Objectives: Understanding the factors influencing mothers’ decision to breastfeed their infants is essential to formulate effective breastfeeding interventions. This study explored the determinants of optimal breastfeeding indicators in Indonesia.Methods: We used the 2017 Indonesia Demographic and Health Survey to analyze factors associated with early initiation of breastfeeding, exclusive breastfeeding (EBF), and continued breastfeeding at 1 year (CBF-1) and 2 years (CBF-2). Multivariate logistic regression models were used to examine bio-demographic, socio-cultural, and behavioral characteristics associated with breastfeeding after considering the survey design effect.Results: The risk of delayed breastfeeding initiation was higher among infants who were born smaller, first-born children, were delivered via cesarean delivery, and did not have immediate skin-to-skin contact (p<0.01). Infant’s age, birth pattern, household wealth index, and the mother’s occupation and smoking status were predictors of EBF (p<0.05). CBF-1 was less common among first-time mothers and those working in the non-agricultural sector, mothers from wealthier families, and mothers who had cesarean deliveries (p<0.01). Infant’s age was negatively associated with CBF-2 (adjusted odds ratio [aOR], 0.85; 95% confidence interval [CI], 0.74 to 0.99). Mothers attending college were less likely to practice CBF-2 than those with no education or primary education (aOR, 0.45; 95% CI, 0.26 to 0.77). The absence of postnatal visits was a risk factor for CBF-1 and CBF-2 (p<0.05).Conclusions: Breastfeeding interventions in Indonesia should pay particular attention to at-risk groups such as women from wealthier families, working outside the agricultural sector, and with a higher education level. Nutrition-sensitive programs (e.g., postnatal care and smoking cessation) should also be encouraged.

Objectives: Poor complementary feeding practices have consistently contributed to the burden of child undernutrition in Indonesia. This study aimed to estimate the prevalence and predictors of the time of the introduction of solid, semi-solid, and soft foods (ISSSF), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD).Methods: We analyzed 4804 last-born infants aged 6-23 months from the 2017 Indonesia Demographic and Health Survey, which employed multistage cluster random sampling. The outcomes were calculated based on the 2021 World Health Organization/United Nations Children’s Fund guidelines. The predictors of the 4 complementary feeding indicators were assessed using multivariate Poisson regression with robust variance adjusting for potential confounders and study design.Results: The prevalence of ISSSF, MDD, MMF, and MAD was 86.1%, 54.3%, 71.8%, and 37.6%, respectively, with younger children less likely to meet 3 out of the 4 outcomes. Parental education, the presence of a birth attendant, and maternal media consumption were among the predictors of MDD and MAD. Children from families with higher income were more likely to meet MDD than those from low-income households (adjusted prevalence ratio [aPR], 1.16; 95% confidence interval [CI], 1.05 to 1.28). Living in an urban area was positively associated with MMF (aPR, 1.09; 95% CI, 1.04 to 1.15) and MAD (aPR, 1.12; 95% CI 1.02 to 1.24). In eastern regions, the prevalence of children achieving MDD and MAD was lower than in those living in Java and Bali.Conclusions: It is crucial that more attention and efforts are made to improve the recommended practices throughout Indonesia, since the prevalence of adequate complementary feeding practices remains low.

