (p-value: 0.158), mother’s attitude (p-

value: 0.590), and ANC utilization services (p-value:

Inhibitor Factors of Early Initiation of Breastfeeding by Postpartum Mothers in Zainoel Abidin General Hospital Banda Aceh

0.578) with EIB implementation. The result of

multivariate analysis is shown in table 2.

Table 2. Multivariate analysis result

Among the 5 qualified variables to be performed

in multivariate analysis, 2 variables are consistent as

inhibitor factors of EIB implementation, which are

maternal employment status (p-value: 0.016; OR:

6.66; CI: 1.42 – 31.15) and midwives role (p-value:

0.001; OR: 10.33; CI: 2.82 – 38.09). Respondents

who were assisted by a midwife with less

contribution in the implementation EIB have 10.3

times possibility to not performing EIB.

Furthermore, the working respondents have 6.6

times more possibility to not performing EIB.

4 DISCUSSION

This research found that maternal employment status

is the inhibitor factors of EIB implementation.

Similar result was obtained by previous studies

(Khanal, Scott, Lee, Karkee, & Binns, 2015, Titaley,

Loh, Prasetyo, Ariawan, & Shankar, 2014). The

bivariate analysis showed a higher proportion of EIB

implementation in unemployed mothers. Similar fact

was found in the research conducted in Turkey

(Yılmaz et al., 2017) and Nepal (Khanal et al.,

2015). Unemployed mothers have enough leisure

time to access information related to family health.

Moreover, unemployed mother utilizes the ANC

service optimally during pregnancy. Similar results

were found in the research conducted by

Danasekaran et al (2017) and Srivastava et al (2014).

Access to information resources and ANC utilization

services will increase the mother's knowledge and

awareness regarding health. Mothers who

completely utilize ANC services generally have

better knowledge related to pregnancy, labor, and

breastfeeding/Early Initiation Breastfeeding.

Furthermore, midwives role is the main inhibitor

factors of EIB implementation in Zainoel Abidin

General Hospital Banda Aceh. This study revealed

that respondents accompanied and fully helped by

the midwives were successful (60%) in

implementing EIB, while those with less

contributing midwives were not really successful

(15%). The results were relevant with the study

conducted in Nepal by Adhikari, Khanal, Karkee,

and Gavidia (2014) and Ariyani and Handayani

(2015) at Pulang Pisau Hospital, Central

Kalimantan. Midwife’s role is strongly required to

perform EIB since a mother’s physical and

psychological conditions are in exhaustion after the

delivery. Therefore, midwife's role is needed to

motivate and guide the mother to implement the

EIB.

This research is one of the studies reporting the

implementation of EIB in hospitals in Indonesia.

This study has several weaknesses, including limited

research duration and sample size. Furthermore, the

researcher did not directly observe the EIB process

during the first hours of life due to limited access to

the delivery room. In general, the results of this

study are relevant to various researches that have

been published.

5 CONCLUSION

According to the results and discussion, it can be

concluded that only two variables play important

role as inhibitor factors of EIB implementation:

midwives role and maternal employment status. In

particular, midwives role is the most influential

factors on EIB implementation in Zainoel Abidin

General Hospital Banda Aceh. Therefore, periodic

monitoring and evaluation are required to be

conducted by Zainoel Abidin General Hospital to

ensure that each newborn in the hospital goes

through EIB process.

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Variables

S.E

Wald

Maternal

employment

status

1.89

.787

5.80

0.016

6.66

(1.42-31.15)

Midwives

role

2.33

.664

12.43

0.001

10.33

(2.82-38.09)

ICSDH 2018 - International Conference on Social Determinants of Health

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Inhibitor Factors of Early Initiation of Breastfeeding by Postpartum Mothers in Zainoel Abidin General Hospital Banda Aceh