VOL. 2 NO. 2 DESEMBER 2018 77 INDONESIAN JOURNAL OF NURSING PRACTICES Isytiaroh Stikes Muhammadiyah Pekajangan Pekalongan Indonesia Korespondensi: Isytiaroh Email: Isytiaroh@stikesmuh-pkj.ac.id Myths and Failure of Exclusive Breastfeeding: Study in Buaran Community Health Center Pekalongan Regency Central Java Info Artikel Online ISSN DOI : : http://journal.umy.ac.id/index.php/ijnp : 2548 4249 (Print) : 2548 592X (Online) : 10.18196/ijnp.2282 Abstract Background: Fai l ure of excl us i ve breas tfeedi ng i s s ti l l hi gh i n Pekal ongan regency, Central Java Indones i a. The one of reas ondue to the exi s ti ng myth about breas t mi l k and breas tfeedi ng acti vi ty i n s oci ety cul ture. Objective: Thi s s tudy ai med to determi ne the rel ati ons hi p between myth about breas tfeedi ng and fai l ure of excl us i ve breas tfeedi ng. Method: Thi s cros s -s ecti onal s tudy des i gn conducted among 151 mothers wi th i nfant 6-12 month age whi ch s el ected by cl us ter s ampl i ng, i n Buaran Communi ty Heal th Center i n Pekal ongan Regency Central Java Indones i a, from January to May 2017. An i ns trument us ed was a ques ti onnai re devel oped by the res eacher. Result: The res ul ts s howed 70.1% parti ci pants fai l ed excl us i ve breas tfeedi ng, 56.9% of them bel i eved negati ve myths about excl us i ve breas tfeedi ng by p = 0.001 (95% CI: 1,757 -8,057). The characteri s ti c of parti ci pants was i n reproducti ve age (81,5%), mul ti parous (71,5%), unempl oyed (70,9%), and from extended fami l y (66,9%). Mos t of the parti ci pants had a vagi nal del i very (86,8%). There was as i gni fi cant rel ati ons hi p between myths about breas tfeedi ng and fai l ure of excl us i ve breas tfeedi ng. Breas tfeedi ng educati on s houl d del i ver i n communi ty-bas ed, i n terms of growi ng breas tfeedi ng cul ture, i n Indones i an s oci ety. Keywords: cul ture; excl us i ve breas tfeedi ng; myth INTRODUCTION Breastfeeding is the most ideal and valuable food for growing infant since it suffices nutritional requirements by adequately and inappropriate manner. Exclusive breastfeeding for the first six months of baby’s life followed by adequate and safe complementary foods, with continued breastfeeding up to two years isneededfor optimized baby health (World Health Organisation, 2013). The set target of exclusive breastfeeding by Nutrition and Maternal and Child Health Program in Indonesia,is 50% with the initiation of early breastfeeding in newborns by 50% (Indonesian Ministry of Health, 2015). The target set based on many benefits of breastfeeding, for both mother and baby.Stuebe(2009)explained the benefits of breastfeeding such as having immunityfor infection protectionthat babies will get immunoglobulin that will protect babies fro m infection, babies are better protected from otitis media, respiratory, diarrhea and other gastrointestinal diseases, avoiding juvenile diabetic disease, lymphoma, obesity, hypertension and some other diseases. While the mother will avoid post-birth bleeding d u e to weak uterine contractions, breast cancer risk, and obesity. http://journal.umy.ac.id/index.php/ijnp http://u.lipi.go.id/1477106461 http://issn.pdii.lipi.go.id/issn.cgi?daftar&1478151103&1&& http://journal.umy.ac.id/index.php/ijnp/article/view/5097 INDONESIAN JOURNAL OF NURSING PRACTICES 78 In fact, the benefits of breastmilk and doing breastfeeding very much for babies and mothers have not been able to increase coverage of breastfeeding in infants, especially exclusive breastfeeding target. Nationally, the coverage of exclusive breastfeeding in Indonesia until 6 months of 2016 was 29.5% and Central Java Province was 42.7% (Indonesian Ministry of Health, 2017). The Pekalongan Regency as one of the districts in Central Java has exclusive breastfeeding coverage of 30.3% by 2015. The latest data in February 2016 was that the lowest exclusive breastfeeding coverage i s at community health centers in BuaranPekalongan Regency with a percentage ranged from 14.22% (Departement of Health Pekalongan Regency, 2016). This is the lowest coverage in Pekalongan Regency. One of the reasons for the exclusion of exclusive breastfeeding targeting is due to incorrect myths about breast milk and doing breastfeeding that still exists in society (Eram, 2017). Some myths that develop in society, among others, are colostrum should not be given to newborns because it can cause babies stomach ache, newborns