The Perceptions of Pregnant Mothers on Exclusive Breastfeeding: Motivation to Perform Early Breastfeeding Initiation (EBI) at Hayati Clinic Medan

Faradita Wahyuni*, Yuni Vivi Santri P, Tika Kencana, Eka Darmayanti, Dame Meldaria Sipahutar, Nurhamida Fithri

STIKes Senior Medan, 20141 Sumatera Utara, Indonesia.

*Corresponding Author’s Email: faraditawahyuni8@gmail.com

ABSTRACT

Introduction: Pregnancy is a natural and physiological process that brings happiness to mothers with the arrival of their newborn. When a baby is born, it is placed on its mother's chest, where it will have physical contact with its mother and instinctively search for its mother's nipple to breastfeed. This is where the process of early breastfeeding initiation (EBI) occurs. Breast milk is a natural food for babies, and the World Health Organization recommends exclusive breastfeeding for six months. Despite a 49% decrease in under-five mortality rates worldwide, child mortality remains a significant issue, with almost half of all child deaths occurring in the last two decades. The aim of this study is to determine the relationship between pregnant women's attitudes towards exclusive breastfeeding and their motivation to perform EBI. Methods: This study used a cross-sectional analytical survey design, with data collected through questionnaires distributed to 44 pregnant mothers at Hayati Clinic. The sampling technique used was saturation sampling, and the data were analyzed using chi-square statistical tests with α 0.05. Results: Based on the research results, the relationship between pregnant mothers' perceptions of exclusive breastfeeding and their motivation to perform EBI was significant, with p (0.000) < α (0.05), indicating that mothers with less favorable perceptions were less motivated to perform EBI. Conclusion: From the study's findings, it is recommended that pregnant mothers increase their knowledge and seek more information about exclusive breastfeeding and motivation to achieve successful early breastfeeding initiation (EBI).

Keywords: Early Breastfeeding Initiation; Exclusive Breastfeeding; Pregnant Mothers

INTRODUCTION

Pregnancy is a natural and physiological process. When planned, it brings happiness and hope to Pregnancy is a natural and physiological process. When planned, it brings happiness and hope to mothers (Jebena & Tenagashaw, 2022). The birth of a child is a joyful moment for a mother. However, one crucial thing that is often overlooked by mothers and healthcare workers is the need for early initiation of breastfeeding (EIB), which happens in the first hour after birth when the baby is placed on the mother's chest (Admasu et al., 2022). This contact allows the baby to seek out the mother's breast and initiates the process of exclusive breastfeeding. Breastfeeding is the natural food provided by the mother for her baby (Naja et al., 2022). Initiating breastfeeding soon after birth triggers the baby's natural sucking reflex and is a crucial factor in promoting exclusive breastfeeding (Hasanah, Sari, & Natalia, 2023).

Exclusive breastfeeding aims to ensure that the baby receives breast milk exclusively from birth until six months of age, taking into account the baby's growth and development. The impact of not giving exclusive breastfeeding is a higher risk of death due to diarrhea for babies who receive non-exclusive or no breast milk (Astuti et al., 2015). So, breastfeeding is the best way to provide essential nutrients and antibodies for infants' growth and health, with the potential to prevent thousands of infant deaths in Indonesia and millions worldwide if practiced exclusively for the first six months (Putri, 2019).

The World Health Organization (WHO) recommends exclusive breastfeeding for six months. The WHO's recommendation is lower than the average standard for exclusive breastfeeding during the first six months. Child survival has been one of the greatest international development success stories, with child deaths nearly halving in the past two decades compared to the 2010 Millennium Development Goals. Between 2010 and 2020, infant mortality rates dropped by 49%, falling from around 90 deaths per 1000 live births. Worldwide, the number of neonatal deaths decreased from 4.7 million in 2010 to 2.8 million in 2020. The neonatal death rate per 1000 live births decreased from 33–20 over the same period, a 39% reduction. This rate of decline is slower than that for overall child mortality, with the proportion of child deaths occurring in the neonatal period increasing from 37% in 2010 to 44% in 2020 for children under five years old (WHO, 2023).

According to Raihana (2019), the percentage of early initiation of breastfeeding (EIB) was less than 1 hour, between 1-6 hours, 7–23 hours, 24-47 hours, and equal to or more than 47 hours. The results of Raihana (2019) showed that the percentage of infants who received breast milk within the first hour of birth was 34.5% in Indonesia in 2020. The percentage of infants who started to receive breast milk between 1-6 hours after birth was 35.2%. The percentage of infants who started to receive breast milk between 24-47 hours after birth was 13.0%, and the percentage of infants who started to receive breast milk after more than 47 hours was 13.7%. West Nusa Tenggara (52.9%), South Sulawesi (44.9%), and West Sumatra (44.2%) had the highest percentages of early breastfeeding initiation. West Papua Province (21.7%), Riau Province (22.1%), and Riau Islands Province (22.7%) had the lowest percentages of early breastfeeding initiation (Ri, 2021).

