The Effectiveness of Multilevel Promotion of Exclusive Breastfeeding in Rural Indonesia

Susiloretni, Kun Aristiati; Krisnamurni, Sri; Sunarto, .; Widiyanto, Santo Yosef Didik; Yazid, Ahmad; Wilopo, Siswanto Agus

doi:10.4278/ajhp.120425-quan-221

Cited by 27 publications

(36 citation statements)

References 37 publications

(36 reference statements)

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“…There should be various levels of action and education to include the family, the community, health staff, retailers, companies, and local and central governments. 10,33,37 Furthermore, large-scale community education to promote breastfeeding and safe feeding practices is needed, particularly to counteract the years of formula promotion. Families, especially young women and adolescent females, must receive adequate education and information to make well-informed infant feeding decisions.…”

Section: Lessons From the Formula Industrymentioning

confidence: 99%

“…There is evidence that in countries where an authority has the power to draft regulations and monitor and enforce them, compliance with the Code can be successful. 10,[32][33][34]37 Political agreement on the Code must be backed by local regulations and adapted to a country's specific conditions in order to regulate all individuals acting as intermediaries in formula promotion (good examples are India, Indonesia, and Pakistan). 5,8,14,15,33,36,39 Effective partnerships, focused strategies, and community-based actions can indeed double the rates of EBF in a relatively short time (as demonstrated in the state of Assam).…”

Section: Lessons From the Formula Industrymentioning

confidence: 99%

“…4 Indonesia passed a very strict law with precise penalties for Code violations in 2011, ranging from fines of 100 million rupiah (approximately US$7572.90) to a 1-year prison term. [32][33][34] Exclusive breastfeeding rates among infants < 6 months of age increased from 32% in 2007 to 42% in 2012. However, implementation of the law remains poor and formula companies continue to promote BMS.…”

mentioning

confidence: 99%

“…However, implementation of the law remains poor and formula companies continue to promote BMS. 14,[32][33][34] India has one of the most stringent legislations protecting breastfeeding. 4 The sale of infant formula remains low, but EBF rates (46% among infants < 6 months old) are not increasing, suggesting other challenges.…”

mentioning

confidence: 99%

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Enforcing the International Code of Marketing of Breast-milk Substitutes for Better Promotion of Exclusive Breastfeeding

Hubert

Slesak²,

Goyet

et al. 2015

J Hum Lact

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Exclusive breastfeeding, one of the best natural resources, needs protection and promotion. The International Code of Marketing of Breast-milk Substitutes (the Code), which aims to prevent the undermining of breastfeeding by formula advertising, faces implementation challenges. We reviewed frequently overlooked challenges and obstacles that the Code is facing worldwide, but particularly in Southeast Asia. Drawing lessons from various countries where we work, and following the example of successful public health interventions, we discussed legislation, enforcement, and experiences that are needed to successfully implement the Code. Successful holistic approaches that have strengthened the Code need to be scaled up. Community-based actions and peer-to-peer promotions have proved successful. Legislation without stringent enforcement and sufficient penalties is ineffective. The public needs education about the benefits and ways and means to support breastfeeding. It is crucial to combine strong political commitment and leadership with strict national regulations, definitions, and enforcement. National breastfeeding committees, with the authority to improve regulations, investigate violations, and enforce the laws, must be established. Systematic monitoring and reporting are needed to identify companies, individuals, intermediaries, and practices that infringe on the Code. Penalizing violators is crucial. Managers of multinational companies must be held accountable for international violations, and international legislative enforcement needs to be established. Further measures should include improved regulations to protect the breastfeeding mother: large-scale education campaigns; strong penalties for Code violators; exclusion of the formula industry from nutrition, education, and policy roles; supportive legal networks; and independent research of interventions supporting breastfeeding.

