Proceeding International Webinar “The International Conference on Lactation Management (ICLM) in Covid-19 Pandemic Era"

Center of Excellence for Science & Technlogy of Breast Milk Health Polytechnic
Ministry of Health East Kalimantan

This publication is issued as the Proceedings of the International Conference on Lactation
Management in COVID-19 Pandemic Era in Samarinda, Indonesia September 30, 2021.
Published by:
Health Polytechnic Ministry of Health East Kalimantan
Jl. Kurnia Makmur No. 64 Rt.24 Samarinda,Indonesia
Telp (0541)738153 Fax (0541)768523
Email : [email protected]
https://poltekkes-kaltim.ac.id/
ISBN:

© Health Polytechnic Ministry of Health East Kalimantan

No part of this publication may be reproduced or transmitted in any forms or by any means,
electronic or mechanical, now known or heretofore invented, without permission in writing
form the publisher.

ii

PROCEEDING

ORGANIZING COMMITTEE INTERNATIONAL WEBINAR OF LACTATION
MANAGEMENT IN COVID-19 PANDEMIC ERA

Steering Commite Editorial:
Advisor
Person in charge of the event : H. Supriadi B, S.Kp., M.Kep Ketua Dewan Redaksi
Chairman of the Committee
Secretary : Joko Sapto Pramono, S.Kp., MPHM, H. , Dr. Hj. Endah Wahyutri, M.Kes., Dr. Dini Indo Virawati, S.Sit., MPH
Treasurer
Division of Secretary Dr. Hj. Nina Mardiana, M.Kes, Ns. Wiyadi, S.Kep., M.Sc, dr. Hilda, M.Kes

Division of Event : Dr. Dini Indo Virawati, S.SiT., MPH Anggota

Division of Science : Ratnawati, S.Gz., M.Kes Nursari Abdul Syukur, M.Keb

Division of Publication and : Suhartini, M.Pd Satriani, M.Kes
Documentation
Division of Sponsorship : Maria Eka Suryani, STr. Kes, Riana Tri Novitasari, S.Keb., Bd, Tiara Dini Farida Hariyani, S.SiT., M.Keb
Division of Human Resources
Division of Logisticks/ IT Harlita. SST., M.Si, Cristina, M.Keb, Indah Nurimamah, S.ST., M.Kes, Nino Adib Chifdillah, M.Kes

Sepsina Reski, S.Gz., M.Gizi, Fara Imelda Th. Patty, M.Tr.Keb

: Dwi Hendriani, SKM., M.Kes, Grace Carol Sipasulta, S.Kep., M.Kep Sp Mat, Editor

Sri Hazanah, SST., MPH, Dr. DP Era, M.Kep, Dr. Hj. Evi Nurachma, SST., Nursari Abdul Syukur, M.Keb

M.Kes, Rosalin Ariefah Putri, M.Keb, Dr. Aminah Toaha, M.Kes, Lidia Satriani, M.Kes

Lushinta, M.Keb Farida Hariyani, S.SiT., M.Keb

: Inda Corniawati, S.SiT., M.Keb, Hj. Umi Kalsum, S.Pd., M.Kes, Eli Nino Adib Chifdillah, M.Kes

Rahmawati, S.SiT., M.Kes, H.Azhari, M.Kes, Rieska Indah Mulani, M.Sc,

Diah Setiani, M.Kes, Yona palin, M.Kes Reviewer

Dr. Hj. Endah Wahyutri, M.Kes

: Nursari Abdul Syukur, M.Keb, Satriani, M.Kes, Farida Hariyani, S.SiT., Dr. H. Lamri, M.Kes

M.Kes, Nino Adib Chifdillah, M.Kes, Sendy Vanilla, AA., S.Tr.Gz Dr. H. Edi Sukamto, S.Kep., Ns., M.Kep

: Suprihartini, SKM., M.Kes, Nursyahid Siregar, M.Keb Dr. Dini Indo Virawati, S.Sit., MPH

: Kurniati Dwi Utami, MPH, Ni Nyoman Murti SPd., MPd, Jasmawati, S.Kep., Dr. Dwi Prihatin Era, S.Kp., M.Kep.,

M.Kes, Dra. Meity Albertina, SKM., MPd, Ns Nilam Noorma, S.Kep., M.Kes Sp.Kep.MB

: Suryanata Kusuma, SST., M.Si, Jamil Anshory, M.Si, Qusairi Rahman,

S.Kom, Armawi Eka Putra, SS, Yuliansyah Riannur, A.Md

ISBN :
Published by:
Health Polytechnic Ministry of Health East Kalimantan
Jl. Kurnia Makmur No. 64 Rt.24 Samarinda,Indonesia
Telp (0541)738153 Fax (0541)768523
Email : [email protected]

iii

PREFACE

Breast milk is beneficial for the health of mother and baby. According to Victora CG (2016),
feeding breast milk can decrease the cases or severity of infectious diseases and child mortality.
Breast milk contains various antimicrobial materials, anti-inflammation components, and factors
which support the development of immune system and reduce the cases of respiratory tract
infections. Almost one third of the cases of respiratory tract infections can be tackled by feeding
of breast milk. The risk of baby mortality among non breastfed baby is 14 times higher compared
to exclusive breastfed baby.

Pandemic of Coronavirus disease 2019 (COVID-19) established by WHO on March 11th 2020
has still been continuing, and until now more than 27 million cases has been spread all over the
world. The infection of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infects
all age groups, e.g pregnant women and neonatus. The information about the impact of COVID-
19 infections on pregnant women and neonatus are still limited. Based on the case study,
neonatus infected by SARS-CoV-2 showed mild clinical manifestations or asymptomatic; the
total number of severe cases , complications and good prognosis were relatively rare to happen.
The risks of neonatal infections through vertical transmission from mother-baby or breast milk
can not be concluded and need further research.

According to the purpose of this program is becoming a center of the research and development
of technology in breast milk, therefore this international webinar with theme The 1St
International Conference on Indonesia Lactation Management (ICLM) in Covid-19 Pandemic
Era will be held.

Editor in Chief

iv

REPORT OF THE CHAIRMAN OF THE INTERNATIONAL WEBINAR COMMITTEE
INTERNATIONAL CONFERENCE ON LACTATION MANAGEMENT
IN COVID-19 ERA

Bissmilahirohmanirohim
Assalaamu'alaikum warahmatullahi wabarakaatuh,
Good morning and greetings to all of us.

Whom I respect Head of Development and Empowerment Human Resources Ministry of Health
Republic of Indonesia

All The speakers
1. Associate Professor Karleen gribble, Ph.D
2. Fiona Lang-Sharpe, IBCLC, NAMCW
3. Dr. Endah Wahyutri, M.Kes

Whom I respect
Director of Politeknik Kesehatan Kementerian Kesehatan Kalimantan Timur , Dr. M. H Supriadi
S. Kp., M.Kep

Whom I respect
Deputy Director of Poltekkes Kemenkes Kaltim
Head of Center, Head of Unit, Head of Department, Head of Study Program, Lecturer and health
laboratory

Whom I respect
All the stakeholders , Head of health professional organizations, All participants of the webinar,
whether researchers, lactation experts, and students who are members of room zoom and
youtube.

First of all, let’s express our gratitude to the presence of Allah SWT, for the abundance of grace
and gifts, so that this morning we can attend an international webinar with the theme "Lactation
management in Covid-19 era".

We as the committee, would like to extend our welcome, appreciation, and gratitude for the
presence of Mr. and Mrs. who have fulfilled our invitation to this international webinar. Your
presence at this time actually gives you a sense of pride, joy and we feel that we have received a
special appreciation for our efforts. Thanks to All the committe for their effort in preparing this
Webinar since some time ago.

Dear webinar participants, this webinar started from a thought of PUIPK or center of excellent
and Tecnology of Breastfeeding team to also contributed in dealing with the COVID-19
pandemic situation by presenting ideas and solutions, were the result of research, especially to
help the government achieve the goals of achieving the Breastfeeding program.

v

Therefore, this international webinar is organized with the aim of :
1. Make all parties to convey ideas, experiences, expertise, and knowledge about global
issues of lactation management
2. Open an international forum to develop insight and improve the competences of
lecturers, health workers, lactation experts and students in the field of lactation
management on an international scale

Participants in this webinar was from various professions and institutions, including academics,
researchers, lactation experts, practitioners, and non-governmental organizations.

Dear webinar participants,
This International Webinar is expected to become a meeting forum between scientists,
researchers, policy makers, and users of research results, as well as encourage collaboration
between various groups who are interested in the success of the breastfeeding program so that it
can help the government in educating the nation's life in preparing the next generation of quality
can be achieved immediately

In more detail, this webinar is divided into three themes as follows: The first, The Role of
Midwives and Nurses in Protecting, Promoting, and Supporting Breastfeeding in Covid-19
Pandemic Era. The second, implementation Guidance on Counseling Women to Improve
Breastfeeding Practices in Covid-19 Pandemic Era.The third, Building Healthcare Professional
Skills to Support Breastfeeding in the Covid-19 pandemic Era

Dear webinar participants,
The material for this webinar consists of : 2 speakers, namely the main speaker and the
supporting speaker. There are 3 main speakers. They are specially invited and experts in their
fields. Supporting speakers are participants who have passed the selection. The papers to be
presented have been selected and grouped by the team. The paper will be presented at the Group
Session this afternoon.

Dear webinar participants,
To conclude of this report, I would like to thank the committee members who have worked hard
to prepare this webinar as well as possible. However, I apologize if the implementation of this
webinar are still have things that are not pleasing to you.

Finally, to the participants of the webinar, I wish you good luck in joining this webinar.
I hope this webinar is able to produce useful recommendations and there is real follow-up from
all stakeholders.