The percentage of exclusive breastfeeding among infants aged 0–6 months in Indonesia in 2022 was 54.3%, slightly higher than in 2021, which was 48.6%. The highest percentage of exclusive breastfeeding was found in East Nusa Tenggara, at 74.37%. Meanwhile, the lowest percentage of exclusive breastfeeding was found in Maluku Province at 25.21%, followed by West Java at 33.65% and North Sulawesi at 34.67% (Septina & Djami 2022).

From an initial survey conducted by researchers at Hayati Clinic Medan Marelan, there were 10 pregnant women, of whom only 7 were motivated to perform EBI when giving birth, while 3 were not motivated to perform EBI due to unwillingness and a lack of perception of the benefits of exclusive breastfeeding with early initiation of breastfeeding (EBI).

The study involved educating participants on breastfeeding techniques using animated videos and leaflets, suggesting potential for future research by incorporating additional variables or media formats. The findings aim to serve as a foundational reference for improving health education and seminars, particularly on effective breastfeeding techniques at community health centers (Hayatiningrum et al., 2023).

METHODOLOGY

The research design used in this study is an analytical survey, which attempts to explore how and why a phenomenon occurs. It then analyzes the correlation dynamics between the phenomena, both between risk factors and effect factors. The approach used is cross-sectional to study the relationship between independent variables and dependent variables, namely by determining the extent of the relationship between pregnant mother’s perceptions of exclusive breastfeeding and their motivation to perform IMD at Klinik Hayati Medan Marelan in 2023. The population in this study is all 44 pregnant mothers at Klinik Hayati Medan in 2023 (Notoatmodjo, 2012). The sample is the object that is studied and considered to represent the entire population. Sampling in this study is done through total sampling, which means the sample size is equal to the population size. Based on the population size, the sample in this study consists of 44 respondents (Notoatmodjo, 2012).

The Bivariate Analysis

After obtaining the characteristics of each variable in this study, the analysis proceeds to the bivariate level. This is to determine the correlation between the independent and dependent variables (Tulis, 2016).

To prove the significant relationship between the independent and dependent variables, a Chi- square analysis is used with a significance level of p-value (0.05). If the calculation result shows p < p-value (0.05), then the null hypothesis (H0) is rejected, meaning that both variables have a significant statistical relationship. Then, to explain the association between the dependent and independent variables, a cross-tabulation analysis is used (Tulis, 2016).

Ethical Consideration

The study was approved by the health research ethical committee of the STIKes Senior Medan, Indonesia with the reference number 422.260/STIKes-SENIOR/VIII/2022 on 27th August, 2022.

RESULTS

Results of the researcher's study on the relationship between pregnant women's attitude towards exclusive breastfeeding and motivation for early breastfeeding initiatives (EBI) at Hayati Clinic Medan in 2023.

Figure 1: Frequency Distribution of Pregnant Women's Perception of Exclusive Breastfeeding at Hayati Clinic Medan in 2023

Based on figure 1, it can be seen that out of 44 respondents (100%), the majority of pregnant mothers who have a negative perception towards exclusive breastfeeding are 29 respondents (65.9%), while the minority who have a positive perception are 15 respondents (34.1%).

Figure 2: Frequency Distribution of the Motivation of Pregnant Mothers in Performing Early Initiation of Breastfeeding (EIB) at Hayati Clinic Medan in 2023

Based on table 2, it can be seen that out of 44 respondents (100%), the majority of pregnant mothers with low motivation are 25 respondents (56.8%), while the minority of pregnant mothers with high motivation are 19 respondents (43.2%).

Table 1: Cross-Tabulation of Pregnant Mothers' Perception About Exclusive Breastfeeding and Motivation to Perform Early Initiation of Breastfeeding at Hayati Clinic Medan in 2023

Based on table 1, it can be seen that the majority of pregnant mothers with a negative perception and low motivation are 25 respondents (56.8%), while the minority of pregnant mothers with a positive perception and high motivation are 19 respondents (43.2%).

DISCUSSION

Pregnant Mothers' Perception of Exclusive Breastfeeding

Based on figure 1, it can be seen that out of 44 respondents (100%), the majority of pregnant mothers who have a negative perception towards exclusive breastfeeding are 29 respondents (65.9%), while the minority who have a positive perception are 15 respondents (34.1%).

Perception in general refers to a person's view of something that will influence how they respond and act (Pickens, 2005). Perception can be divided into two views: narrow and broad. The narrow view defines perception as vision—how someone sees something. While the broad view defines it as how someone perceives or interprets something (Sternberg & Grigorenko, 2014).

According to the researcher's assumption, the perception of the respondents greatly affects their motivation to initiate breastfeeding early. If a pregnant mother has a low perception of exclusive breastfeeding, then most likely their motivation to perform early initiation of breastfeeding will not be fully realized due to their lack of knowledge and reluctance to perform early initiation of breastfeeding. Another study shows that primi moms had poor knowledge and practice about breastfeeding and face a lot of trouble after childbirth with latching, according to the study's findings (Ibrahiem et al., 2022).