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Section: Lessons From the Formula Industrymentioning

confidence: 99%

Section: Lessons From the Formula Industrymentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Enforcing the International Code of Marketing of Breast-milk Substitutes for Better Promotion of Exclusive Breastfeeding

Hubert

Slesak²,

Goyet

et al. 2015

J Hum Lact

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“…Pakistan Cross-sectional X X Ssenyonga et al (38) 353 Uganda Cross-sectional X Suresh et al (53) 400 India Cohort Susiloretni et al (20) 541 Indonesia Cross-sectional X X Tamiru et al (22) 382 Ethiopia Cross-sectional X X Tiwari et al (15) 279 India Cross-sectional X Ugboaja et al (16) …”

mentioning

confidence: 99%

Addressing barriers to exclusive breast-feeding in low- and middle-income countries: a systematic review and programmatic implications

Kavle¹,

LaCroix²,

Dau³

et al. 2017

Public Health Nutr.

147

141

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Objective: Despite numerous global initiatives on breast-feeding, trend data show exclusive breast-feeding (EBF) rates have stagnated over the last two decades. The purpose of the present systematic review was to determine barriers to exclusive breast-feeding in twenty-five low-and middle-income countries and discuss implications for programmes. Design: A search of Scopus, MEDLINE, CINAHL and PsychINFO was conducted to retrieve studies from January 2000 to October 2015. Using inclusion criteria, we selected both qualitative and quantitative studies that described barriers to EBF. Setting: Low-and middle-income countries. Subjects: Following application of systematic review criteria, forty-eight articles from fourteen countries were included in the review. Results: Sixteen barriers to EBF were identified in the review. There is moderate evidence of a negative association between maternal employment and EBF practices. Studies that examined EBF barriers at childbirth and the initial 24 h postdelivery found strong evidence that caesarean section can impede EBF. There is moderate evidence for early initiation of breast-feeding and likelihood of practising EBF. Breast-feeding problems were commonly reported from crosssectional or observational studies. Counselling on EBF and the presence of family and/or community support have demonstrated improvements in EBF. Conclusions: Improving the counselling skills of health workers to address breastfeeding problems and increasing community support for breast-feeding are critical components of infant and young child feeding programming, which will aid in attaining the 2025 World Health Assembly EBF targets. Legislation and regulations on marketing of breast-milk substitutes, paid maternity leave and breast-feeding breaks for working mothers require attention in low-and middle-income countries.

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What Works to Improve Duration of Exclusive Breastfeeding: Lessons from the Exclusive Breastfeeding Promotion Program in Rural Indonesia

Susiloretni

Hadi

Prabandari

et al. 2014

Matern Child Health J

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The aim of the study was to identify determinants of exclusive breastfeeding (EBF) at the individual, family, community, and organizational level. This study was a secondary analysis of data from a multilevel promotion of EBF program in two rural public health centers (PHCs) in the Demak district, Central Java, Indonesia. The program was a quasi-experimental study with a pretest-posttest control group. A total of 599 participants were enrolled, consisting of 163 mother infant pairs, 163 fathers, 163 grandmothers, 82 community leaders, and 28 midwives. EBF duration and its determinants were measured and analyzed using Cox proportional-hazard model. Mothers with a high level of breastfeeding knowledge had the greatest EBF duration. Mothers who had a knowledge score >80 had a 73 % (HR 0.27, 95 % CI 0.15, 0.48) greater chance of EBF compared to mothers who had a knowledge score of <60. Factors which shortened EBF duration were grandmother's lack of support for EBF (HR 2.04, 95 % CI 1.33, 3.14), received formula samples at discharge (HR 1.99, 95 % CI 1.25, 3.16), and maternal experience of breast engorgement (HR 1.97, 95 % CI 1.32, 2.94). High maternal breastfeeding knowledge was the only factor associated with longer duration of EBF. Barriers to EBF were breast engorgement, receiving formula samples at discharge, and a grandmother's lack of support for EBF.

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The Effectiveness of Multilevel Promotion of Exclusive Breastfeeding in Rural Indonesia

Abstract: Multilevel promotion can prolong the duration and increase the prevalence of EBF.

Cited by 27 publications

References 37 publications

Enforcing the International Code of Marketing of Breast-milk Substitutes for Better Promotion of Exclusive Breastfeeding

Enforcing the International Code of Marketing of Breast-milk Substitutes for Better Promotion of Exclusive Breastfeeding

Addressing barriers to exclusive breast-feeding in low- and middle-income countries: a systematic review and programmatic implications

What Works to Improve Duration of Exclusive Breastfeeding: Lessons from the Exclusive Breastfeeding Promotion Program in Rural Indonesia

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