That is all and thank you

Wabillahi taufik wal hidayah,
Wassalamu'alaikum warahmatullahi wabarakaatuh

Dr. Dini Indo Virawati, S.SiT, MPH
Chairman

vi

OPENING REMARKS
DIRECTOR OF HEALTH POLYTECHNIC OF EAST KALIMANTAN

Assalamualaikum warrahmatullahi wabbarakatuh
Good Morning everyone

To the honored,
Acting Chief of Staff to the Board for Development and Empowerment Human Resources of
Health , dr.Kirana Pritasari, MQIH

To the honored,
Deputy directors in Health polytechnic East Kalimantan
Associate professor Karleen Gribble, Ph.D
Fiona Lang Sharpe,IBCLC, NAMCW
Head of Study Programs in Health Polytechnic East Kalimantan
Head of Center of Excellence
All staff in Health Polytechnic East Kalimantan
And All participants of International seminar in the zoom’s room

Ucapan rasa syukur dan shalawat
Welcome greeting to all the speakers and participants
1. Acting Chief of Staff to the Board for Development and Empowerment Human Resources of

Health , dr.Kirana Pritasari, MQIH (keynote speaker)
2. Associate professor Karleen Gribble, Ph.D from Western Sydney (The role of Midwifes and

Nurses in Protecting, Promoting and Supporting Breastfeeding in Covid-19 Pandemic Era)
3. Fiona Lang Sharpe,IBCLC, NAMCW (Implementation Guidance on Counselling Women to

Improve Breastfeeding Practices in Covid-19 Pandemic Era)
4. Dr.Hj. Endah Wahyutri, M.Kes, Deputy Director 2 and lecturer in Health Polytechnic East

Kalimantan (Building Healthcare Professional Skills to Support Breastfeeding in Covid-19
Pandemic Era)

Covid-19 is a disease caused by SARS-CoV-2. SARS-CoV-2 is the name of virus which has
been identified for the first time since late 2019.This covid-19 pandemic has spread worries for
most of lactating mothers. This worries is related to the anecdotal reports in some of local news,
international and social media about breastfeeding is a transmission medium for Covid-19. We
put more concern about the decrease of breastfeeding practices during this covid-19 pandemic
because many mothers still lack information about breastfeeding during pandemic.

vii

Breastmilk is the best nutrition for baby because it contains antibody to increase immune system
on baby. WHO has recommended the exclusive breastfeeding for 6 months and continued to
breastfed the baby with suitable complementary feeding until 2 years old. However, some
worries for breastfeeding among lactating mothers appear in this covid-19 pandemic. For
example, physical contact between mother and baby will probably transmit the Covid-19 virus.
This thing will cause some doubt to practice breastfeeding during pandemic among mothers.

Generation with good health, strong and smart is born from a strong mother too. A mother who
is pregnant and delivers her baby always takes care her nutrition so that she can deliver a healthy
baby. Nowadays,pregnant and lactating mothers during covid-19 Pandemic are expected to keep
good body immune system. According to the Control and Prevention Center of Covid-19, this
Covid-19 virus has not been detected yet in the breast milk. Moreover, it has not been known
whether breastfeeding mothers can transmit new variant of Covid-19 to their babies or not, either
during pregnant or breastfeeding. Therefore, good lactation management is necessary to prevent
from Covid-19 virus. In this way, health promotion to improve the successful breastfeeding
practices is also performed by educating the proper breastfeeding practices according to the
health protocol for breastfeeding in covid-19 Pandemic.

During covid-19 Pandemic, Some innovations are necessary to support the target of exclusive
breastfeeding practices for babies in the first 1000 days of life. Training or workshop is
appropriate way for health workers to handle about infodemic in lactation, and regular training
for lactation counsellor is also necessary for helping pregnant and lactating mothers to
understand the importance of exclusive breastfeeding during covid-19 pandemic.

This conference is the implementation of community dedication in Health Polytechnic East
Kalimantan. This conference is also in line with one mission of Health Polytechnic East
Kalimantan to implement community dedication based on Applied Research and Technology.

Purpose of this Program :

The purpose of this program is to obtain some information from speakers about how to increase
the knowledge about lactation management during this covid-19 pandemic and able to give
education and become facilitators of lactation management for mothers and community.
Furthermore, this program is expected to participate actively to support the government’s
program, especially the exclusive breastfeeding program.

In brief, We would like to give appreciate to many participants who attend this conference. We
also would like to say thank you especially to all speakers who has spare their times to share
their knowledge to us, moreover I would like to say thank you to Deputy Directors, Head of
Subdivisions,Head of Center, Head of Study Programs in Health Polytechnic of East Kalimantan
and all committee of this conference. Besides that, I would like to say thank you to Professional
Associations & Organizations such as : PPNI, IBI, PATELKI, PERSAGI and PPKMI which also
support this conference.

I hope that this conference can contribute many benefits, especially the benefits related to update
information about breastfeeding during this covid-19 Pandemic. Amin ya rabbal allamin.

I think that’s all from me today and thank you

Wassalamualaikum Wr. Wb

Dr. H. Supriadi B, S.Kp, M.Kep
Director

viii

LIST OF CONTENTS

TITLE PAGE i
iii
ORGANIZING COMMITTEE iv

PREFACE v

REPORT OF THE CHAIRMAN OF THE INTERNATIONAL WEBINAR vii
ix
COMMITTEE .

OPENING REMARKS DIRECTOR OF HEALTH POLYTECHNIC OF EAST
KALIMANTAN

LIST OF CONTENTS

ESSENTIAL COMMUNICATION SKILLS FOR LACTATION PROFESSIONALS

1. Meta-Analysis: The Influence Of Health Education On Exclusive Breastfeeding

With Video, Booklet And Leaflet Media On Knowledge In Early Married

Adolescents In 2021

Ega Ersya Urnia, Dini Indo Virawati 1

2. The Effect Of Maternal Health Education On Family Support in The Breastfeeding

Process of Newborn Babies

Grace Carol Sipasulta, Sri Hazanah, Nina Mardiana 14

3. A Rapid Online Survey On Breastfeeding Counselor’s Practices Facing The Covid-

19 Pandemic

Kurniasari Hikmah, Agusnawati, Nurillah Ika 32

4. Protect Breasfeeding (Case Study: Midwives And The International Code Of 42

Marketing Of Breast Milk Substitute Products)
Kusmayra Ambarwati

5. Compliance Of Breast Milk Substitutes Advertisement In Medical Journals Under 49
The Scope Of Government Regulation
Wiyarni Pambudi, Michelle Ruth Natalie, Diana Amilia Susilo

6. The Efect Of Breastfeeding Technical Guidance On Breastfeeding Mothers To 61
Knowledge, Skill And Breastfeeding Self-Efficacy In Olak Kemang Medical Centre
In 2021
Yuli Suryanti, Ajeng Galuh W, Puja Nala Sari

ix

CREATING EFFECTIVE LACTATION CARE PLANTS 72

7. Effectiveness Of Care Treatment Using Topical Breast Milk And Dry
Gauze At The Time Of Release New Born Umbilical Cord At PMB Misliana
Inna Muthmainnah, Hilda, Rosalin Ariefah Putri

BREASTFEEDING PRACTICES AND DETERMINANTS OF EXCLUSIVE 88
BREASTFEEDING

8. The Relationship Of Exclusive Breast Milk With Baby Growth And
Development 6-12 Months Ages In Bukit Biru Sub-District Tenggarong
Year 2021
Dwi Astuti, Hj. Umi Kalsum, Nursyahid Siregar, Joko Sapto Pramono

9. Correlation Between Maternal Hemoglobin Levels During Pregnancy 100
And Lactation Hemoglobin Levels
Endah Wahyutri, Rosalin Ariefah Putri

10. Effectiveness Of Home Visits Treatment On Breastfeeding In Balikpapan 2019

Ernani Setyawati, Novi Pasiriani 110

11. The Effect Of Traditional Music And Classical Music (Mozart) In Breast 119
Milk Production At Puskesmas Rapak Mahang
Wahyu Eka Novita, Hj. Endah Wahyutri, Nursari Abdul Syukur

PREVENTION OF TRANSMISSION OF COVID-19 INFECTION DURING 129
BREASTFEEDING

12. Literature Review: Potential Of Transmission And Prevention Of Covid-19
During Breastfeeding
Agustiawan, Riri Dwianggarani

13. Breastfeeding Knowledge And Attitudes During Covid-19 Isolation Among 137
Mothers With Mild Cases
Wiyarni Pambudi, Nuralisa Safitri

MYTHS AND MISCONCEPTION SURROUNDING BREASTFEEDING 146
156
14. Diet Taboos For Breastfeeding Mothers: An Overview
Riri D, Agustiawan

LACTATION MASSAGE FOR INCREASING BREAST MILK PRODUCTION

15. Differences Of Oketani Massage And Oxytocin Massage On Breast Milk
Production In Postpartum Mothers At UPT Sepaku 3 Public Health Center
Penajam Paser Utara In 2021
Ani Fitriani, Susi Purwanti, Nursari Abdul Syukur

x

16. Effectiveness Of Oxytocin Massage And Marmet Massage On Breast Milk 166
Production In Post Partum Mothers At Mutia Clinic, Penajam Paser North
District In 2021
Suprapti, Inda Corniawati, Elisa Goretti Sinaga

HERBAL AND PHARMACEUTICAL GALACTAGOGUES FOR BREASTFEEDING

17. The Effect Of Moringa Leaf On Breastfeeding Mothers On Increasing Baby Weight

In Puskesmas Loakulu

Dewi Wahyuni, Jasmawati, Rizky Setiadi 180

18. Giving Moringa Leaf Nugget (Moringa Oleifera) As A High Energy And Protein

Snack For Breastfeeding Mothers

Humaira Azzahra, Kurniati Dwi Utami 192

19. Siomay Manday as Alternative and Economical Food for Breastfeeding Mothers 201
Muthmainnah Hasanuddin Usman, Satriani, Mujahadatul Fitriya

20. Kalakai Nugget (Stenochlaena Palustris) To Prevent Anemia For Breastfeeding

Mothers

Putri Zainul Inayah, Gea Amanda Safitri 207

21. Cork Fish and Pumpkin Flour Substitute Biscuits As Supplementary Food 220
for Breastfeeding Mothers
Ratnawati, Satriani

22. Utilization of Red Dragon Fruit Peel (Hylocereus polyrhizus) and Kelakai Leaves

(Stenochlaena palustris) as Functional Drinks for Breastfeeding Mothers 231
Rif’atul Amini, Mentari Fadia Almiranti

23. Application of Food Modification Techniques in Lomesa Snack Bars

as a Functional Food Alternative for Breastfeeding Mothers

Singgih Dwi Karsono, Mujahadatul Fitriya, Muthmainnah Hasanuddin Usman

Rif’atul Amini 244

24. The Effect of The Consumption of Morage Fortification Pudding on Breast Milk 259
And Hb Production of Breastfeeding Mothers in The Area of The UPT Puskesmas
Penajam
Siti Nurhapiah, Endah Wahyutri, Rahmawati Wahyuni

xi



The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

META-ANALYSIS: THE INFLUENCE OF HEALTH EDUCATION ON
EXCLUSIVE BREASTFEEDING WITH VIDEO, BOOKLET AND
LEAFLET MEDIA ON KNOWLEDGE IN EARLY MARRIED
ADOLESCENTS IN 2021

Ega Ersya Urnia1, Dini Indo Virawati2
1 Bachelor of Applied Midwifery and Professional Education of Midwifery, Health

Polytechnic Ministry of Health East Kalimantan
2Lecturer of the Department of Midwifery, Health Polytechnic Ministry of

Health East Kalimantan
*Author Correspondence: [email protected]

Abstract: According to data from the 2018 National Basic Health Research in
Indonesia, 4.1 percent of those aged 10-14 years have been pregnant and married
and 63.2 percent are pregnant and married at the age of 15-19 years (National
Basic Health Research, 2018). Meanwhile, according to data from the Indonesian
Child Profile in East Kalimantan Province in 2018, 1,159 children married under
the age of 19 (Indonesian Child Profile, 2018). According to data from the 2018
National Basic Health Research in Indonesia, 65.7 percent of children aged 0-23
months have not/never been breastfed. Meanwhile, according to data from the
2018 East Kalimantan Basic Health Research, 77.9 percent of children aged 0-23
months have not/never been breastfed (National Basic Health Research, 2018).
The purpose of the study was to explain the analysis of the effect of providing
health education on exclusive breastfeeding with video media, booklets and
leaflets on knowledge of adolescents who marry early. The research design used
was a meta-analysis with a pre-post contrast meta-analysis research design.
Statistical data analysis was carried out computerized by using the metamar
program to analyze the Raw (unstandardized) mean difference test data on effect
size and Standardized mean difference on the effect size. The results of the meta-
analysis of research articles on the effect of providing health education on
exclusive breastfeeding with video media on adolescent knowledge obtained a p-
value of 0.0000 (< 0.005), the effect of providing health education on exclusive
breastfeeding with booklet media on adolescent knowledge obtained a p-value of
0.00013 (< 0.005), the effect of providing health education regarding exclusive
breastfeeding with leaflet media on adolescent knowledge obtained a p-value of
0.0000 (< 0.005) which means that there is a significant influence between video,
booklet and leaflet media with the knowledge of adolescents who are married
early.

