International Journal of Public Health Science (IJPHS)

Vol. 99, No. 1, Month 2099, pp. 1~1x

ISSN: 2252-8806, DOI: 10.11591/ijphs.v99i1.paperID  1

Factors Affecting Exclusive Breastfeeding

Sri Wahyuni1, Sigit Ambar Widyawati2, Alfan Afandi3

1
Public Health Study Program, Faculty of Health Science, Universitas Ngudi Waluyo, Semarang, Indonesia
2
Public Health Study Program, Faculty of Health Science, Universitas Ngudi Waluyo, Semarang, Indonesia
3
Public Health Study Program, Faculty of Health Science, Universitas Ngudi Waluyo, Semarang, Indonesia

Article Info ABSTRACT

Article history: Exclusive breastfeeding is breastfeeding only for babies up to 6 months
without additional fluids or other foods Other foods and drinks referred to
Received month dd, yyyy include water, formula milk, oranges, honey, tea water, or solid foods such
Revised month dd, yyyy as bananas, papayas, milk porridge, biscuits, rice porridge, and team.
Accepted month dd, yyyy Exclusive breastfeeding for 6 months is recommended by international
guidelines that are based on scientific evidence about the benefits of
breastfeeding for babies, mothers, families, and countries. The purpose of
Keywords: this study was to determine the factors that influence exclusive
breastfeeding. This research method uses simple random sampling ,
Exclusive Breastfeeding respondents were selected by random sampling as many as 95 respondents.
Knowledge The results of this study found that 62 respondents (65%) gave exclusive
Education breastfeeding and 33 people did not breastfeed (35%). Based on the results
of the Chi-Square analysis, it was found that there was a significant
relationship between the level of knowledge (p = 0.001), age (p = 0.036),
and education level (p = 0.001) with exclusive breastfeeding. Increase
knowledge by promoting health and counseling about the benefits and
process of exclusive breastfeeding.
This is an open access article under the CC BY-SA license.

Corresponding Author:
Sigit Ambar Widyawati
Public Health Study Program, Faculty of Health Science, Universitas Ngudi Waluyo, Semarang, Indonesia

Email: [email protected]

1. INTRODUCTION
One of the national development goals is to build quality Human Resources (HR) so that they can
continue the struggle for national development towards a prosperous, just and prosperous family. To produce
quality human resources, one of them is by fulfilling nutrition in childhood. Nutritional problems can have an
impact on growth, intelligence and long-term health. However, most of these can be prevented by giving the
gold standard of optimal infant and child food, namely early initiation of breastfeeding (IMD), exclusive
breastfeeding, complementary foods with balanced nutrition, breastfeeding for up to 2 years or more. Data in
Indonesia states that, 9 out of 10 mothers who have ever breastfed, 51.5% gave only breast milk and only 3
months, 44% at birth received other intakes (IDHS, 2017). For this reason, it is important to improve the
health and nutritional status of the community (National Team for the Acceleration of Poverty Reduction [1].
In order to prepare reliable human resources, the Indonesian government implements various
programs including the fulfillment of nutrition for newborns with breastfeeding programs until the age of 2
years and exclusively for 6 months. In general, a mother produces milk, which we call breast milk) as a
natural food provided for babies [2]. Breastfeeding is the safest food choice for babies when there is limited
access to food and health services. Breast milk has a high antibody content so that it increases the baby
immune system [3]. According to WHO [4] , exclusive breastfeeding is no other food or drink, even water,

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2  ISSN: 2252-8806

except breast milk for six months including syrups consisting of vitamins, mineral supplements or drugs, and
others [5]. In addition, breastfeeding can reduce family spending, where during the pandemic many families
experience a decrease in financial income due to large-scale social restrictions.
Breastfeeding is a scientific process, millions of mothers around the world successfully breastfeed
their babies without ever reading a book about breastfeeding. Along with the times, there is also an increase
in knowledge about breastfeeding which is sometimes forgotten. Whereas losing knowledge about
breastfeeding means a big loss, because breastfeeding is a knowledge that for millions of years has an
important role in maintaining human life [2]. However, the mother reluctance to give colostrum is due to the
belief that colostrum is a dirty liquid/dirty milk, the yellow color is not good for babies and even causes
stomach pain. This reluctance can be caused by knowledge factors, educational factors, experience factors,
cultural and socio-economic factors [6]. Another problem besides giving colostrum is the mother reluctance
to give exclusive breastfeeding. A study in Nigeria states that babies who do not get exclusive breastfeeding
are caused by basic education and the absence of maternal education [7]. The purpose of this study was to
determine the factors that influence exclusive breastfeeding.