need additional food to be big fast because breast milk alone is not enough. Myths are either mythical or religious (Susantina & Purnomo, 2013). They explain the definitions of myths and religions are associated with the presence of the belief in the existence of supernatural forces above human strength.The myth can also be interpreted as the assumption of a thing that developed in the society without the true nature of the truthbut believed to be something obeyed. Blumenberg (2003 as cited in Morales 2013) explain about myths too, myths are stories that have a high degree of constancy in their narrative core and also some margins of variation. In addition, i n t h e reality of the world and the human, myths also express the complexity inherent. Improper myths about breast milk and breastfeeding also occur in Pekalongan district. Preliminary studies conducted on some breastfeeding mothers showed that still the myths that breastfeeding mothers believe. The mythsare that the baby is born to need to eat so must be fed (foods such as bananas and rice are crushed), breastfeeding moth e rs cannot eat when it's night so that the body is not overweight, babies who cry continues to mean less milk so it needs to be fed infant formula quiet. The myth is growing in the community and is believed to be true by breastfeeding mothers, especially if nursing mothers live a house with parents, then the myth is getting thicker and should be run by nursing mothers. This phenomenon is an attraction for researchers to examine the topic of myth and exclusive lecture. METHODS The study design used cross sectional study of 151 mothers with infant 6-12 month age. In Buaran community Health Center as the coverage of exclusive breast the lowest coverage of exclusive breastfeeding in Pekalongan Regency in 2016 (14.22%). A cluster sampling design was used to select populations. The studi was conducted in Buaran Community Health Center in Pekalongan Regency Central Java Indonesia from January to May 2017.The inclusion criteria included mother who has infant aged 6-12 months, no complications that affect breastfeeding, and living with their husbands or relatives. The exclusion criteria were mother that delivere d baby with congenital defects and infant having illness which interferes with successful breastfeeding. Freguency distributions, and cross-tabulations were used to describe the variable of the study. The study used confidence interval 95%. The instrument used in this study was a questionnaire prepared by the researcher. This questionnaire were consists of demographical data (age, parity, educatio n al level, employment status, type of family, an d mode of delivery), failure of exclusiv e breastfeeding and myths about breastfeeding. VOL. 2 NO. 2 DESEMBER 2018 79 The consten of questionnaire failure of exclusive breastfeeding is one question. The question is whether the baby has received other than breastmilk, such as liquids or solids with the exception of drops or syrups consisting of vitamins, mineral supp lemen ts , or medicines during the first months delivery . The Guttman scale used to categorize data. I f participans answered “yes” (noted to 1), th e n failure of exclusive breastfeeding, but if answered “no”, then not failure of exclusive breastfeeding (noted to 0). The other content questionnaire are myths about breastfeeding. The Guttman scale us e d to categorize data. The choises for answering questionnaire devided into believed (noted to 1) and not believed (noted to 0). If participan t answer at least one believe from questionnaire, it means that they believ e th e myth. The questions involved whether the mother has believe and do that believe, namely 1). Breastfeeding mothers should n o t eat fish, meat, chicken eggs; 2). Breast- colored milk (colostrum) is stale breast milk so it should not be given to the baby; 3). Breastfeeding mothers should not eat when it was late; 4). Breastfeeding can change the shape and size of the breasts and can cau s i n g disturbance body image; 5). Babies who given formula-fed will sleep long and calm than those fed breast milk; 6). A baby who asks f o r breastfeeding continues means less breast milk so formula milk is required; 7). The quality of formula milk is the same as breast milk so formula-fed is not problem for the babies; 8). Newborns should be fed like bananas or liquid food to be calm. Researchers also conducted interviews to explore other myths about