Keywords: Exclusive Breastfeeding, Teenagers, Early Marriage, Health
Education Media, Knowledge, Videos, Booklets, Leaflets.

INTRODUCTION

Law Number 1 of 1974 Article 7 concerning Marriage states that marriage is

only permitted if the man reaches the age of 19 years and the woman has reached

1

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

the age of 16 years. Law Number 16 of 2019 Article 7 concerning Marriage is
only permitted if the man and woman have reached the age of 19 years. Based on
the UNICEF report, Indonesia is a country with the seventh highest child marriage
rate in the world, namely 457.6 thousand women aged 20-24 years who married
before the age of fifteen (Profile of Indonesian Children, 2018).

According to data from the 2018 National Basic Health Research in Indonesia,
4.1 percent of those aged 10-14 years have been pregnant and married and 63.2
percent are pregnant and married at the age of 15-19 years (National Basic Health
Research, 2018). Meanwhile, according to data from the Indonesian Child Profile
in East Kalimantan Province in 2018, 1,159 children married under the age of 19
(Indonesian Child Profile, 2018).

According to the 2018 National Basic Health Research data in Indonesia, 65.7
percent of children aged 0-23 months have not/never been breastfed. Meanwhile,
according to data from the 2018 East Kalimantan Basic Health Research, 77.9
percent of children aged 0-23 months have not/never been breastfed (National
Basic Health Research, 2018).

According to Hotchkiss et al. (2016) risk factors associated with the incidence
of early marriage include place of residence (urban or rural), religion, economic
status, education level, age at first marriage and tolerance for domestic violence.
The results of the meta-analysis of Windiarti and Besral (2018) based on an
analysis of collected journals, it was found that the determinants of early marriage
in Indonesia are unwanted pregnancy, peer influence, parental roles, education
level, knowledge of reproductive health, family economic status, Culture, Media
Exposure, Temporary Rural Residence, Region, Shows the Geographical Role of
Religion, Ethnicity and Others. The results of the meta-analysis research
conducted by UNICEF in 2011 the determinants of child marriage in Indonesia
are also influenced by three aspects. The three aspects are the condition of the
individual, household, and community. According to UNICEF, there is a positive
correlation between child marriage and internet use via mobile phones, the age of
the head of the household and the number of children in the family who are in
primary school. The results showed that adolescents who have knowledge that

2

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

women can experience pregnancy when having sexual intercourse 0.9 times can
prevent them from having premarital sex. Someone who knows that women can
experience pregnancy during sexual intercourse can make the decision not to
engage in premarital sexual behavior (Fitrianingsih et al, 2015).

According to Wendiranti et al (2017) risk factors for the failure of exclusive
breastfeeding include breastfeeding mothers who are not supported by their
husbands to do exclusive breastfeeding. have a greater risk of experiencing
exclusive breastfeeding failure, and breastfeeding mothers who receive incorrect
information from health workers are at 8.06 times greater risk of experiencing
exclusive breastfeeding failure.

Knowledge can be increased by providing health education. Health education
is a process of changing a dynamic behavior, the change is not just a process of
transferring material or theory from one person to another and is not a set of
procedures, but changes occur because there is awareness from within the
individual, group and society itself (Mubarak et al. 2007).

Health education requires media to maximize the information received by the
recipient of the information. Media is something that has the nature of channeling
messages and can stimulate the thoughts, feelings and abilities of the audience so
as to encourage the learning process in him. The use of creative media allows the
audience to learn better and can improve their performance in accordance with the
goals to be achieved (Mubarak et al, 2007). The results of research by Fadhillah et
al (2020) show that several variables in maternal characteristics have a
relationship with mother's knowledge, attitudes, beliefs and intentions.

Furthermore, the researchers searched for research articles on the effect of
health education media (videos, booklets and leaflets) on knowledge about
exclusive breastfeeding in adolescents who married early and found that 62.24%
(89 research articles) stated that health education media could change knowledge
of early marriage. adolescents while 37.76% (54 research articles) stated that
health education media could not increase the knowledge of adolescent early
marriage.

3

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

From the background above, it is found that there is a gap that there is still
research that says there is no effect of providing health education with the video,
booklet and leaflet methods on adolescent knowledge and it is not yet known
significantly what health education method is used to increase adolescent
knowledge so that researchers intend to find out educational methods. What kind
of health is good to use as a medium to provide health education to adolescents by
conducting a systematic meta-analysis review from various journals and research
articles related to meta-analysis.

METHOD

The type of research used is meta-analysis. Meta-analysis is research
conducted by researchers by summarizing research data, reviewing and analyzing
research data from several previous research results. The form of a pre-post
comparative research design is to compare the central tendency (mean or
proportion) of the variable measured at one time with the central tendency of the
same variable measured at another time. Statistical data analysis was carried out
computerized by using the Meta-Mar program to perform data analysis with the
Raw (unstandardized) mean difference test on effect size and Standardized mean
difference on the effect size. With these very different measures, they produce
different numerical values that are only meaningful in relation to the particular
operationalization and scale used. Research data collection was carried out by
researchers by browsing articles contained in online journals using Google
Scholar, Garuda Portal and PubMed.

From a search using ten keywords, “exclusive breastfeeding” OR “early
marriage” OR “child marriage” OR “exclusive breastfeeding health education
media” AND “exclusive breastfeeding knowledge” AND “video media and
exclusive breastfeeding” OR “booklet media and exclusive breastfeeding” OR
“leaflet media and exclusive breastfeeding” obtained 147 articles, then screening
of articles that met the inclusion criteria was carried out. The process of screening
articles in this study uses the flow protocols diagram of systematic reviews and
meta-analyses (PRISMA-2015) obtained 25 articles that fit into the criteria.

4

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

RESULTS

Based on the screening with the PRISMA diagram, several articles were
obtained and then the articles that met the criteria were selected, namely as many
as 25 research articles.

Unstandardized Mean Difference

Motion Picture

Table 1. Effect Size Unstandardized Mean Difference Media Video on Knowledge about Exclusive

Breastfeeding in Adolescents who Married Early

UMD P-Value

Fixed Effect Model 0.166 0.0000

Random Effect Model 2.445 0.0000

Source: Calculation of research articles with the Meta-Mar . application

From the results of data analysis in table 1, it is found that there is an effect of

providing health education with videos on knowledge about exclusive

breastfeeding in adolescents who marry at an early age with a p-value of 0.0000.

Booklet

Table 2. Effect Size Unstandardized Mean Difference Media Booklet on Knowledge about

Exclusive Breastfeeding in Adolescents who Married Early

UMD P-Value

Fixed Effect Model 0.146 0.0000

Random Effect Model 1,892 0.00013

Source: Calculation of research articles with the Meta-Mar . application

From the results of data analysis in table 2, it is found that there is an effect of

providing health education with booklet media on knowledge about exclusive

breastfeeding in adolescents who marry at an early age with p-values of 0.0000

and 0.00013.

Leaflet

Table 3. Effect Size Unstandardized Mean Difference Media Leaflet on Knowledge of Exclusive

Breastfeeding in Adolescents who Married Early

UMD P-Value

Fixed Effect Model 4.85 0.0000

Random Effect Model 8.57 0.0000

Source: Calculation of research articles with the Meta-Mar . application

5

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

From the results of data analysis in table 3, it is found that there is an effect of
providing health education with leaflet media on knowledge about exclusive
breastfeeding in adolescents who marry at an early age with a p-value of 0.0000.

Standardized Mean Difference

Motion Picture

Table 4. Effect Size Standardized mean difference Media Video on knowledge about exclusive

breastfeeding in adolescents who marry at an early age

high P-Value

school

Fixed Effect Model 4.54 0.0000

Random Effect Model 11.84 0.0000

Source: Calculation of research articles with the Meta-Mar . application

From the results of data analysis in table 4, it is found that there is an effect
of providing health education with video media on knowledge about exclusive
breastfeeding in adolescents who marry at an early age with a p-value of 0.0000.

Booklet

Table 5. Effect Size Standardized mean difference Media Booklet on Knowledge about Exclusive

Breastfeeding in Adolescents who Married at an Early Age

high P-Value

school

Fixed Effect Model 3.53 0.0000

Random Effect Model 7.24 0.00013

Source: Calculation of research articles with the Meta-Mar application

From the results of data analysis in table 5, it is found that there is an effect

of providing health education with booklet media on knowledge about exclusive

breastfeeding in adolescents who marry at an early age with p-values of 0.0000

and 0.00013.

Leaflet

Table 6. Effect Size Standardized mean difference Media Leaflet on Knowledge of Exclusive

Breastfeeding in Adolescents who Married Early

high P-Value

school

Fixed Effect Model 4.85 0.0000

Random Effect Model 8.57 0.0000

Source: Calculation of research articles with the Meta-Mar application

6

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

From the results of data analysis in table 6, it is found that there is an effect
of providing health education with leaflet media on knowledge about exclusive
breastfeeding in adolescents who marry at an early age with a p-value of 0.0000.

DISCUSSION

The Effect of Providing Health Education on Exclusive Breastfeeding with
Video Media on Knowledge of Adolescents who Married at an Early Age

The results of the meta-analysis of research articles on the effect of providing
health education regarding exclusive breastfeeding with video media on changes
in knowledge in adolescents who marry at an early age obtained a p-value of
0.0000 (< 0.005) which means that there is a significant effect between video
media and adolescent knowledge.