2. METHOD
The type of research used in this research is quantitative research with a cross sectional approach. This
research method uses simple random sampling.The selected respondents were all mothers who had babies aged
0-6 months as many as 95 respondents who were in the Working Area of the Bergas Public Health Center,
Semarang Regency, Central Java Province, Indonesia. This type of research is an analytic survey with a cross
sectional approach. The statistical test used is Chi Square. The independent variable in this study was the
mother level of knowledge, the source of information about exclusive breastfeeding, with the dependent
variable being exclusive breastfeeding.

3. RESULTS AND DISCUSSION (10 PT)

Table 1. Frequency Distribution Based on Exclusive Breastfeeding
No. Exclusive Breastfeeding Frequency (f) Percentage (%)
1 Exclusive Breastfeeding 62 65
2 No Exclusive Breastfeeding 33 35
Total 95 100

Based on table 1, it is known that respondents who gave exclusive breastfeeding were 62
respondents (65.0%), while not exclusive breastfeeding were 33 respondents (35.0%). Exclusive
breastfeeding is breastfeeding without any additional food and drink for infants aged 0-6 months. Other foods
and drinks referred to include water, formula milk, oranges, honey, tea water, or foods such as bananas,
papaya, milk porridge, biscuits, rice porridge, and team. A baby digestive system before the age of 6 months
is immature. The baby intestinal pores are still open. Meanwhile, food other than breast milk is not
necessarily hygienic. If bacteria in food enter the pores of the baby intestine and are carried by the
bloodstream, it is very dangerous for the baby and causes the baby to easily experience diarrhea. Breast milk,
besides always being available in a clean and hygienic condition, also contains immune substances that can
coat the baby digestive system. Therefore, only giving breast milk to infants up to the age of 6 months can
increase the baby body resistance to disease [2].
Some nutritionists agree that breast milk contains DHA and AA which are needed for brain
development. Exclusive breastfeeding for the first 6 months after the birth of the baby has two positive
effects. First, the smooth process of breastfeeding allows for maximum nutritional intake. This is due to the
good interaction between mother and baby, which is established when breastfeeding. Second, based on the
results of research in Denmark, it is known that babies who are breastfed for more than 9 months will grow
smarter [8].
The baby need for nutrients is very high to maintain his life. These needs can be fulfilled if the baby
gets breast milk. Breast milk is divided into 3, namely colostrum breast milk, transitional breast milk, and
mature breast milk [9]. The first milk that comes out is generally a clear, yellowish liquid called colostrum.
The colostrum usually comes out on the first day to the fourth/seventh day. Colostrum should be given as
early as possible after the baby is born, because colostrum contains more antibodies than mature breast milk,
and can provide protection for babies until the age of 6 months (Soetjiningsih, 1997). The definition of
exclusive breastfeeding is a baby who receives only breast milk. No other liquids or solids are given, not
even water, except for oral rehydration solutions or drops/syrups or vitamins, minerals or drugs (WHO,
2018).

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3Int J Public Health Sci ISSN: 2252-8806 

Breast milk is a white liquid produced by the mother breast glands through the breastfeeding process
(Khasanah, 2011). Breast milk is food prepared for babies, starting during pregnancy, the breasts have
changed to produce breast milk. Foods that are mixed using modern technology cannot match the advantages
of breast milk because breast milk has a high nutritional value compared to man-made food or milk derived
from cows, buffaloes or goats. Electrophoretic, chromatographic and radio immunoassay proved that breast
milk, especially colostrum, contains immunoglobulins, namely secretory IgA (SigA), IgE, IgM, and IgG.
Antibodies in breast milk can survive in the baby digestive tract because they are resistant to acids and
proteolytic enzymes of the digestive tract and create a layer on the mucosa to prevent pathogenic bacteria and
enteroviruses from entering the intestinal mucosa. In the feces of breastfed babies there are bacteria E. coli in
high concentrations so that the number of bacteria E. coli in the baby stool is also low. In breast milk, in
addition to antibodies, there are E. coli It has also been proven the presence of antibodies against Salmonella
typhi, Shigella, and antibodies against viruses such as rotavirus, polio and measles. Antibodies contained
high rotavirus in colostrum which then dropped in the first week and lasted until the age of 2 years. In breast
milk also found antigens against Helicobacter jejuni cause of diarrhea. The levels in colostum are high and
decrease at the age of 1 month and then persist during breastfeeding [6].

