Interventions analysis of addressing exclusive breastfeeding (EBF) barriers to improve EBF coverage among industrial women employees in indonesia


Mail Google Scholar Orcid Andari Wuri Astuti(1*)
Mail Rosemary Morgan(2)

(1) Universitas ‘Aisyiyah Yogyakarta, Indonesia
(2) John Hopkin Bloomberg School of Public Health, Baltimore, United States
(*) Corresponding Author
10.31101/jhtam.442| Abstract views : 974 | PDF views : 142


Low coverage of EBF is a global public health problem. Employment has been recognized as a factor that contributes to additional problems of EBF practice among women employees in Indonesia as they work more than 8 hours per day. In Indonesia, about 200,000 industrial companies which employed women in their production activities and they give only 3 months maternity leave. As a result, the coverage of EBF among industrial remains low. While policies already exist, the technical guidelines on the interventions are not well implemented due to unpractical approaches on these guidelines. This dissertation aims to analyse the interventions to address barriers of EBF in order to increase EBF coverage among industrial women employees in Indonesia. This is an in depth study using secondary data to review best practices to increase low coverage of EBF among industrial women employees. Propose of the study was to provide recommendations that could be implemented in Indonesian setting. The study show that there are three group level barriers i.e individual, group and social-culture contributed to low coverage of EBF. The analysis revealed that work place intervention such as lactation program and increasing employers’ awareness on breastfeeding are effective in implementation and feasible to be implemented in Indonesia. Another intervention is personal intervention i.e prenatal planning and preparation, job sharing and day care. It is recommended that those two interventions could be implanted simultaneously to address the barriers of EBF practice among industrial women employees in Indonesia.


Exclusive breastfeeding; Indonesia; Women employees

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Abada, T. S., F. Trovato and N. Lalu. 2001. Determinants of breastfeeding in the philippines: A survival analysis. Soc Sci Med, 52(1), pp.71-81.

American Academy Of Pediatric (Aap) Workgroup On Breastfeeding. 1997. Breastfeeding and the use of human milk. Pediatrics. 100(6).1035—9.

Amir, L.H., D.A. Forster., H.L. Mclachlan., A.M. Moorhead., C.R Chamberlain and H.J. Mckay.2010. Breastfeeding in Victoria : A report. Victorian Breastfeeding Research Project. La Trobe University.

Arts, M., D. Geelhoed, C. De Schacht, W. Prosser, C. Alons and A. Pedro. 2010. Knowledge, beliefs, and practices regarding exclusive breastfeeding of infants younger than 6 months in Mozambique: a qualitative study. J Hum Lact, 27(1), pp.25-32; quiz 63-5.

Bai, Y., S. E. Middlestadt, C. Y. Peng and A. D. Fly. 2010. Predictors of continuation of exclusive breastfeeding for the first six months of life. J Hum Lact, 26(1), pp.26-34.

Baker, M. and K. Milligan. 2008. Maternal employment, breastfeeding, and health: Evidence from maternity leave mandates. J Health Econ, 27(4), pp.871-87.

Bakuola, C., V. Alexandra. P. Analgylaora, M. Mutzaki, A. Fretzyayaz and P. Nicouledou. 2006. Working Mothers Breastfeed Babies more than Housewives. Acta Paedeatrica. 96(1), pp. 510-515.

Bar-Yam, N. B. 1998. Workplace lactation support, part ii: Working with the workplace. J Hum Lact, 14(4), pp.321-5.

Berlian, R.D. 2010. Factors Influencing the practice of Exclusive Breastfeeding in Indonesia : Evidence from the 2007 Indonesian Demographic and Health Survey. Master of Applied Population Studies Thesis, Flinders University of South Australia.

Bolton, T. A., T. Chow, P. A. Benton And B. H. Olson. 2009. Characteristics associated with longer breastfeeding duration: An analysis of a peer counseling support program. J Hum Lact, 25(1), pp.18-27.

Carlson, C. 2008. Promoting Early and Exclusive Breastfeeding. [Online]. [Accessed 21 April 2012]. Available from http://www.mercycorps.org/countries/indonesia/11703.

Cat, W. 2011. New Indonesia Law: Allow Breastfeeding, or Face Punishment. [Online]. [Accessed 21 April 2012]. Available from : http://www.mercycorps.org/inthenews/24948

Chapman, D. J., G. Damio and R. Perez-Escamilla. 2004. Differential response to breastfeeding peer counseling within a low-income, predominantly latina population. J Hum Lact, 20(4), pp.389-96.

Chen, W., Y. Wu and W. Chie. 2006. Effect of Work-Related Factors on the Breastfeeding Behaviour of Working Mothers in Taiwanese Semiconductur Manufacturer : a Cross Sectional Survey. BMC Public Health. 160 (6). pp. 1171-1186.