Before discussing the causes of video media can change adolescent
knowledge, it is necessary to know what is meant by knowledge. Knowledge is
the result of "knowing" and this occurs after people have sensed a certain object.
In the sensing process to produce knowledge, it is strongly influenced by the
intensity of attention and perception of the object. Knowledge itself is influenced
by several factors, including age, education, occupation, social and culture.
Knowledge is also very closely related to education where it is hoped that with
higher education the person will have more extensive knowledge (Larassati &
Rumintang, 2018). Adolescents who choose to marry at an early age have low
knowledge about exclusive breastfeeding.

The lack of knowledge of adolescents is caused by the fact that information
has not been conveyed effectively. The effectiveness of delivering information is
influenced by the use of media. In learning, media is needed that can help increase
attention and learning atmosphere. Teenagers will not feel bored and the message
will be conveyed optimally when using interesting media. Media helps the
educational process so that it can be captured by the five senses. The more senses
used, the clearer the knowledge obtained (Putri et al, 2019).

7

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

Media can be visual or audio visual. One of the audio visual media is motion
picture. A number of studies have proven that audiovisual media can help
teaching. Video media uses the senses of sight and hearing. Teenagers will
understand better because they not only know through lectures but also through
moving pictures (Putri et al, 2019).

Video media is media that has sound and image elements. This type has a
better ability, because it includes both types of auditory (hearing) and visual
(seeing) media. Motion picture media is an audiovisual aid which means materials
or tools used in learning situations to help written and spoken words transmit
knowledge, attitudes, and ideas (Budiman, 2017). Videos can attract attention,
improve motor skills, observe phenomena directly, analyze interactions, issues,
and problem solving, can be displayed repeatedly, form attitudes, develop
appreciation (Putri et al, 2019).

The advantage of using video media in learning activities is not only as a tool,
but also as a carrier of information or messages to be conveyed. The use of videos
about Exclusive Breastfeeding can clarify the abstract description of the
importance of Exclusive Breastfeeding for children of teenagers who marry at an
early age, because in the process of giving it, respondents not only hear the
material being delivered, but also see directly and clearly about the negative
impact of not giving exclusive breastfeeding. The benefits of using video media
are according to the concept of learning according to the pyramid of experience
written by Edgar dale, that people learn more than 50% of what they have seen
and heard (Aeni & Yuhandini, 2018).

According to the results of research from Lestari & Sundayani (2018), it was
found that the p-value = 0.000 or <0.05, it was stated that there was an effect of
counseling with or without video media on adolescent knowledge.

Similar research results were obtained from Kusuma & Indarjo (2017), the
results of statistical tests showed that there was a difference in the level of
knowledge before and after the screening of the Mancur film, the p-value = 0.000,
which means <0.05. That is, there is a significant difference between knowledge
before and after the screening of the Mancur film.

8

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

Video media is very often used in various community service activities,
according to research results by Rohmawati, Hidayah and Marwan (2020) it was
found that 60 of 68 participants experienced an increase in knowledge about
exclusive breastfeeding due to health education using video media. Information
media and various factors influence knowledge and changes in adolescent life
behavior which then affect their reproductive health behavior (Masrizal et al.,
2019). As a result of the limited research articles on video health education media,
there has been no long-term evaluation of the benefits of the health education
media.

The Effect of Providing Health Education on Exclusive Breastfeeding with
Media Booklets on Knowledge in Teenagers who Married at an Early Age

The results of the meta-analysis of research articles on the effect of providing
health education regarding exclusive breastfeeding with booklet media on changes
in the knowledge of adolescents who marry at an early age obtained a p-value of
0.00013 (< 0.005) which means that there is a significant effect between booklet
media and adolescent knowledge.

Booklets or pocket books are useful media for conveying health messages in
sheet form, both in writing and in pictures (Murtiyarini et al, 2020). Health
education using booklet media is expected to increase knowledge about exclusive
breastfeeding in adolescents who marry at an early age. The advantage of
providing health education with booklet media has advantages because it is a
small book that can be carried everywhere so that it can be read anywhere
(Murtiyarini et al, 2020).

According to the results of research from Samaria in 2016, p-value = 0.002 or
<0.05, it was stated that there was an effect of counseling with booklet media on
adolescent knowledge about exclusive breastfeeding. The results of a similar
study from Murtiyarini in 2020 obtained a p-value = 0.000 or <0.05, it was stated
that there was an effect of counseling with booklet media on adolescent
knowledge about exclusive breastfeeding. The limited research that mentions the
lack of booklet media makes it difficult to compare the results of the study.

9

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

The Effect of Providing Health Education on Exclusive Breastfeeding with
Leaflet Media on Knowledge of Early Married Adolescents

The results of the meta-analysis of research articles on the effect of providing
health education regarding exclusive breastfeeding with leaflet media on
increasing the knowledge of adolescents who marry at an early age obtained a p-
value of 0.0000 (< 0.005) which means that there is a significant effect between
leaflet media and adolescent knowledge.

The Leaflet method basically has an effectiveness in increasing knowledge,
this is because the treatment is a method of health education and both are one-way
methods, namely health education and both are active, while the target is passive
(Dewi et al, 2017).

The advantage of leaflet media as a source of reproductive health information
for adolescents is that leaflet media is easy to access, but it needs to be observed
because not all easily accessible information has the best quality (Dewi et al,
2017).

Leaflet media is effective in increasing adolescent knowledge and attitudes
about health at SMA Surakarta showing an increase in the average value of
knowledge and attitudes of adolescents from before being given counseling
treatment with leaflet media compared to after being given counseling treatment
with leaflet media (Afridayanti, 2020).

According to the results of research from Dewi (2017), it was found that the p-
value = 0.000 or <0.05, it was stated that there was an effect of counseling with
leaflet media on adolescent knowledge about exclusive breastfeeding. The results
of a similar study from Elba & Wijyaya in 2019 obtained a p-value = 0.000 or
<0.05, it was stated that there was an effect of counseling with leaflet media on
adolescent knowledge about exclusive breastfeeding.

A person's level of knowledge will affect his psychosocial maturity and
thinking ability. The higher the level of knowledge, the easier it is to think
rationally, describe and address problems, and make decisions (Elba & Wijaya,
2019). The presence of various kinds of health education media for adolescents is

10

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

expected to increase adolescent knowledge about exclusive breastfeeding. The
limited research that mentions the lack of leaflet media makes it difficult to
compare the results of the study for further improvement.

CONCLUSION

The conclusion from the research results is that there is a significant effect
between video media, booklets, and leaflets with adolescent knowledge about
exclusive breastfeeding, with each p-value of 0.0000 for the video variable,
0.00013 for the booklet variable, and 0.0000 for the leaflet variable.

REFERENCES

Indonesian Children Profile. PAI Book 2018. Educational Science 2018; 5(1): 12–
21. South Kalimantan Basic Health Research, 2018.

UNICEF. Child Marriage in Indonesia, 2016.
Hotchkiss, DR, Godha, D., Gage, AJ, & Cappa, C. Risk Factors Associated With

The Practice Of Child Marriage Among Roma Girls in Serbia Health and
Human Rights Of Marginalized Populations. BMC International Health
and Human Rights 2016; 16(1): 1–10.
Windiarti S, and Besral (2018).Determinants of Early Marriage in Indonesia: A
Systematic Review.Proceedings of the International Conference on
Applied Science and Health 2018; 3: 287-293.
Fitrianingsih et al. 2017. Effectiveness of Methods Focus Group Discussion (Fgd)
Parental Communication In The Role Of Adolescent Sexual Behavior In
SMAN 3 Cirebon City Year 2016. Journal of Care 2017; 5(3): 418-430.
Mubarak, et al. Health Promotion: An Introduction to Teaching and Learning in
Education. Yogyakarta: Graha Ilmu, 2007.
Lestari, AD, & Sundayani, L. Effect of Extension with Video Media and Leaflets
on Adolescent Knowledge and Attitudes about the Risks of Early Marriage
in Gerung Butun Timur in 2018. Journal of Midwifery Update (MU) 2020;
1(2): 79.

11

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

Murtiyarini, I., Nurti, T., & Sari, LA Effectiveness of Health Promotion Media on
Adolescent Knowledge About Maturation Age at Marriage in SMAN 9
Jambi City. Journal Health & Science: Gorontalo Journal Health and
Science Community 2019; 1(2): 71–78.

Dewi, RK, et al. The Effectiveness of Leaflets and Lectures on Knowledge Levels
About the Risks of Early Marriage at Sma Negeri I Baturetno Wonogiri
2017. Journal of Stikes Wirahusada, 2017.

Retnawati, H., et al. Introduction to Meta Analysis, 2018. (Issue August 2019).
Larassati, PA, & Rumintang, I. Effect of Health Education Using Video Media on

Increasing Knowledge of Young Women Regarding Introduction to
Development in Health Directed to Increase Public Awareness,
Willingness and Ability. JOURNAL Midwifery Update (MU) 2018; 8511:
21–29.
Putri, IM, & Rosida, L. Knowledge Improvement of Marriage Age Maturation
Program in Youth Youth Organizations in Salakan Bantul Yogyakarta.
Journal of Midwifery Community Service 2019; 1(1): 5–11.
Budiman, MA The Effectiveness of Audio Visual Media-Assisted Classical
Guidance on Early Marriage. Indonesian Educational Research Journal
(JPPI) 2017; 2(2): 1–5.
Aeni N, Yuhandini DS.Health Education With Video Media And Demonstration
Methods Against BSE Knowledge. Journal of Care 2018; 6(2): 162-174.
Kusuma FR, Indarjo S. Film Mancur (Manten Kencur) as an Enhancer of
Knowledge and Attitudes About Early Marriage. Journal of Health
Education 2017; 2(1): 53-59.
Rohmawati, DL, Hidayah, N., & Marwan, M. Peer Counselor Training in Efforts
to Improve Nutrition and Reproduction in Adolescents. Journal of
Community Engagement in Health 2020; 3(2): 194–199
Masrizalm KL, Arbimes. Reproductive Health Education as a Health Promotion
Effort at SMPN 5 Padang City. Nagari Scientific Bulletin Building 2019;
2(1): 218-224.

12

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

Djanah, N., Muaslimah, M., & Wulan, R. Community Service in Promotive
Efforts in the Form of Increasing the Ability of Young Women About the
Marriage Age Maturation Program (PUP) in Banguntapan Village, Bantul
2020; 1(1): 19–25.

Yanti EA, et al. The Effectiveness of Leaflet Media Extension and Lecture
Methods on Knowledge and Attitudes of Students About Early Marriage at
SMA Negeri 1 Pancur Batu Deli Serdang in 2019. Colostrum Midwifery
Journal 2020; 1(2):

Elba, F., & Wijaya, M. Effects of Provision of Reproductive Health Materials
About the Dangers of Early Marriage for Young Women. Dharmakarya
2019; 8(1).