Table 2. Frequency Distribution of Respondents Based on Mother Knowledge Level About

Exclusive Breastfeeding
No. Knowledge Level Frequency (f) Percentage (%)
1 Average 22 23
2 Good 73 77
Total 95 100

Based on table 2, it can be seen that the majority of respondents have good knowledge about breast
care, giving colostrum and exclusive breastfeeding ie 77%, while respondents who have sufficient knowledge
only 23%.
Exclusive breastfeeding is regulated in Government Regulation Number 33 of 2012. The regulation
of exclusive breastfeeding aims to: 1) ensure the fulfillment of the baby requirement to receive exclusive
breastfeeding from birth to 8 (six) months of age by taking into account growth and development; 2) provide
protection to mothers in providing exclusive breastfeeding to their babies; and 3) increasing the role and
support of families, communities, and government for exclusive breastfeeding.
Breastfeeding contributes to maternal health and well-being; help give children space, reduce the
risk of ovarian cancer and breast cancer, increase family and national resources, is a safe and environmentally
friendly way of feeding [10]. Currently, the application of the best feeding pattern for babies from birth to the
age of 2 (two) years has not been implemented properly, especially in terms of exclusive breastfeeding. Some
of the obstacles in exclusive breastfeeding are because the mother is not confident that she is able to
breastfeed properly so that it can meet all the needs of the baby. This is partly due to the lack of knowledge
of mothers, lack of family support and low public awareness about the benefits of exclusive breastfeeding.
The government regulations no. 33 of 2012, In addition, the lack of support from health workers, health
service facilities, and baby food producers for the success of mothers in breastfeeding their babies.

Table 3. Frequency Distribution of Respondents Based on Maternal Age Category

No. Category Mother Age Frequency (f) Percentage (%)
1 Less than 20 years 21 22
2 20-35-years-old 57 60
3 More than 35 years 17 18
Total 95 100

Based on table 3, it can be seen that the age of 57 respondents (60%) are 20-35 years, 21
respondents (22%) are less than 20 years old, and 17 respondents (18%) are more than 35 years old. Maternal
age is related to readiness in breastfeeding. The ideal age for mothers to produce optimal breast milk is 20-35
years. The age range has reached the physical and spiritual maturity of the mother. Age less than 20 years is a
period of growth for reproductive people (breasts), while those over 35 years of age have weakened
reproductive organs, so the ability to exclusively breastfeed is not optimal due to decreased function of
reproductive organs [11].

Table 4. Frequency Distribution of Respondents Based on Mother Last Education

No. Mother Last Education Frequency (f) Percentage (%)
1 Primary school 11 11.6
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2 Secondary school 20 21.2

3 High School 47 49,5
4 University 17 17.9
Total 95 100
Based on table 4, the frequency distribution of respondents based on their mother last education,
most of them have a high school education as many as 47 respondents (49.5%), 20 respondents (21.2%) with
junior high school education, 17 respondents (17.9%) with education end of college, and 11 respondents
(11.6%) with elementary education. The mother final education level can be a factor in exclusive
breastfeeding to the baby. The level of education affects knowledge and behavior formation, the higher the
level of education, the mother has a higher curiosity about the growth and development of her baby, has
better knowledge of nutrition, understands the benefits of breastfeeding for babies, and the basics of
exclusive breastfeeding [12] .
The level of education will encourage the willingness to know something, mothers who have higher
education are more likely to know the benefits of breastfeeding for babies compared to those with low
education. This explains that individuals with higher education can more easily find out something or easily
understand the information obtained compared to those with low levels of education (Notoatmodjo, 2003).

Table 5. Frequency Distribution of Respondents Based on the Relationship of Mother Knowledge Level with
Exclusive Breastfeeding
Exclusive Breastfeeding
Mother
Exclusive No Exclusive Total 2
No. Knowledge
Breastfeeding Breastfeeding
Level
f % f % f %
1 Good 55 75.3 18 24/7 73 100
0.001
2 Average 7 31.8 15 68.2 22 100
Total 62 65.3 33 34.7 95 100