breastfeeding. Data collection including basic demographic (mother age, parity, educational level, employment status, type of family, and mo d e of delivery), and myths about breastfeeding are independent variable. Dependent variabel is failure of exclusive breastfeeding. Data was entered in MS Excel and analyzed using Statistical Package for Social Sciences (SPSS) software version 11.5. Chi square test was used to find out the association of myth s an d failure exclusive breastfeeding. RESULTS Table 1 shows the characteristics of the participants. There are 151 mothers participated in this study. Almost participants were in reproductive age (n=121; 81.5%), multiparous (n=108; 71.5%), and unemployed (n=107; 70.9%). The majority type of family were low educational level (n=96; 63.6%) an d type of family was extended family (n=101; 66.9%). The majority mode of delivery was vaginal (n=131; 86.8%). Table1. Sosiodemographic Characteristic Participants Characteristics Summary (n=151) Percentage Mother Age category (i n year) ˃ 20 20 – 35 < 35 0 121 28 0 81.5 18.5 Pari ty nul l i parous mul typaraous 43 108 28.5 71.5 Educati onal Level Low Mi dl e-Hi gher 96 55 63.6 36.4 Empl oyment s tatus Empl oyed Unempl oyed 44 107 29.1 70.9 Type of Fami l y Nucl ear Extended 50 101 33.1 66.9 Mode of Del i very Ces arean Secti on Vagi nal 20 131 13.2 86.8 INDONESIAN JOURNAL OF NURSING PRACTICES 80 Table 2.Distribution of Participans Based on the Breastfeeding Myths andFailure Exclusive Breastfeeding Vari abl e Excl us i ve Breas tfeedi ng Total 95% CI P val ue Fai l ed Succed n % n % n % Breas tfeedi ng Myths Not Bel i eve 20 13.2 21 14 41 27.2 1.757-8.057 .001 Bel i eve 86 56.9 24 15.9 110 72.8 106 70.1 46 29.9 151 100 The table 2. showed a total of 106 (70.1%) failed exclusive breastfeeding. A total of 56.9% of paticipants believed the negative myths about exclusive breastfeeding with p= .001 (95% CI: 1.757-8.057). DISCUSSION Analysis bivariate showed most respondents who believed in negative myths and failed to exclusive breastfeeding were 86 (56.9%) and who gave exclusive breastfeeding were 24 (15.9%). P v al u e was 0.001 (95% CI 1.757-8.057). This result indicates a relationship between negative my th s about breastfeeding and exclusive breastfeed in g failure. The results of this study showed that myths are believed to affect a person's behavior. Morales (2013) said myths is a direct link with culture practices, and an important part in cultural competences and represent a significant development in daily life. In breastfeeding mothers, myths thrive from generation to generation so that breastfeeding mothers will b e frightened if they do not do. Especially if the mother live together in a house with her parents , parents will influence based on past breastfeeding experience, although the knowledge of the myth cannot be proven. Breastfeeding decisions also were based on the influences of exposure to formula milkcommercials. A qualitative study in Indonesia by Marzuki et al (2014) to elucidate the factors that influence mothers’ choices for infant feeding. The result study finding reasons mother to introduce additional milk formula. The most frequent reasons for mothers to introduce additional mi l k formula or food were the perception of an inadequate milk supply, infant dissatisfaction or fussiness after feeding.They believed that b re as t milk alone was insufficient for their infants and the babies crying and fussiness were con s i de red to be signs of hunger so food was introduced to calm them. This result is similar to Eram's (2017) study. Eram's a riview articlestudy showed an incorrect myth about breastfeeding to be one of the factors causing exclusive breastfeeding failure. These myths include colostrum should not be given to the baby, the mother should not breastfeed if infected, the baby needs water beside breast milk, the pregnant mother should stop breastfeeding, the nipple should be clean ed every time before the baby suckles, no safe drugs are given to Breastfeeding mothers, the amount of breast milk production depends on the s i z e o f the breast, the baby needs sweet water before the first feed. The result study Kamath et al (2016) also showe d that the advantages of breast milk were in poor perceptions among 188 Indian mother, with respect to nutritive value, immune effect, and disease protection (n=188). Among of them had discontinuation of breastfeeding in previous child if