Chow, T., E. W. Wolfe and B. H. Olson. 2012. Development, content validity, and piloting of an instrument designed to measure managers' attitude toward workplace breastfeeding support. J Acad Nutr Diet.

Dabritz, H. A., B. G. Hinton And J. Babb. 2009. Evaluation of lactation support in the workplace or school environment on 6-month breastfeeding outcomes in yolo county, california. J Hum Lact, 25(2), pp.182-93.

Faizal, B. 2011. Govt encourage mums to breastfeeding. Jakarta post : [Online]. [Accessed 21 April 2012]. Available from : http://www.thejakartapost.com/news/2011/08/06/govt-encourages-moms-breast-feed.html

Februhartanty, J. 2008. Strategic Roles of Fathers in Optimizing Breastfeeding Practice : A Study in an Urban Setting of Jakarta. Doctorate Degree thesis, Indonesian University.

Gao, Y-T, Shu X-O, Dai Q, et al. 2000. Association of menstrual and reproductive factors with breast cancer risk: Results from the Shanghai Breast Cancer Study. Int J Cancer. 87 (1). pp. 295–300.

Havnes, T and M. Mungstad. 2011. Money for Nothing? Universal of Child Care and Maternal Employment. Journal of Public Economics. 95 (1). pp. 1455-1465

Hector, D., L. King and K. Webb. 2005. Factors Affecting Breastfeeding Practices Applying A Conceptual Framework. NSW Public Health Bulletin. 16 (3-4). pp. 52-55.

Heinig, M. J. 2007. Using Organizational Theory to Promote Breastfeeding Accommodation In The Workplace. J Hum Lact, 23(2), Pp.141-2.

Hirani., S. A. A and R. KarmalianI. 2011. Evidence Based Workplace Interventions to Promote Breastfeeding Practices Among Pakistani Working Mothers. Women and Birth. 12 (5). pp. 1010-1016.

Hojnacki, S. E., T. Bolton, I. S. Fulmer and B. H. Olson. 2012. Development and piloting of an instrument that measures company support for breastfeeding. J Hum Lact, 28(1), pp.20-7.

Horwood, J. L. And D M. Fergusson. 1998. Breastfeeding and Later Cognitive and Academic Outcomes. J. Pediatrics. 101 (1). pp. 9-17

Inayati, Da., V. Scherbaum., R. C. Purwestri., E. Hormann, N. N. Wirawan., J Suryantan., S. Hartono., M. A. Bloem., R. V. Pangaribuan., H. K. Biesalki, V. Hoffmann and A C Bellows. Infant feeding practices among mildly wasted children: a retrospective study on Nias Island, Indonesia. International Breastfeeding Journal. 7 (3). pp. 2-9.

Indonesian Ministry of Health (IMoH). 2012a. Peraturan Pemerintah Republik Indonesia Tentang ASI (Breastfeeding Indonesian Law). Online]. [Accessed 21 April 2012]. Available from : http://www.depkes.go.id/downloads/PP%20ASI.pdf

Indonesian Ministry of Health (IMoH). 2012b. Breastfeeding Corner in Indonesia . Online]. [Accessed 21 April 2012]. Available from : http://www.kesehatananak.depkes.go.id/index.php?option=com_content&view=article&id=83:direktorat-bina-kesehatan-anak-wujudkan-asi-eksklusif-dengan-pojok-asi&catid=1:public&Itemid=50

Indonesian Ministry of Human Resources and Transmigration (IMoHRT). 2010a. Health and Assurance law for Employees. Online]. [Accessed 21 April 2012]. Available from : http://www.depnakertrans.go.id/ayamjago/doc/perundangan/20435385014992738dd4076.pdf

Indonesian Ministry of Human Resources And Transmigration (IMoHRT). 2010b. JAMSOSTEK Assurance Procedure. Online]. [Accessed 21 April 2012]. Available from : http://www.depnakertrans.go.id/ayamjago/doc/perundangan/5930212644cd3a205cb3a6.pdf

International Labour Organisation (ILO). 2005. Women Employment : Global Trends and ILO Responses. [Online]. [Accessed 21 April 2012]. Available from : http://www.ilo.org/dyn/gender/docs/RES/399/F1503666968/Womens%20Employment%20-%20Global%20Trends%20and%20ILO%20Respon.pdf

ILO. 2012a. Maternity Protection Resource Package Part 1 Module 1. [Online]. [Accessed 7 April 2012]. Available from : http://mprp.itcilo.org/allegati/en/m1.pdf