Oktarina, J., Marono, HM, & Purnomo, W. The Effect of Peer Reproductive
Health Education on Knowledge and Attitudes in Prevention of Premarital
Sex at SMAN 1 Sukamara, Sukamara Regency, Central Kalimantan.
Health

Systems Research Bulletin 2017; 20(1).

13

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

THE EFFECT OF MATERNAL HEALTH EDUCATION ON FAMILY
SUPPORT IN THE BREASTFEEDING PROCESS
OF NEWBORN BABIES

Grace Carol Sipasulta 1 , Sri Hazanah 2 . Nina Mardiana3
Nursing Study Program of the Ministry of Health of East Kalimantan Polytechnics

Health Promotion Study Program of the Ministry of Health of East Kalimantan
Polytechnics

Midwifery Study Program of the Ministry of Health of East Kalimantan Polytechnics
Email1: [email protected]

Abstract: Introduction. The quality of maternal and newborn care, the most
important period in childbirth, prevents maternal and infant mortality. Childbirth
and the puerperium and healthy newborns, family support is needed to prevent
disturbances during pregnancy, childbirth and early breastfeeding during the
puerperium. The purpose of implementing maternal health education for family
support in the early process of breastfeeding newborns.
Method. Analytical observational research with cross sectional design. The
research design of the independent maternal health education from health workers
obtained by postpartum mothers during ANC visits during the first to third
trimesters of pregnancy with the dependent variable being family support in the
process of breastfeeding newborns. Consecutive Sampling n 60 postpartum
mothers at the Maternity Hospital Sayang Ibu Balikpapan. Data collection using
instruments according to the MCH handbook. Data analysis univariate frequency
distribution, bivariate Chi Square test.
Results and Discussion. Maternal health education has an effect on family support
for the initial process of breastfeeding for newborns. Maternal Health Education
sig p-value 0.011. There were 7 (12.9%) mothers who did not receive assistance
from health workers but received support in the early process of breastfeeding
their babies. There were 13 (46.4%) mothers who felt the assistance of health
workers but did not receive support for the early process of breastfeeding their
babies. The OR value of maternal health education is 4.121. Postpartum mothers
do not feel the assistance of health workers, the risk is 4 times that they do not
receive early support for breastfeeding their babies from experiencing assistance
from health workers
Conclusion Maternal health education from pregnant women to postpartum has
not been implemented properly. maternal health education to secondary school,
when the bride and groom and antenatal care continues.

Keywords: Maternal Health Education, Early breastfeeding , Newborns and post
partum mother

14

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

INTRODUCTION

Maternal and infant deaths that occur mostly on the day of birth, with mostly
preventable causes. Research shows that up to 3 million people can be saved from
maternal and infant mortality each year through the coverage of high-quality care
provided during pregnancy, delivery and newborn care and when experiencing
illness with additional surgical costs (WHO.2017).

WHO and UNICEF have launched a Network to Improve the Quality of
Health Care for Mothers, Infants and Children in order to reduce disease and
prevent maternal and infant mortality, as well as to improve problems experienced
by mothers during care through the quality of care provided by health workers,
also the experience experienced by patients while being treated. (WHO. 2017).

Addressing the quality of care that has not been felt by every mother and baby
will be the basis for reducing maternal and newborn mortality in order to achieve
the SDG targets related to health. The period around delivery is most important to
save the maximum number of maternal lives and prevent infant mortality. WHO
has outlined a global vision in which every pregnant woman and newborn
receives quality care in the mother's period during pregnancy, into labor through
to termination and the postnatal period for mother and newborns through
Universal Health Coverage and Quality by 2030 (WHO. 2016).

Studies show that family and community support are important factors for
successful breastfeeding. Many mothers benefit from breastfeeding and early
initiation of breastfeeding is important. Mothers from rural areas found low
knowledge about the importance of breastfeeding their babies, they tended to get
less family support for breastfeeding. Without family support, it can be obtained
that the implementation of early breastfeeding initiation in rural areas will be
lower (Joshi SK, Barakoti B, Lamsal S. 2012)

Education and sources of knowledge have a significant effect on breastfeeding
practices. But there was a significant difference in the practice of giving the first
feeding in different educational groups, the group with higher education was
breastfeeding as the first choice, while the other group gave prelacteal food.

15

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

Mothers have received breastfeeding guidelines from health workers and mothers
with higher levels of education indicate better breastfeeding knowledge and
practices (Roshan R, Sajjad S, Tanvir S. 2018)

In the Chinese cultural and occupational environment, it was found that
mothers with higher education levels were less likely to breastfeed their babies,
compared to mothers with lower levels of education (Zhao. J, Zhao Y, Du M,
Binns CW & Lee AH. (2017). If the number of women starting to breastfeed
between women increases, it is carried out below and varies in ethnicity can be
together with health professionals and non-health professional-led counseling and
peer intervention support. But if it is done by each of them will get low-quality
breastfeeding education (Balogun OO, et all. 2016)

Knowledge of maternal and newborn health is felt to be very important for
pregnant women and their families, so that mothers and their families can obtain
information about ongoing pregnancy, danger signs during pregnancy, preparation
for delivery, early breastfeeding after birth, schedule for examination of pregnant
women, postpartum, as well as immunization and infant care until the child
reaches the age of 2 years (SIJARIEMAS, 2017)

The 2016 Indonesian Health Profile describes the coverage of TTS of pregnant
women 65.28%. service coverage for pregnant women K4 85.3%, coverage for
delivery in health care facilities 80.61%, coverage for newborns carried out by
IMD 51.9%, coverage for postpartum visits KF3 84.41%, Mortality rate for
infants and toddlers in 2015 22.23% and 26.2%,.(Indonesian Health Profile,
2017). This national condition needs attention from health services which in some
aspects have shown improvement but still need to increase the knowledge and
curiosity of both young women and couples of childbearing age in improving their
reproductive health.

Data and Information on the Indonesian Health Profile in 2016 the estimated
number of fertile ages 15-49 for East Kalimantan is 78,486, estimated pregnant
women are 82,224, estimated maternity is 78,486 people, while the estimated
number of live births is 74,749, estimates for 0 years are 70,749. This data shows
the need for comprehensive care. for both mother and newborn, the period after

16

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

the baby is born early initiation of breastfeeding is paramount to save maximum
life and prevent stillbirth ((Ministry of Health Data and Information Center,
2017).

The results of the 2016 study using the Ante Natal Risk Questionnaire
(ANQR) were effective in helping early detection of postpartum depression in
primiparous, multiparous and grande multiparous pregnant women. effectively
used in early detection of pregnant women who can experience postpartum
depression so that they can provide early breastfeeding after giving birth
(Sipasulta & Nurhayati, 2016). The psychosocial condition of pregnant women is
influenced by the mother's condition during adolescence, so it requires attention
for health service providers. Through maternal health education to prepare
adolescents and couples of childbearing age in their reproductive health.

Reproductive health problems Riskesdas in 2013, married women aged 10-54
years, 2.6 percent married for the first time at the age of less than 15 years and
23.9 percent married at the age of 15-19 years. The pregnancy rate between 10-54
years old is 2.68 percent, there are 0.02% pregnancies less than 15 years old even
though it is very small and teenage pregnancies aged 15-19 years are 1.97 percent.
If a young pregnancy under 20 years is still found, it will affect the process of
early breastfeeding and the success of exclusive breastfeeding does not reach the
target.

Efforts made by the Balikpapan City Health Office to reduce maternal
mortality from data on 9 maternal deaths, in addition to infant mortality from 78
cases and Toddler 6 cases through the issuance of KIBLA Regulation Number 9
of 2015, strengthening the use of MCH books, implementing maternal perinatal
audits, as well as improve coordination of maternal perinatal programs in the East
Kalimantan region by forming a maternal perinatal team in Balikpapan, as well as
strengthening the human resources of the PONED Health Center, increasing
partnerships and improving the recording and reporting system (Balikpapan City
Health Office, 2015).

In the first few days after giving birth, the mother produces a small amount of
yellowish milk called colostrum. It is rich in nutrients and provides all the calories

17

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

your baby needs for the first few days. Many women worry that their baby is not
getting enough milk soon after delivery, when small amounts of colostrum are
said to be normal. This is because babies are born with excess fluid and sugar
stores so that they can be used when there is not much milk supply. If you
continue to breastfeed, more milk will be produced within three to five days.
Babies will lose weight the first few days of life but gradually two weeks after
delivery they will regain their weight.

Pregnant women often do not carry out or implement correctly what health
workers say. Maternal health education is not carried out because the mother does
not understand, or does not meet the needs during antenatal visits. The cause of
the occurrence of pregnant women not understanding can be due to one-way
communication by health workers and besides that the mother does not get
enough support from her husband and family to apply the information obtained.
explanation of pregnancy, childbirth and early initiation of breastfeeding (IMD),
postpartum, newborn care, exclusive breastfeeding, family planning and
immunization of infants. (Ministry of Health RI. 2013: WHO, 2009).

I am interested in the implementation of maternal health education in the city
of Balikpapan which has been achieved through classes for pregnant women and
explanations of the MCH book during antenatal visits by health workers, but
husband and family support is still needed in order to achieve the IMD target for
early newborn breastfeeding, and exclusive breastfeeding. also the red line,
malnutrition in infants and toddlers can be resolved, after that the results of this
study will be presented to become a data base for the city of Balikpapan;
Therefore, my research is “The Effect Of maternal health education on family
support in the process of breastfeeding a newborn babies”

The purpose of implementing maternal health education for family support in
the early process of breastfeeding a newborn babies in Balikpapan City

18

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

METHOD

The research design used a cross sectional study, this study studied the
dynamics of the correlation between risk factors and their effects, by means of an
observation approach or data collection at once (point time approach), where the
types of research subjects were only observed. Once between variables, including
the effect of maternal health education on family support in the early process of
breastfeeding a newborn, were observed simultaneously at the same time
(Notoatmodjo, 2012).

Researchers made observations on maternal health education from health
workers obtained by postpartum mothers during ANC visits during the first to
third trimesters of pregnancy with family support in the process of breastfeeding
newborns. At Sayang Ibu Hospital, Balikpapan.

Hipotesa , There is no effect of maternal health education on family support in
the early process of breastfeeding a newborn. The independent variable in this
study was Maternal Health Education.

The dependent variable is family support in the early breastfeeding process.
The population in this study were all postpartum mothers who gave birth at the
Maternity Hospital Sayang Ibu in Balikpapan City during September to October
2018.

The sample of this study was taken based on the Consecutive sample, which
was done by selecting all postpartum mothers and newborns who met and met the
criteria, until the desired number of samples was reached (Dharma, 2011).