Table 5 shows that as many as 55 respondents (75.3%) have a good level of knowledge and carry
out exclusive breastfeeding. There are 18 respondents (24.7%) with a good level of knowledge but do not do
exclusive breastfeeding. The results of bivariate analysis obtained p value of 0.001 < alpha 0.05, then there is
a relationship between the level of knowledge of mothers with exclusive breastfeeding. The results of this
study are in line with Lindawati research (2019) in Cigemblong Lebak (Banten) with a p value of 0.028 for
the relationship between knowledge and exclusive breastfeeding. given additional food and do not understand
the benefits of breastfeeding for infants [13].
Knowledge is the result of knowing and occurs after people sense a certain object. Sensing occurs
through the five human senses, namely the senses of sight, hearing, smell, taste, and touch. Most of human
knowledge is obtained through the eyes and ears. Knowledge or cognitive is a very important domain in
shaping individual actions (overt behavior) (Notoatmodjo, 2012). Knowledge is a predisposing factor which
is an important domain in shaping individual behavior.
Knowledge is an important domain in the formation of individual behavior. Behavior is influenced
by knowledge, understanding, awareness, and a positive attitude or willingness to accept or apply in
everyday life. Good knowledge about exclusive breastfeeding will make it easier for a mother to give or
practice exclusive breastfeeding. The knowledge factor is the cause of the mother behavior to provide
exclusive breastfeeding, because knowledge can be the basis or motivation for individuals in making
decisions [14].
Good knowledge of mothers about the benefits of exclusive breastfeeding causes the formation of a
decision to give exclusive breastfeeding compared to mothers with less knowledge, they will prefer to give
formula milk to their babies [15]. Based on the results of a study conducted in Wuhan, 70% of mothers
believed that good breastfeeding to meet the nutritional adequacy of infants should be given for 6 months
without additional food or drink. In addition, as many as 74% of mothers have a good understanding of the
process of good breastfeeding not only given every 2 to 3 hours, but good breastfeeding is also seen from the
condition of the baby (when the baby is hungry) [16] .

Table 6. Frequency Distribution of Respondents Based on the Relationship of Maternal Age with Exclusive
Breastfeeding
No. Mother Age Exclusive Breastfeeding Total 2
Exclusive No Exclusive

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Breastfeeding Breastfeeding
f % f % f % 0,036
1 Less than 20 10 47.6 11 52.4 21 100
years
2 20-35-years-old 43 75.4 14 24/6 57 100
3 More than 35 9 52.9 8 47.1 17 100
years
Total 62 65.3 33 34.7 95 100

Table 6 shows the data on the frequency distribution of respondents based on the relationship
between maternal age and exclusive breastfeeding, the majority of respondents who gave exclusive
breastfeeding were aged 20-35 years as many as 43 people (75.4%). Exclusive breastfeeding at the age of
more than 35 years was carried out by 9 respondents (52.9%) and at the age of less than 20 years there were
10 respondents (47.6%). The largest percentage of respondents did not give exclusive breastfeeding at the
age of less than 20 years as many as 11 people (52.4%) while at the age of more than 35 years there were 8
respondents (47.1%).
The results of Chi Square analysis resulted in a p value of 0.036 < alpha 0.05, it can be concluded
that there is a relationship between maternal age and exclusive breastfeeding. The results of this study are in
line with research conducted by Elham et al (2020) in Rasht City (Iran) with a p value of 0.0001, explaining
that exclusive breastfeeding is mostly carried out by 20-35 years. This can be due to the readiness of the
mother age in breastfeeding and experience in exclusive breastfeeding [17]. Exclusive breastfeeding for
babies is mostly done by mothers aged 30 years or more, this is related to the mother emotional readiness and
mental health. Meanwhile, mothers who are less than 20 years old are less or have a small prevalence in
exclusive breastfeeding [18].
Mother age greatly determines maternal health because it is related to readiness in undergoing
pregnancy, childbirth and the postpartum period, as well as how to care for and breastfeed the baby. Mothers
who are less than 20 years old do not have physical and social readiness in dealing with pregnancy,
childbirth, and breastfeeding their babies. Meanwhile, at the age of 35 years and over, the process of
breastfeeding to babies will decrease, this happens due to reduced hormone production in the body. At the
age of adolescence or maternal age less than 20 years, problems usually occur in milk production, this is
because at that age is a period of physical, psychological, and social development so that it can disrupt
psychological and hormonal balance [12].

Table 7. Frequency Distribution of Respondents Based on the Relationship between Mother Last Education
Level and Exclusive Breastfeeding
Exclusive Breastfeeding 2
Mother Last
Exclusive No Exclusive Total
No. Education
Breastfeeding Breastfeeding
Level
f % f % f % 0.001
1 PT. 13 76.5 4 23.5 17 100
2 High School 40 85.1 7 14.9 47 100
3 Secondary 6 30 14 70 20 100
school
4 Primary school 3 27.3 8 72.7 11 100
Total 62 65.3 33 34.7 95 100