their baby had sikcness, such as diarrhea and vomiting. The quality of mother perception on breastmilk around 37.3% (71 mothers) opined that it is nutritious, an equal number were non committal, and one-fourth of the mothers disagreed with its nutritious aspect. Interestingly, majority og the mother felt that breastmilk is healthy for baby (181; 96.3%), breast milk can protects babies from diseases 32 (17%). Almo s t a half (n=93, 49.4%) of the mothers agreed that breast milk would encourage bonding attachment mothers and their babies. VOL. 2 NO. 2 DESEMBER 2018 81 Socio-cultural factors affect the breastfeeding too (Wanjohi, et al 2017). Socially and culturally, breastfeeding mothers learn and observe breastfeeding practices by older parents, grandmothers or older women in their communities. This kind of learning model is carried out from generation to generation and is firmly rooted in people who are less exposed to the development of science, especially in traditional societies. This practice will be detrimental if there is a misperception about breastfeeding. The Madhavi and Manikyamba studies (2016) also identified the reasons for exclusive breastfeeding failure including misperceptions about exclusive breastfeeding with a perce n tage of 35.52% of 2000 respondents. The same study, Yaqub and Gul (2013) discovered the reasons of failure of exclusive breastfeeding were insufficient milk production in 289 (93.2%), working mother in 13 (4.2%) mothers, illness of baby in 2 (.65%), illness of mother in 6 (1.9%) cases. The study showed mothers perseption about insufficient milk production dominant factor cause failure of exclusive breastfeeding. Study in Nyanmar by Thet et al (2016) showed partisipants had high levels of knowledge about exclusive breastfeeding, but low adherence. O n e of the primary barriers to exclusive breastfeeding was that mothers, husbands, and grandmothers believed that exclusive breastfeeding was not sufficient for babies and solid foods and water were necessary. Water and mashed up rice w e re commonly introduced before 6 months of age. False perseption or negative myths can breastfeeding failed programs. Qualitative result study Heidari, et al (2016) were identified three main categories barriers to breastfeeding promotion. There were "incompetency of breastfeeding services", "mother’s inadequate breastfeeding self-efficacy" and "family’s neglect to breast milk." The cause of three main categories bariers f rom the participants are inadequate performance of bab y friendly hospital, failure of prenatal centers in teaching skills to mothers and families, and inadequate support for nursing women after delivery had caused breastfeeding damage. Heidari, et al (2016) giving advice to overcome the barriers to breastfeeding promotion, examples supportive and educational programs should be provided for all individuals invol ve d i n breastfeeding including mothers, families and health workers. The limitation of this study is the way to built a questionnaire by researcher was form emp i ri cal fact. Therefore the result of theis study may not be generalized to another comunity with different culture. CONCLUSION The conclusion of the study is there is a negati v e mythic relationship about breastfeeding with exclusive breastfeeding failure. Negative my th ic in this study is beliets about breast milk and breastfeeding that cannot be verified by scien ce . This study recommends the importance of education on exclusive breastfeeding in terms o f the growing culture in Indonesian society ACKNOWLEDGEMENT We gratefully thanks for STIKES Muhammadiyah Pekajangan Pekalongan, particularly Dr Nur I z z ah M.Kes, Nuniek Nizmah Sp.KMB, Firman Faradisi, MSN and Windha Widyastuti, MSN for their support and corrected english text. We also gratefully thanks for Dewi Puspita as editor IJNP UMY. REFERENCES Departement of health in Pekalongan regency (Dinas Kesehatan Kabupaten Pekalongan).(2016). Exclusive breastfeeding coverage in Pekalongan Regency. Pekalongan Indonesia : Departament of health in Pekalongan regency . Eram,U. (2017). A riview article : myths, beliefs and malpractices relating to breastfeeding and complementary feeding practices. International journal of pharmaceutical science invention, 6.(I), 14-16. Heidari, Z., Keshvari, M., Kohan, S. (2016). Breastfeeding Promotion, Challenges and Barriers: a Qualitative Research. 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