Inclusion criteria as a sample include postpartum mothers who give birth
normally or with surgery, are willing to be respondents, can speak Indonesian
well, can read and write. Exclusion criteria for post partum mothers who have
problems with Consciousness.

The sampling technique that will be used in this study is non-probability
example. Non-probability sampling is a sampling technique that does not give
equal opportunity/opportunity for each element or member of the population to be
selected be sample (Sugiyono,2007). The number of research samples was

19

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

determined based on the formula for proportion data with an infinite population
(unknown), with the following calculations:

So the estimated proportion in 1 month is 60 samples.

Research Place.
This research was conducted at the Maternity Hospital Sayang Ibu in

Balikpapan City.

Research Time
This research was conducted in the period September to October 2018.

Analysis
Test the normality of the data. Data analysis was carried out descriptively and

analytically. Descriptive, The analysis uses a frequency distribution to calculate
the frequency or number and percentage of aspects being measured. Analysis of
Relationships Between Variables, Chi Square test bivariate. The analysis was
conducted to determine the relationship between maternal health education and
the support of husband and family in early breastfeeding for newborns in
Balikpapan City using the chi square test because the study used data categories,
namely ordinal and nominal.

RESULT AND DISCUSSION

Result
Based on the results of research conducted on 60 respondents of postpartum

mothers and newborns to see the process of breastfeeding in newborns through
independent variables, health education given to mothers during pregnancy
includes care during pregnancy, preparation for delivery, danger signs of labor
and newborns until postpartum period, also look at the factors of husband and
family support.

20

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

Table 1. Normality Test Results of Dependent Variables

Shapiro-Wilk

Statistic df Sig.
.000
Support for Post Partum .610 60
Mothers

a Lilliefors Significance Correction

Resource:

In the table above, it can be seen the value of Sig. in the Kolmogorov-Smirnova
and Shapiro-Wilk column is .000 which means 0.000. And if the value of Sig. less than
0.05 then the data are not normally distributed. But this data has written Lilliefors
Significance Correction, meaning that the data is in accordance with the Lilliefors
adjustment

Table 2. Husband and Family Support for Postpartum Mothers Early Breastfeeding

Husband and Family Support for Postpartum Mothers

Frequency Percent Valid Percent

Post Partum 22 36.7 36.7
Mothers Supported EarlyBreastfeeding

Post Partum Mother is not supported early 38 63.3 63.7
Breastfeeding

Total 60 100 100

The data above Postpartum mothers do not feel the assistance of health

workers as many as 32 mothers 53.3%.

Table 3. Description of maternal health education
Maternal health education

Frequency Percent Valid Percent

Postpatum mothers feel the help of health 28 46.7 46.7
workers 32 53.3 53.3

Postpartum mothers do not feel the assistance
of health workers

Total 60 100 100

The data above for Postpartum Mothers who did not receive early breastfeeding

support were 38 mothers, 63.3%.

Table 4. Description of The Effect of maternal health education on family support in the early
process of breastfeeding of newborn

Maternal Health Education Support for Post Partum Mothers

Postpartum mothers feel the help of Post Partum Mothers Supported Early Post Partum Mother is not
health workers
Postpartum mothers do not feel the Breastfeeding supported early Breastfeeding
assistance of health workers
15 53.6% 13 46.4%
Total
7 21.9% 25 78.1%
22 36.7% 38 63.3%

21

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

The data above describes 13 (46.4%) people who felt the assistance of health workers
but did not receive initial support for breastfeeding. There were 7 (21.9%) postpartum
mothers who did not receive assistance from health workers but received early
breastfeeding support.

Discussion

The results of the influence of maternal health education on family support in
the process of breastfeeding newborn mothers did not feel the assistance of health
workers as many as 32 mothers 53.3%. and postpartum mothers who did not
receive early breastfeeding support as many as 38 mothers, 63.3%. The supporting
data for postpartum mothers do not feel the assistance of health workers to 32
mothers. Most of them do not take advantage of Maternal and Child Health
services at the Puskesmas, there are 3 mothers who have checked themselves 2 to
3 times at the Puskesmas but because there is no Ultra Sono Grafi examination to
determine the condition of the fetus then they move around to check for
pregnancy to the hospital or doctor's practice. Results of pregnant women do not
take classes for pregnant women and classes for babies. By providing training and
counseling about breastfeeding. Yurtsal & Kocoglu 2018 stated that mothers from
the prenatal period to the end of the month after the first postpartum, would
increase 50.4 times higher exclusive breastfeeding in the first 6 months
postpartum, from mothers who were not given training only 26.3%. mothers,
increased when they were given training and counseling on breastfeeding

UNICEF and WHO recommend following exclusive breastfeeding for the first
six months of life, starting within one hour of birth. Continuing to exclusively
breastfeed without other foods for the first six months enhances sensory and
cognitive development, and protects infants from infectious and chronic diseases
(Selim. 2018). The attention for pregnant women is especially important when
husbands provide a wide space for their future children and how to enlarge,
nurture them, and the process of giving milk after birth into the world. So that the
wife will not feel alone as a parent. Knowing that her husband is always present

22

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

and will provide full support for herself and those in the womb causes the wife to
feel safe (Herlinda. 2016)

Regular and successful breastfeeding is very important for the baby's health,
mothers with higher education tend not to exclusively breastfeed their babies,
mothers with higher education and also from high households support early
breastfeeding when the baby is born. So if you are going to give breast milk, you
should be able to consider issues related to the mother's level of education (Tang.
K. et all. 2019).

We found as many as 13 (46.4%) postpartum mothers who felt the assistance
of health workers but did not receive initial support for breastfeeding. There were
7 (21.9%) postpartum mothers who did not receive assistance from health workers
but received early breastfeeding support.

Mothers cannot be expected to do it themselves. Early and exclusive
breastfeeding after the baby is born, because mothers need help due to fatigue
after going through the delivery process. Normal postpartum mothers and
cesarean sections need to be supported by hospitals and maternity centers, health
workers, government and families so that the initial breastfeeding process is
successful, supporting breastfeeding starting from the first hour after giving birth
through early initiation of breastfeeding.

Giving mothers all the support they need to start breastfeeding within the first
hour after delivery has tremendous health benefits. But we can't stop there.
Mothers should have the freedom to continue breastfeeding for as long as they
choose. It is our collective responsibility to remove the barriers in our society that
make breastfeeding so difficult

Of the 60 postpartum mothers, 13 mothers gave birth through cesarean
section, this situation is one of the reasons why some mothers are unable to
breastfeed before starting the breastfeeding process. Shrimpton. 2017 in his
comments Mothers giving birth by cesarean section usually face many challenges
after delivery, such as managing the effects of anesthesia, recovering from
surgery, and seeking help to safely carry the baby. However, with the right
support from husbands and families who can initiate early initiation of

23

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

breastfeeding, implement breastfeeding policies in maternal wards, and involve
fathers in breastfeeding, most newborns born by Caesarean section can be
breastfed within the first hour.

Breastfeeding education includes mother's knowledge about breastfeeding, the
decision to breastfeed the baby, or initiation of breastfeeding is more effective
than breastfeeding support provided to mothers including support for
breastfeeding and professional and family support regarding the duration of
breastfeeding (Chan Man Yi & Heung Sin Man. 2011). Direct skin-to-skin contact
helps regulate the body temperature of newborns and exposes them to beneficial
bacteria from their mother's skin. These good bacteria protect babies from
infectious diseases and help build their immune system. Skin-to-skin contact
immediately after birth until the end of the first feeding also has many other
benefits. It has been shown to increase the chances of a baby being breastfed,
prolong the duration of breastfeeding, and also increase the rate of exclusive
breastfeeding.

There is no conclusive evidence supporting antenatal breastfeeding education
to increase initiation of breastfeeding, the proportion of women who provide
breastfeeding or exclusive breastfeeding at three or six months or duration of
breastfeeding. It is necessary to evaluate the effectiveness and side effects of
antenatal BF education, especially in low- and middle-income countries. Evidence
supports antenatal breastfeeding education relevant to high-income settings
(Lumbiganon. et all. 2016)

Make sure the period of pregnancy is not only borne by the wife unilaterally,
but also involves the full role of the husband. Husbands must also monitor the
condition of their pregnant wives, there must be healthy communication between
partners. and keep his wife happy and relaxed. Couples should often discuss about
their prospective baby and all the preparations including discussing the initial
process of breastfeeding a baby who is about to be born. (Herlinda. 2016)

It was found that 25 (78.1%) postpartum mothers who did not receive the
support of their husbands and families also did not receive good medical
education during their pregnancy visits because some of them worked 8 hours in

24

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

the morning so they did not check at the Puskesmas but went to a practicing
doctor. So that they cannot go to the Puskesmas to obtain maternal health
education, both for pregnant women and for babies. Some of the reasons that
postpartum mothers do not carry out the initial process of breastfeeding are babies
born with premature rupture of the membranes and some with meconium amniotic
fluid causing 1 baby to be treated as an infant warmer, so that the baby is born not
placed on the mother's stomach for the beginning of the breastfeeding process.

Giving mothers all the support they need to start breastfeeding within the first
hour after delivery has tremendous health benefits. But we can't stop there.
Mothers should have the freedom to continue breastfeeding for as long as they
choose. it is our collective responsibility to remove barriers in our society so that
helping mothers face when breastfeeding becomes very difficult (Selim. 2018).
The mother should hold the baby on her chest with skin-to-skin contact
immediately after birth. But it may still take twenty minutes before the baby
begins to suckle spontaneously, and most should start feeding within an hour
(Shrimpton, 2017). Early initiation of breastfeeding is associated with a reduced
risk of death, initiation of breastfeeding after the first 24 hours of life is associated
with an 85% increased risk of neonatal death compared with infants who initiate
breastfeeding within 24 hours of birth (Smith et all. 2017).

All postpartum mothers already have a MCH Handbook which is a material
for maternal health education when pregnant women come to check their
pregnancy from trimester one to three. so that all pregnant women have read and
understood the contents of the open MCH, but it was found that during the
observation of postpartum mothers, it turned out that not all of the 60 mothers had
read and understood the contents. There are some husbands who just found out the
contents of the MCH book, when they explain what the metrics of maternal health
education should be known to the mother since pregnancy, the husband and
family are expected to read and know which discusses the danger signs for
postpartum mothers, so that if the mother is in a suitable condition then
immediately taken for help. There are still 16 postpartum mothers with anemia Hb
between 8.1 and 10.5 g/dl, besides that there are 5 mothers whose Hb exceeds

25

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

normal, besides that some babies cannot bond with their mothers because their
leukocytes are not high, this condition needs husband's support and family so that
the initial breastfeeding process can be smooth and colostro can be obtained
properly

Poor practices in maternity hospitals can interfere with early initiation of
breastfeeding with negative consequences in exclusive breastfeeding during the
first month and increase the risk of neonatal death. Initiation of breastfeeding
within 1 hour of birth ends with a reduced risk of neonatal death. Neonates who
started breastfeeding after the first hour of life had twice (combined odds ratio
[OR] 2.02; 95% CI: 1.40, 2.93) the risk of death in the first month of life
compared with those who were breastfed within the first hour. (Shrimp. 2017)

The educational status of mothers allows early initiation of breastfeeding to
increase, it is necessary that long-term approaches to prioritizing education for
women and girls should be explored. In the short term, low-educated or
uneducated mothers should be the target of breastfeeding promotion strategies
such as counseling and peer education. (Smith et all. 2017) Infants who start
breastfeeding between 2-23 hours after birth have a 33% greater risk of neonatal
death than infants within one hour of starting breastfeeding. Babies who have just
started the initial process of breastfeeding more than 24 hours after birth will
experience a risk of neonatal death above 100% greater.

