Barriers to Exclusive Breast-feeding in Indonesian Hospitals: a Qualitative Study of Early Infant Feeding Practices

Overview

Journal Public Health Nutr

Publisher Cambridge University Press

Date 2018 Jul 6

PMID 29973298

Citations 13

Authors

Valerie J Flaherman

Shannon Chan

Riya Desai

Fransisca Handy Agung

Hendri Hartati

Fitra Yelda

Affiliations

Soon will be listed here.

Abstract

Objective: Although initiating breast-feeding is common in Indonesia, rates of exclusive breast-feeding are low. Our objective was to identify early barriers to exclusive breast-feeding in Indonesian hospitals.

Design: Qualitative. Semi-structured interviews were conducted in April-June 2015. The data were analysed using thematic analysis.

Setting: Indonesian provinces of Jakarta, Banten and West Java.

Subjects: Fifty-four participants including public health officials, hospital administrators, health-care professionals and parents.

Results: Five themes were identified as contributing to low rates of early exclusive breast-feeding in Indonesian hospitals: (i) quality and quantity of breast-feeding education; (ii) marketing and influence of infant formula manufacturers; (iii) hospital infrastructure; (iv) policy, legislation and protocols; and (v) perceived need for infant formula supplementation. Participants noted that providers and mothers receive inadequate or incorrect education regarding breast-feeding; manufacturers promote infant formula use both inside and outside hospitals; constraints in physical space and hospital design interfere with early breast-feeding; legislation and protocols designed to promote breast-feeding are inconsistently enforced and implemented; and providers and mothers often believe infant formula is necessary to promote infant health. All participants identified numerous barriers to early exclusive breast-feeding that related to more than one identified theme.

Conclusions: Our study identified important barriers to early exclusive breast-feeding in Indonesian hospitals, finding that participants consistently reported multifaceted barriers to early exclusive breast-feeding. Future research should examine whether system-level interventions such the Baby-Friendly Hospital Initiative might improve rates of exclusive breast-feeding by improving breast-feeding education, reducing manufacturer influence, modifying existing infrastructure and providing tools needed for protocols and counselling.

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