Mothers' Motivation in Performing Early Initiation of Breastfeeding (EIB).

Based on figure 2, it can be seen that out of 44 respondents (100%), the majority of pregnant mothers with low motivation were 25 respondents (56.8%), and the minority of pregnant mothers with high motivation were 19 respondents (43.2%).

Motivation comes from the Latin word moreve, which means an inner drive for humans to act, behave, or fulfill their needs or wants (Burton, 2012). Needs are "potential" within humans that need to be responded to. The response to these needs is manifested in actions to fulfill them, and the result is that the person feels satisfied. If these needs are not responded to (not fulfilled), they will always have the potential to reemerge until they are met (Pitkin, 2016).

According to the study of Cangöl & Şahin (2017) the motivation of pregnant mothers to initiate early breastfeeding is strongly influenced by their perception of exclusive breastfeeding, if the respondents' perception is good, then their motivation and implementation of early breastfeeding initiation will also be good. On the other hand, if a mother has inadequate knowledge and is unwilling to initiate early breastfeeding, then her motivation will be affected.

The Relationship between Pregnant Women's Attitude towards Exclusive Breastfeeding (EBF) and their Motivation to Initiate Breastfeeding Early (EIB)

As can be seen in Table 1, the majority of pregnant mothers with a negative perception have low motivation (25 respondents, or 56.8%), while the minority of mothers with a positive perception have high motivation (19 respondents, or 43.2%). The statistical chi-square test result shows a Sig value of 0.000. Since the p-value (0.000) is less than the significance level (0.05), it can be concluded that there is a relationship between pregnant mothers' perception of EBF and their motivation to perform EIB.

Perception, in general, refers to a person's view of something, which will lead to a response and determine how they act. Perception can be categorized into narrow and broad perspectives. The narrow perspective refers to how someone sees something, while the broad perspective refers to how someone interprets something.

According to Siregar (2021), motivation comes from the Latin word "moreve," which means an internal drive that leads a person to act or behave according to their needs or wants. Needs are potential within a person that needs to be addressed or responded to. The response to these needs is manifested in actions to meet them, and the result is the person feeling satisfied. If the need is not met, it will remain potential until it is fulfilled.

According to the researcher's assumption, pregnant mothers' motivation to perform EIB is strongly influenced by their perception of EBF. This is because the education provided to mothers affects their knowledge of the importance of introducing breast milk to infants through EIB. If a mother's perception of EBF is positive, then her motivation to perform EIB will also be high. Conversely, if a mother's perception of EBF is negative, her motivation to perform EIB will be low. Low motivation to perform EIB can cause a lack of bonding attachment, leading to reduced contact or connection between the mother and the baby. Thus, pregnant women should actively seek information from healthcare workers or the media, as well as participating in counseling about EIB provided by healthcare workers, and actively consulting with healthcare workers to obtain accurate information about EIB implementation.(Suyanti, Evitasari & Idaningsih, 2023).

CONCLUSION

Based on research carried out on the relationship between pregnant women's perceptions of exclusive feeding and motivation to initiate early breastfeeding (EBI) at Hayati Clinic Medan in 2023, the following conclusions can be drawn:

1. The majority of pregnant women who had a negative perception of exclusive breastfeeding were 29 respondents (65.9%), while the minority who had a positive perception were 15 respondents (34.1%).

2. The majority of pregnant women who had low motivation were 25 respondents (56.8%), while the minority who had high motivation were 19 respondents (43.2%).

3. There is a relationship between pregnant women's perceptions of exclusive breastfeeding and motivation to perform EBI, as indicated by the Chi-square statistical test result showing a p- value of 0.000, which means that p (0.000) < a (0.05).

Recommendation

1. For Mothers/Respondents

   Mothers are encouraged to improve their knowledge and seek more information about Exclusive Breastfeeding and motivation to achieve success in performing Early Initiation of Breastfeeding (EIBF).

2. For Maternity Clinics

   Maternity clinics are expected to provide information and counseling about Early Initiation of Breastfeeding (EIB) and exclusive breastfeeding so that mothers can understand the 8 proper breastfeeding techniques, and ultimately develop a good bonding relationship between mother and child.

3. For Future Researchers

   It is expected that further research will be conducted using different methods to support the existing research findings, as well as identify other variables that may influence the motivation of pregnant mothers to perform early initiation of breastfeeding.

4. For Educational Institutions

It is expected that educational institutions provide information and knowledge to midwifery students so that they are competent in providing antenatal care services and can become competent healthcare professionals in their field.

Conflict of Interest

The authors declare that they have no competing interest.

ACKNOWLEDGEMENT

The authors are thankful to the institutional authority for completion of the work.

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