Determinants of Optimal Breastfeeding Practices in Indonesia: Findings From the 2017 Indonesia Demographic Health Survey

Abstract

Objectives: Understanding the factors influencing mothers’ decision to breastfeed their infants is essential to formulate effective breastfeeding interventions. This study explored the determinants of optimal breastfeeding indicators in Indonesia.Methods: We used the 2017 Indonesia Demographic and Health Survey to analyze factors associated with early initiation of breastfeeding, exclusive breastfeeding (EBF), and continued breastfeeding at 1 year (CBF-1) and 2 years (CBF-2). Multivariate logistic regression models were used to examine bio-demographic, socio-cultural, and behavioral characteristics associated with breastfeeding after considering the survey design effect.Results: The risk of delayed breastfeeding initiation was higher among infants who were born smaller, first-born children, were delivered via cesarean delivery, and did not have immediate skin-to-skin contact (p<0.01). Infant’s age, birth pattern, household wealth index, and the mother’s occupation and smoking status were predictors of EBF (p<0.05). CBF-1 was less common among first-time mothers and those working in the non-agricultural sector, mothers from wealthier families, and mothers who had cesarean deliveries (p<0.01). Infant’s age was negatively associated with CBF-2 (adjusted odds ratio [aOR], 0.85; 95% confidence interval [CI], 0.74 to 0.99). Mothers attending college were less likely to practice CBF-2 than those with no education or primary education (aOR, 0.45; 95% CI, 0.26 to 0.77). The absence of postnatal visits was a risk factor for CBF-1 and CBF-2 (p<0.05).Conclusions: Breastfeeding interventions in Indonesia should pay particular attention to at-risk groups such as women from wealthier families, working outside the agricultural sector, and with a higher education level. Nutrition-sensitive programs (e.g., postnatal care and smoking cessation) should also be encouraged.

Association between Skin-to-Skin Contact Duration after Caesarean Section and Breastfeeding Outcomes

“…Skin-to-skin contact was defined as the placement of a dried, naked infant, with the head covered by a dry cap to prevent heat loss, directly on the bare chest of the mother immediately after a CS, without separation and with the exposed back of the infant covered by warm blankets or a towel [ 6 ]. Duration of SSC was defined as the period of direct SSC contact between the bare skin of the mother and newborn.…”

“…The optimal route for breastfeeding recommended by World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) includes early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF) for up to 6 months and continuation of breastfeeding for up to 2 years or beyond [ 2 , 3 ]. Optimal breastfeeding practices are associated with reduced newborn and child morbidity and mortality and have potential long-term benefits for both mother and child [ 4 , 5 , 6 ]. Despite strong evidence for the nutritional and immunological benefits of breastfeeding in promoting maternal and child health, only 48% of newborns globally and 29% in China initiate breastfeeding within the first hour after birth [ 7 ].…”

Trends and determinants of early initiation of breastfeeding in Indonesia: A multivariate decomposition analysis

“…Caesarean delivery has been widely accepted as a critical barrier to EIBF in almost all countries, including Indonesia [ 23 , 32 , 33 , 36 , 37 ]. An increase of almost 20% (2017) in the rate of caesarean deliveries had a negative contribution to the change in EIBF.…”

“…The result also aligned with a previous analysis of LMIC settings [ 39 ]. Determinants analyses also conclude that EIBF is less common among infants who are smaller than average as perceived by mothers [ 32 , 49 , 50 ], as these infants may have specific conditions, such as an illness, that require them to be separated from the mothers for necessary treatments in the Neonatal Intensive Care Unit (NICU). An area for improvement also includes the hospital policy that continues to separate mothers and infants after birth, even when both are in good health [ 51 ].…”

“…Therefore, before running the decomposition analysis, we did initial screenings for variables to be included in the decomposition model by fitting each of those into three logistic models adjusted for forced variables. Maternal education, paternal education, wealth index, region, birth pattern, perceived birth size, caesarean delivery, and place of birth were set as the forced covariates as those have been identified as important determinants of EIBF in Indonesia [ 31 , 32 ] and other countries [ 23 , 33 ]. These models used the samples of 2007, 2017, and both 2007 and 2017 surveys, where in the last one, the survey year was fitted as a fixed effect.…”