ILO. 2012b. Maternity Protection Resource Package Part 1 Module 2. [Online]. [Accessed 7 April 2012]. Available from : http://mprp.itcilo.org/allegati/en/m2.pdf

ILO. 2012c. Maternity Protection Resource Package Part 2 Module 10. [Online]. [Accessed 7 April 2012]. Available from : http://mprp.itcilo.org/allegati/en/m10.pdf

Indonesian Demographic Health Survey. 2007. Health Survey. Online]. [Accessed 7 April 2012]. Available from : http://www.motorcycleoutreach.org/FR218_April_09_2009.pdf

IRIN ( Humanitarian News and Analysis). INDONESIA: Breastfeeding regulations to target formula companies. [Online]. [Accessed 7 April 2012]. Available from : http://www.irinnews.org/Report/93744/INDONESIA-Breastfeeding-regulations-to-target-formula-companies.

KANG, J.S. SO, Y.C And E.J. RYU. 2007. Effect of Breastfeeding Empowerement Programme on Korean Breastfeeding Mothers : a Quasi-Experimental Study. International Journal of Nursing Studies, 45 (1), pp. 14-23.

Kompas. 2010. Indonesian Breastfeeding Fair. [Online]. [Accessed 7 April 2012]. Available from : http://www1.kompas.com/read/xml/2010/05/13/0940061/breastfeeding.fair.2010.kembali.digelar

Labbok, M. H. 1994. Breastfeeding as a women's issue: Conclusions and consensus, complementary concerns, and next actions. Int J Gynaecol Obstet, 47 Suppl, pp.S55-61.

Lamontagne, J.F. Engle, P.L and M.F. Zetlin. 1997. Maternal Employment, Child Care, and Nutritional Status. Social, Sciences and Medicines. 46 (3), pp. 403-413.

Lawellen L.P, Dick M.J, Flower J, Powell. W, Zickefoose K.T, Wall Y.G. 2006. Breastfeeding support and early cessation. Journal of Obstetric Gynecologic and Neonatal Nursing. 35(2). pp. 166—72.

Lawrence, R. A. & Lawrence, R. M. 2005. Breastfeeding : a guide for the medical profession, St. Louis, Elsevier Mosby.

Libbus, M. K. And L. F. Bullock. 2002. Breastfeeding and employment: An assessment of employer attitudes. J Hum Lact, 18(3), pp.247-51.

Mckechnie, A. C., A. Tluczek And J. B. Henriques. 2009. Maternal variables influencing duration of breastfeeding among low-income mothers. Infant Child Adolesc Nutr, 1(3), pp.126-132.

Menon, P. 2011. The Crisis of Poor Complementary Feeding in South Asia : Where next?. J. Nutrition and Child Health. 8 (1). pp. 1-4.

MurtyarinI. 2012. Hak-hak Keibuan Buruh. [Online]. [Accessed 21 April 2012]. Available from : http:ds.leeds.ac.ukstudentstudent19hs11awadissertationchap2litHak Keibuan Buruh.mht

Ogbuanu, C., S. Glover, J. Probst, J. Hussey and J. Liu. 2011. Balancing work and family: Effect of employment characteristics on breastfeeding. J Hum Lact, 27(3), pp.225-38; quiz 293-5.

Penn, T. 2011. Another busy day busy day in the world's tenth biggest city in Indonesia. [Online]. [Accessed 21 April 2012]. Available from : http://www.mercycorps.org/travispenn/blog/24903

Pricilla, V. 2008. Early Breastfeeding Practices in West Sumatra, Indonesia : Determinants and Interventions for Promotion. ICHD report, KIT Royal Tropical Institute Amsterdam University.

Riordan, J. and Wambach, K. 2010. Breastfeeding and human lactation, Sudbury, MA, Jones and Bartlett Publishers.

Rogers, J. 2011. Mothers supporting mothers. [Online]. [Accessed 21 April 2012]. Available from : http://www.mercycorps.org/julierogers/blog/24958

Salud, M. A., J. I. Gallardo, J. A. Dineros, A. F. Gammad, J. Basilio, V. Borja, A. Iellamo, L. Worobec, H. Sobel and J. M. Olive. 2009. People's initiative to counteract misinformation and marketing practices: The pembo, philippines, breastfeeding experience, 2006. J Hum Lact, 25(3), pp.341-9; quiz 362-5

Sanyoto, D. 2004. Indonesia Code Violations : A Survey of State of the International Code of Marketing of Breastmilk Subtitutes and subsequent WHA Resolutions. [Online]. [Accessed 21 April 2012]. Available from :

Available from : http://www.ibfan.org/art/298-4.pdf

Senarath, U., M. J. Dibley And K. E. Agho. 2010. Factors associated with nonexclusive breastfeeding in 5 east and southeast asian countries: A multilevel analysis. J Hum Lact, 26(3), pp.248-57.