Table 7 shows that 40 respondents (85.1%) with a high school education level did exclusive
breastfeeding and only 7 respondents (14.9%) high school did not. At the higher education level, 13
respondents (76.5%) did exclusive breastfeeding. Respondents who did not do exclusive breastfeeding had a
junior high school education level of 14 respondents (70%) and 8 respondents elementary school (72.7%).
Based on the results of the analysis obtained p value 0.001 <0.05, then there is a relationship between the
level of mother education with exclusive breastfeeding. The results showed that the percentage of exclusive
breastfeeding was more in mothers with a higher education background or at the high school and college
education levels. Mothers with a high level of education have a level of understanding and are easy to digest
the information obtained so that they can increase their knowledge and tendency to exclusively breastfeed.
The results of this study are the same as the research conducted in Indonesia by Laksono (2021)
where the higher the education level of the mother, the higher the possibility of the mother to exclusively
breastfeed. So it can be concluded that the results of the study in Indonesia, the level of mother education has
an impact or relationship with the practice of exclusive breastfeeding [19]. The results of a survey on mothers
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6  ISSN: 2252-8806

in China in 2017 showed that a good level of education had a positive contribution to the process of exclusive
breastfeeding and increased rates of exclusive breastfeeding [15]. Pangestika research in Kulon Progo, a p
value of 0.006 was found in the relationship between education level and exclusive breastfeeding, with the
highest number of mothers who did not give exclusive breastfeeding having a low level of education
(Pangestika, 2016).
Education is one of the facilitating factors in efforts to improve exclusive breastfeeding behavior
where the education obtained affects individual knowledge and attitudes. Mothers with higher education will
more easily receive new information than mothers with low education, including in providing information
related to exclusive breastfeeding. So it can be concluded that a high level of education will increase the
success of exclusive breastfeeding [20].

4. CONCLUSION
The results showed that the number of respondents who gave exclusive breastfeeding was 62 people
(65%) and respondents who were not exclusively breastfed were 33 people (35%). Bivariate analysis showed
that there was a relationship between knowledge level (p= 0.001), age (p = 0.036), and education level (p=
0.001) with exclusive breastfeeding. A good level of education can increase knowledge of exclusive
breastfeeding. The age range of 20-35 is the ideal age to breastfeed or have a tendency to carry out exclusive
breastfeeding.
Increase knowledge of mothers about the benefits and practices of exclusive breastfeeding by
conducting health education and promotion both through print and electronic media. This is so that whey
protein and colostrum found in mother milk are considered able to increase the immune system of babies
who are relatively vulnerable. Increase awareness of mothers who are less than 20 years old to prepare for
pregnancy, childbirth and the postpartum period, as well as provide education on how to care for and
breastfeed their babies.

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BIOGRAPHIES OF AUTHORS (10 PT)

The recommended number of authors is at least 2. One of them as a corresponding author.

Please attach clear photo (3x4 cm) and vita. Example of biographies of authors:

Yu-Tzu Wu is an epidemiologist/statistician working on the Improving the

Experience of Dementia and Enhancing Active Life (IDEAL) project, a longitudinal
cohort focusing on quality of life and wellbeing in people with dementia and their
carers across the United Kingdom. I am interested in exploring environmental determinants
of health and wellbeing in later life. He can be contacted at email: [email protected].

David Stuckler is a Full Professor of Policy Analysis and Public Management

at Bocconi University in Milan and an Intellectual Forum Senior Research Associate at
Jesus College, Cambridge. Before, he has been a Professor of Political Economy and
Sociology and a Senior Research Leader at Oxford University. He has published over one
hundred peer-reviewed scientific articles in major journals on the subjects of economics and
global health, and his work has featured on the cover of The New York Times and The
Economist, as well as on BBC, NPR, and CNN, among others. He has written the books The
Body Economic and Sick Societies. He can be contacted at email:
[email protected].

Gaetano Isola is a Researcher Assistant of Clinical Odontostomatology, School

of Dentistry, University of Messina, Italy. DDS at the University of Messina. PhD in
“Phisiopathology of the Stomatognatic Apparatus and Dental Materials” at the University of
Turin, Italy. Researcher fellow at the “Laboratory the Study of Calcified Tissues and
Biomaterials” and “Department of Periodontology” Université de Montréal. Advanced
Course in Periodontology, University of Ferrara. Master Course University of Verona, 2014.
Involved with several research projects in the field of the periodontology, oral surgery and
orthodontics. His research interests are mainly focused on the physiopathology of
Periodontal Diseases and the jaw muscles, craniofacial growth, the aetiology and
management of the different malocclusion and the relationship between jaw musculature
and orthodontics. Active member of The European Orthodontic Society (EOS), IADR and
member of the Italian Society of Periodontology (SIdP). Author of several international peer
reviewed publications about orthodontics, masticatory function and periodontology. He can
be contacted at email: [email protected]

Paper’s should be the fewest possible that accurately describe … (First Author)