Early initiation of breastfeeding was associated with a reduced risk of death,
initiation of breastfeeding after the first 24 hours of life was associated with an
85% increased risk of neonatal death compared with infants who started
breastfeeding within 24 hours of birth. Early breastfeeding includes skin-to-skin
contact between the newborn and the mother, this may be one of the mechanisms
that can improve neonatal survival. Causes of morbidity include diarrhea,
respiratory tract infections and nutrition (Smith et all. 2017). Selim. 2018
Working women don't have to decide between breastfeeding and work. When p
returns to work, nursing mothers need support from their husbands and families
and employers in order to continue breastfeeding. The International Labor
Organization has recommended that governments give women the right to 18

26

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

weeks of maternity leave and ensure they have time and space to continue
breastfeeding when they return to work. It is very important for breastfeeding
mothers in the workplace to have sufficient time and space to continue
breastfeeding or express and store breast milk.

The assumption of researchers prioritizing education for women and children
must be explored so that they are prepared from adolescence and during
preparation for marriage to know about the importance of breastfeeding for a
mother to give her baby for life from the Health Office, so that teenagers and
prospective brides already know and are ready to provide breast milk for their
children. her baby. This condition requires husband's support and family support
so that the early breastfeeding process can be smooth and the baby can get
colostrum which contains lots of antibodies properly, making the baby healthy
and developing and developing well.

CONCLUSSION
Maternal health education from pregnant women to postpartum has not been
implemented properly. maternal health education to secondary school, when the
bride and groom and antenatal care continues

ETICAL CLEARENCE
Permission letter as the first step to start the research will be given to the
Director of the Maternity Hospital Sayang Ibu where the research is conducted.
After obtaining the permission letter, then this research began. Mothers who are
planned to be involved in this study will initially be given a letter of consent
(Information and Consent Form) to be involved in the study accompanied by an
explanation of the benefits and final results of the study. Research ethics
certificate from KEPK Poltekes Kemenkes Kaltim

27

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

REFERENCES

Acharya P & Khanal V. 2015. The effect of mother’s educational status on early
initiation of breastfeeding: further analysis of three consecutive Nepal
Demographic and Health Surveys. BMC Public

Balogun OO, O'Sullivan EJ, McFadden A, Ota E, Gavine A, Garner CD, Renfrew
M, MacGillivray S . 2016.Interventionsfor encouraging women to start
breastfeeding. Pregnancy & childbirth> Lactation
>Supportingbreastfeeding mothers

Ballard O, Morrow AL. 2013. Human milk composition: nutrients and bioactive
factors. Pediatric clinics of North America. 60(1):49–74. Epub2012/11/28.
pmid:23178060; PubMed Central PMCID: PMC3586783

Chan Man Yi & Heung Sin Man . 2011. The effectiveness of breastfeeding
education on maternal breastfeeding self-efficacy and breastfeeding
duration: a systematic review. JBI Library of Systematic Reviews: Volume
9 - Issue 64 - p 1-24. doi: 10.11124/jbisrir-2011-348

Debes AK, Kohli A, Walker N, Edmond K, Mullany LC. 2013. Time to initiation
of breastfeeding and neonatal mortality and morbidity: a systematic
review. BMC public health. 2013;13 Suppl 3:S19. Epub 2014/02/26.
pmid:24564770; PubMed Central PMCID: PMC3847227.

Herlinda. W.D. 2016. Pentingnya Peran Suami Selama Masa Kehamilan Istri", :
https://lifestyle.bisnis.com/read/20160904/236/580960/pentingnya-peran-
suami-selama-masa-kehamilan-istri.

Joshi SK, Barakoti B, Lamsal S .2012. Colostrum Feeding: Knowledge, Attitude
and Practice in Pregnant Women in a Teaching Hospital in Nepal.
Kathmandu Medical College, - Nepal. https://www.webmedcentral.com/
article_view/3601

Kemenkes RI. 2013. Riset Kesehatan Dasar (Riskesdas) 2013
.http://www.depkes.go.id/
resources/download/general/Hasil%20Riskesdas %202013.pdf

28

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

Kemenkes RI. 2016. Buku Kesehatan Ibu dan Anak (Buku KIA). Jakarta:
Kementerian Kesehatan dan JICA (Japan International Cooperation
Agency),

Khan J, Vesel L, Bahl R, Martines JC. 2015. Timing of breastfeeding initiation
and exclusivity of breastfeeding during the first month of life: effects on
neonatal mortality and morbidity—a systematic review and meta-analysis.
Maternal and child health journal. 2015;19(3):468–79. Epub 2014/06/05.
pmid:24894730. https://pubmed.ncbi.nlm.nih.gov/24894730/

Krueger. VM. Carney L M. Graham. J S. Prenatal Breastfeeding Education and
Breastfeeding Outcomes . Madigan Army Medical Center . MCN. The
American journal of maternal child nursing https://www.researchgate.net/
publication/23224667_Prenatal_Breastfeeding_Education_and_Breastfeed
ing_Outcomes

Le Huerou-Luron I, Blat S, Boudry G. 2010. Breast- v. formula-feeding: impacts
on the digestive tract and immediate and long-term health effects.
Nutrition research reviews. 2010;23(1):23–36. Epub 2010/05/11.
pmid:20450531. https://pubmed.ncbi.nlm.nih.gov/23178060/

Lumbiganon,P. Martis R. Laopaiboon, M. Festin MR. Ho JJ. Hakimi M. 2016.
Antenatal breastfeeding education for increasing breastfeeding duration.
https://doi.org/10.1002/14651858.CD006425.pub4

Notoatmojo. S. 2012. Metodologi Penelitian Kesehatan. Rineka Cipta. Jakarta
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006425.
pub4/fullNotoatm

Roshan R, Sajjad S, Tanvir S. 2018. Impact of maternal education and source of
knowledge on breast feeding practices in Rawalpindi city. MOJ Curr Res
& Rev. 2018;1(5):212-214. DOI: 10.15406/mojcrr.2018.01.00035
https://medcraveonline.com/MOJCRR/impact-of-maternal-education-and-
source-of-knowledge-on-breast-feeding-practices-in-rawalpindi-city.html

Sipasulta.G C & Nurhayati. 2017. Efektifitas Penilaian menggunakan Ante Natal
Risk Questionnaire (ANRQ) Terhadap Kejadian Depresi Postpartum Di
Kota Balikpapan. MNJ (Mahakam Nursing Journal), [S.l.], v. 1, n. 2, p.

29

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

90-108, jan. 2017. ISSN 2548-
6292.<http://ejournalperawat.poltekkeskaltim.ac.id/index.php/nursing/artic
le/view/SIJARIEMAS. 2017.
Selim L. 2018. Breastfeeding from the first hour of birth: What works and what
hurts Here’s what it takes to make sure mothers have a supportive
environment for early and continuous breastfeeding
.https://www.unicef.org/stories/breastfeeding-first-hour-birth-what-works-
and-what-hurts
Smith.RE. 2017. Delayed breastfeeding initiation and infant survival: A
systematic review and meta-analysis. Published: July 26,
https://doi.org/10.1371/journal.pone.0180722, https://journals.plos.org
/plosone/article?id=10.1371/journal.pone.0180722

Shrimpton. R. 2017. Early initiation of breastfeeding. Dept. of Global Community
Health and Behavioural Sciences. Tulane School of Public Health and
Tropical Medicine, USA. https://www.who.int/elena/titles
/commentary/early_breastfeeding/en/

Sugiyono . 2007. Statistika untuk Penelitian. Cetakan . Alfabetha.CV. Bandung
Tang. K. et all. 2019. Association between maternal education and breast feeding

practices in China: a population-based cross-sectional study. BMJ
Jiurnalis. https://bmjopen.bmj.com/content/9/8/e028485
WHO. 2009. WHO recommended interventions for improving maternal and
newborn healthIntegrated management of pregnancy and childbirth, 2nd
Edition.http://www.who.int/maternal_child_adolescent/documents/who_m
ps_0705/en/
WHO. 2017. Launch of Network for Improving Quality of Care for Maternal,
Newborn and Child Health. http://www.who.int/pmnch/media/events
/2017/lilongwe/en/
WHO.2018. Integrated Management of Pregnancy and Childbirth (IMPAC) http:
//www.who.int/maternal_child_adolescent/topics/maternal/impac/en/

30

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

YURTSAL.Z.B. & KOCOGLU. G. 2018. The effects of antenatal parental
breastfeeding education and counseling on the duration of breastfeeding,
and maternal and paternal attachment. Cumhuriyet University Faculty of
Health Sciences, Department of Midwifery, Sivas, Turkey.
https://www.oatext.com/The-effects-of-antenatal-parental-breastfeeding-
education-and-counseling-on-the-duration-of-breastfeeding-and-maternal-
and-paternal-attachment.php

Zhao. J, Zhao Y, Du M, Binns CW & Lee AH. (2017). Maternal education and
breastfeeding practices in China: A systematic review and meta-analysis
https://pubmed.ncbi.nlm.nih.gov/28390256/

31

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

A RAPID ONLINE SURVEY ON BREASTFEEDING COUNSELOR’S
PRACTICES FACING THE COVID-19 PANDEMIC

Kurniasari hikmah1, Agusnawati2 and Nurillah Ika3
Research Division Indonesia Breastfeeding Counselor Indonesia (IKMI)

Email: [email protected]

Abstract: The COVID-19 pandemic since March 2020 in Indonesia has
substantially impacted maternity health services include breastfeeding counseling
practices. Many accesses to health care facilities have been disrupted. This study
was to document breastfeeding counselor’s practices in Indonesia during the
Covid-19 pandemic. A cross-sectional study was conducted using an online rapid
survey with SurveyMonkey™, disseminated through breastfeeding counselor
networks and social media from 12th to 31st, July 2021. There were 205
respondents. 21 who did not practice breastfeeding counseling during the
pandemic were excluded. 129 work at health facilities and 139 were completely
all the questionnaire. 46,04% respondents practiced blended counseling. Mothers
with COVID-19 faced not enough breastmilk, confused breastfed their babies for
fear of transmitting COVID-19. While the problems encountered in mothers who
survived COVID-19 were not enough breastmilk and nipple confusion. 54,5% of
health facilities did not practice rooming-in with some reasons. The most
challenges for breastfeeding conselour during this pandemic were the limitation of
telecounseling. The COVID-19 pandemic impacted breastfeeding counselor’s
practices. Mothers faced many problems in breastfeeding. There were also gaps in
practices of rooming-in and the limitation of telecounseling. Guidelines for
telecounseling and continuing breastfeeding education are important to practice
more optimally facing this COVID-19 pandemic.