Soewito Suhardiman Edymurty Kardono (Ssek). 2011. A guide of Indonesian Employement Law : Maternity and Family Leave. [Online]. [Accessed 21 April 2012]. Available from : ds.leeds.ac.ukstudentstudent19hs11awadissertationchap2litA Guide to Indonesian Employment Law Maternity & Family Leave SSEK Lawfirm.mht

Stratton, J.R And B.W. Henry.2011a. Employers of Low-Income, Full-Time Working Women Cite Mixed Perspectives on Strategies to Provide Workplace Breastfeeding Support. J.American Dietetic Association.36 (1). pp.113-123.

Stratton, J.R And B.W. Henry.2011b. What Employers and Health Care Providers Can Do to Support Breastfeeding in the Workplace : Aiming to Match Positive Attitudes With Action. ICAN : Ifant, Child and Adolescence Nutrition. 3 (1). pp. 300-310.

Tarrant, R. C., K. M. Younger, M. Sheridan-Pereira And J. M. Kearney. 2011. Factors associated with duration of breastfeeding in ireland: Potential areas for improvement. J Hum Lact, 27(3), pp.262-71.

United Nations Population Fund (UNFPA). 2008. UNFPA Indonesia : Population-Poverty Network. [Online]. [Accessed 2 Nov 2011]. Available from : http://unfpaindonesia.blogspot.co.uk/

United Nations International Children's Emergency Fund (UNICEF). 2002.

UNICEF and the Global Strategy on Infant and Young Child Feeding (GSIYCF). [Online]. [Accessed 9 Nov 2011]. Available from : http://www.unicef.org/nutrition/files/FinalReportonDistribution.pdf

UNICEF. 2008. Strengthening action to improve feeding of infants and young children 6-23 months of age in nutrition and child health programmes. [Online]. [Accessed 9 Nov 2011]. Available from : http://whqlibdoc.who.int/publications/2008/9789241597890_eng.pdf

UNICEF. 2010. Following World Breastfeeding Week, UNICEF Indonesia urges companies to be "baby friendly". [Online]. [Accessed 2 Nov 2011]. Available from : http://www.unicef.org/indonesia/media_13919.html

UNICEF. 2012. Child Nutrition : Statistic by area. [Online]. [Accessed 2 Nov 2011]. Available from : http://www.childinfo.org/breastfeeding_progress.html

Walker, M. 2011. Breastfeeding and employment : Make it work. [Online]. [Accessed 2 March 2012]. Available from : http://www.ibreastfeeding.com/newsletter/2011/06/breastfeeding-and-employment-making-it-work

Walley, J. and J. Wright. 2010. Public health : An action guide to improving health. 2nd ed. Oxford: Oxford University Press.

World Bank. 2011. Reproductive Health at a Glance Indonesia. [Online]. [Accessed 21 April 2012]. Available from : http://info.worldbank.org/etools/docs/library/122031/bangkokCD/BangkokMarch05/Week1/4Thursday/S1BoundariesofRH/RHataGlance.pdf

World Health Organisation (WHO). 2002. Infant and Young child nutrition : global strategy on infant and young child feeding. [Online]. [Accessed 21 April 2012]. Available from : http://apps.who.int/gb/archive/pdf_files/WHA55/ea5515.pdf

WHO. 2003. Complementary Feeding. [Online]. [Accessed 21 April 2012]. Available from : http://whqlibdoc.who.int/publications/2002/924154614X.pdf

WHO. 2005. Nutrient adequacy of Exclusive Breastfeeding for the term infant during the first six months of live . [Online]. [Accessed 21 April 2012]. Available from : http://whqlibdoc.who.int/publications/9241562110.pdf

WHO. 2007. Planning Guide for national planning implementation of the global strategy for infants and young child feeding. [Online]. [Accessed 21 April 2012]. Available from : http://whqlibdoc.who.int/publications/2007/9789241595193_eng.pdf

Yimyam, S., 1998. Breastfeeding, work, and women's health among Thai women in Chiangmai. Breastfeeding Rev. 6 (1), pp. 17-22.

Yimyam, S. Morrow, M and W, Srisuphan. 1999. Role Conflict and Socio-Economic Change : Breastfeeding Among Employed Women in Thailand. Social, Sciences and Medicines, 49 (3), pp. 957-965.

Zinn, B. 2000. Supporting the Employed Breastfeeding Mothers. J. Midwifery and Women's Health, 45 (1), pp. 216-226.

DOI: https://doi.org/10.31101/jhtam.442

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