Keyword: Breastfeeding counselor; breastfeeding; COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic and the associated many sectors crisis pose huge
global and local challenges. The health, social and economic impact has affected
all segments of the population (World Health Organization, 2021). This pandemic
is posing considerable challenges for countries to maintain the provision of high
quality, essential maternal and newborn health services (UNICEF, 2020).

The adverse effects of the COVID-19 pandemic on maternal and perinatal
health are not limited to the morbidity and mortality caused directly by the disease
itself but Nationalwide lockdowns, disruption of health-care services, and fear of
attending health-care facilities might also affect the wellbeing of pregnant people

32

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

and their babies (Roberton et al., 2020).
A systematic review and meta-analysis found global maternal and fetal

outcomes have worsened during the COVID-19 pandemic and need urgent safe
accessible (Chmielewska et al., 2021). An observational study in primary care in
Belgium found women’s medical counseling and social support were negatively
affected by the lockdown. Women without previous breastfeeding experience and
in the early postpartum period experienced a higher burden in terms of reduced
medical counseling and support (Ceulemans et al., 2020).

Study from Australia documented feedback from mothers seeking assistance
from The Australian Breastfeeding Association during the COVID-19 pandemic
that found decreased access to face-to-face lactation support (Hull, Kam and
Gribble, 2020). In Indonesia, since March 2020 COVID-19 pandemic also has
substantially impacted maternity health sevices (Saputri et al., 2020).

Due to the COVID-19 pandemic, access to essential services such as
breastfeeding counseling through hospitals, clinics and home visits has been
disrupted. WHO and UNICEF encourege women to continue to breastfeed during
the pandemic, with no separation of mother and baby, while adhering to
appropriate infection and control measures (World Health Organization, 2020).
The objective of this study was to document breastfeeding counselor’s practices in
Indonesia during the Covid-19 pandemic.

METHOD

Study design, population and sampling

This is cross-sectional study of breastfeeding counselors. The target
population was breastfeeding counselors providing counseling for maternal or
breastfeeding mothers including health workers such as midwives, nurses,
nutritionists, general practitioners, paediatricians or obstetricians. Sampling was
non-random sampling, not intended to generate generalisable nationally
representative results of all breastfeeding counselors in Indonesia. Rather, our
intetion was to learn more from practices of breastfeeding counselors from various

33

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

contexts, services and facility types facing the COVID-19 Pandemic. This study
was conducted using rapid online survey with SurveyMonkey™. An invitation
and link disseminated through breastfeeding counselor networks and social media,
collected from 12th to 31st, July 2021. Respondents were encouraged to share the
survey with other colleagues.

Questionnaire
A questionnaire was developed by research division of Indonesia

Breastfeeding Counselors Association (IKMI) and reconfirmation by others
committee in IKMI. It was piloted by asking three of breastfeeding counselors to
complete the questionnaire and provide feedback, which used to assess face
validity and refine the wording of questions and response options.

Data processing and analysis
We use responses collected from 12th to 31st, July 2021. From 205

respondents, we excluded from 21 respondents who did not practice breastfeeding
counseling in COVID-19 Pandemic. We got Quantitative analysis from
SurveyMonkey™ in frequencies and percentages.

RESULT AND DISCUSSION
Respondents’ characteristics

The samples included breastfeeding counselors who actively practice
breastfeeding counseling during COVID-19 pandemic, there were 184 but only
139 respondents who completely all the questionnaire. The Table 1 showing
breastfeeeding counselors’ characteristic. Mostly were general practitioners and
then midwives and pediatricians. 28.06% of breastfeeding counselors were not
health workers.

34

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

Table 1. Breastfeeding Counselors’ Characteristics

Professions Breastfeeding counselors’
characteristics
Pediatricians
Obstetricians N%
General Practitioners 20 14.39
2 1.44
Midwives
Nurses 41 29.5
21 15.11
Nutritionists
Non health workers 5 3.6
11 7.91

39 28.06

From health workers we found that 44.6% (62) respondents worked at
hospital, 10.07% (14) at primary health care, 25.9% (36) at private clinics and
others 36.69% (51). Others worked at non-government organizations, community,
company clinic, campus or worked from home.

Breastfeeding Practices

Table 2. Type of breastfeeding counseling practices

Type Breastfeeding counseling practices
Face-to-face counseling N%

34 24.46

Home visit with PPE 3 2.16
Telecounseling 31 22.3

\ Blended counseling 64 46.04
others 7 5.04

During COVD-19 Pandemic, most of breastfeeding counselors practiced
counseling to maternal or breastfeeding mothers through blended counseling. This
means that they did face-to-face counseling combined with telecounseling.
Telecounseling through few platforms such as WhatsApp, zoom, Instagram,
Facebook. From this survey we found that there were many challenges facing
breastfeeding counselors in this pandemic. The most challenge is limitation of
practice telecounseling (35.44%). The limitation was when helping mother when
potitioning their babies or looking forward at latch on while breastfeeding. The
limitation of face-to-face counseling was using of Personal Protective of
Equipments (PPE). The others challenges were facing during this pandemic are

35

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

mother and family afraid of visiting health facilities, mother afraid of transmission
COVID-19 to their babies and there was still different argument between health
workers about breastfeeding and COVID-19. Research from the Northeastern
United States found more than half of the participants who conducting telehealth
in any form, found that virtual lactation support was moderately effective
compared to in-person support. Weakness of virtual support included technical
and logistic difficulties, challenges assisting with latching or reading body
language over the phone or online, and accurately assessing infant growth
(Schindler-Ruwisch and Phillips, 2021).

Many mothers need support during the COVID-19 pandemic. Experiances of
breastfeeding during COVID-19 from United States found that 27.0% of mothers
struggled to get support and had numerous barriers stemming from lockdown with
some stopped breastfeeding before they were ready. The findings are vital in
understanding how breastfeeding counselors could support in many ways to make
sure all breastfeeding women are better supported (Brown and Shenker, 2021).
Centers for Disease Control and Prevention (CDC) stated during the COVID-19
pandemic, telehealth services help provided necessary care to patients while
minimizing the transmission risk of SARS-C0V-2 to healthcare personal and
patients. Many professional medical societies endorse telehealth services and
provide guidance for medical practice including counseling to mothers (CDC,
2020). In Indonesia, Majelis Kehormatan Etik Kedokteran (MKEK) Pusat Ikatan
Dokter Indonesia already state about telemedicine services for health facilities in
the COVID-19 pandemic. (MKEK, 2020)

Table 3. Problems facing mothers with COVID-19

Problems Problems facing mothers with
Sore nipples COVID-19
N%

6 6.82

Engorgement 7 7.95

Mastitis 1 1.14

Not enough breastmilk 37 42.05

others 37 42.05

36

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

We analysis many problems facing mothers with COVID-19. The most
problems are not enough breastmilk (42.05%) whether Mothers feel there were
not enough breastmilk or truly not enough breastmilk. Respondents who choosed
others found that they were confused of whether breastfeed their babies or not,
separated from baby or afraid of transmission of the virus. For the problems
facing mothers, breastfeeding counselors help them with counseling about
potitioning and latch on, how to milking and give support, motivation and
education particularly about COVID-19 and breastfeeding. Some research showed
about transmission of virus to breastmilk. A literature review for clinical practice
stated that the Coronavirus is not transmitted via breastmilk. Breastfeeding
benefits outweigh possible risk during the COVID-19 pandemic (Lubbe et al.,
2020). A living systematic review found that there is no evidence of SARS-CoV-2
transmission through breastmilk (Centeno-Tablante et al., 2021).

Table 4. Problems facing COVID-19 survivor mothers

Problems Breastfeeding counseling practices
N%

Sore nipples 5 6.1
Engorgement 6 7.32

Mastitis 0 0.00

Not enough breastmilk 21 25.61

Nipple confusion 45 54.88

Others 5 6.1

While the problems conducting to survivor COVID-19 mothers mostly were
nipple confusion (54.88%) and then not enough breastmilk (25.61%). Nipple
confusion happened because of being separated from their babies and afraid of
transmission of COVID-19. Breastfeeding counselors did practical to help
mothers facing those all COVID-19 Pandemic with helping in potitioning and
latch on. But the most was given relactation (54.88%). Research from Australia
found from mothers seeking for support in breastfeeding that most common
breastfeeding concerns were related to insufficient milk or weight gain, painful

37

The International Conference on Lactation
Management in COVID-19 Pandemic Era
September 30, 2021, Samarinda, Indonesia

breast, relactation and reducing supplemental milk. Respondents reported that
mothers were worried that stress had reduced milk supply that impact on their
breastfeeding (Hull, Kam and Gribble, 2020).

Table 5. Rooming-in practice at Health Facilities

Type Rooming-in Practices at
Health Facilities
Rooming-in N%
Not Rooming-in 22 15.82

others 68 54.67

49 35.25

This study found 54.67% health facilities did not practce rooming-in.
Respondents who choose others found that theird health facilities did not
accepting patients with COVID-19, did not work at health facilities, did not know
or the health facilities did not have inpatient facilities. The reasons did not
practice rooming-in because there were no guidelines at their health facilities,
mother could not take care of her babies because of her illness, afraid of
transmission and lack of isolation room. Many countries in South East Asia
already had guidelines for rooming-in, breastfeeding and skin to skin contact for
the COVID-19 pandemic but there were still gaps in practices (Olonan-Jusi et al.,
2021). A rapid online global survey found that substantial knowledge gaps exist in
guidance on management of maternity cases with or without COVID-19. There
was a wodespread perception of reduced of rutine maternity care services, and of
modification in care processes, some of which were not evidence-based practices
(Semaan et al., 2020).

CONCLUSION

The COVID-19 pandemic impacted breastfeeding counselor’s practices. There
was limitation of telecounseling to support breastfeeding mothers. Mothers with
COVID-19 or survived COVID-19 had many problems in breastfeeding. There
were also gaps in practices of rooming-in at health facilities. Guidelines for
telecounseling and continuing breastfeeding education are important for
breastfeeding counselors to work more optimally especially in this COVID-19

38