The prevalence of exclusive breastfeeding and early initiation of breastfeeding in Indonesia, is still low 37.3% and 58.2%, respectively. However, cesarean delivery increased from 12.3% in 2012 to 17.0% in 2017. Women who gave birth by cesarean section were less likely to breastfeed earlier. This study aimed to determine the relationship between cesarean delivery and early initiation of breastfeeding among women in Indonesia. This study was a further analysis of the 2017 IDHS data with a sample of the 6,877 last-born children in the two years preceding the survey. The dependent variable was early initiation of breastfeeding, while the main independent variable was cesarean delivery. Other covariate variables included age, education, occupation, place of residence, parity, history of antenatal care, place of delivery and wealth index. Data analysis used logistic regression to determine the relationship between cesarean delivery and early initiation of breastfeeding, showing as the Adjusted Odds Ratio among 95% confidence interval. The results of the study showed that eight out of ten (82.75%) women who gave birth by cesarean section did not experience early initiation of breastfeeding, compared to those who delivered vaginal delivery (62.75%). Women who gave birth by cesarean section were 7.16 times more likely to not practice early initiation of breastfeeding (AOR 7.16; 95% CI: 3.66-14.01) compared to those who delivered vaginal delivery. To improve early initiation of breastfeeding, pregnant women need to be encouraged to do antenatal care (ANC) to increase their knowledge and confidence about breast milk. In addition, health workers and health care providers need to provide support to women who give birth by cesarean section to breastfeed as early as possible through providing adequate information about breastfeeding, encouraging rooming-in and preventing the promotion of formula milk. Abstrak Prevalensi air susu ibu (ASI) eksklusif dan inisiasi menyusu dini (IMD) di Indonesia, masih rendah yaitu masing-masing 37,3% dan 58,2%. Di sisi lain, kelahiran melalui operasi sesar meningkat dari 12,3% pada 2012 menjadi 17,0% pada 2017. Wanita yang melahirkan dengan operasi sesar lebih kecil kemungkinannya untuk menyusui lebih awal. Studi ini bertujuan untuk mengetahui hubungan persalinan sesar dengan IMD pada wanita di Indonesia. Studi ini merupakan analisis lanjut data Survei Demografi dan Kesehatan Indonesia (SDKI) tahun 2017 dengan sampel 6.877 anak terakhir yang lahir dalam kurun waktu dua tahun sebelum survei. Variabel dependen adalah IMD, sedangkan variabel independen utama adalah persalinan sesar. Variabel kovariat lainnya antara lain usia, pendidikan, pekerjaan, tempat tinggal, paritas, riwayat antenatal care, tempat persalinan, dan indeks kekayaan. Analisis data menggunakan regresi logistik untuk mengetahui hubungan antara persalinan sesar dengan IMD, yang dilihat dari nilai Adjusted Odds Ratio dengan interval kepercayaan 95%. Hasil studi menunjukkan bahwa delapan dari sepuluh (82,75%) wanita yang melahirkan dengan operasi sesar tidak melakukan IMD, dibandingkan dengan yang melahirkan persalinan pervaginam (62,75%). Wanita yang melahirkan melalui operasi sesar memiliki kemungkinan 7,16 kali lebih tinggi untuk tidak melakukan IMD (AOR 7,16; 95% CI: 3,66-14,01) dibandingkan dengan mereka yang melahirkan secara pervaginam. Untuk meningkatkan praktik IMD, ibu hamil perlu didorong untuk melakukan pemeriksaan kehamilan (ANC) meningkatkan pengetahuan dan kepercayaan dirinya mengenai ASI. Selain itu, petugas kesehatan dan penyedia layanan kesehatan perlu memberikan dukungan kepada wanita yang melahirkan melalui operasi sesar untuk menyusui sedini mungkin melalui pemberian informasi mengenai ASI secara memadai, mendorong adanya rooming-in, serta mencegah pemberian promosi susu formula.

Pre-lacteal feeding is a challenge to optimal breastfeeding practices in developing countries, and it directly or indirectly affects the health of infants. Furthermore, it is widely known as a distraction to exclusive breastfeeding, and the malpractice continues to be prevalent in Indonesia. Therefore, this study aimed to explore the potential determinants of pre-lacteal feeding among mothers of infants below aged 24 months. A sample of 6,455 mother-infant pairs from the 2017 Indonesia Demographic and Health Survey (IDHS) was used. Also, multivariate logistic regression was employed to identify factors associated with pre-lacteal feeding practice. In Indonesia, 44.0% of infants were introduced to solid/liquid feeds in their first three days of life. Infant formula was the most common pre-lacteal feed given, followed by any other milk, plain and sugar water, and honey. Early initiation of breastfeeding and living in an urban area were protective method against pre-lacteal feeding (AOR: 0.24; 95% CI: 0.21-0.28; AOR: 0.76; 95% CI: 0.65-0.90, respectively), while cesarean delivery acted as a risk factor (AOR: 1.36; 95% CI: 1.14-1.63). Meanwhile, gender role attitude, parity, perceived birth size, and household wealth index was also associated with pre-lacteal feeding. Overall, the percentage of mothers introducing pre-lacteal feeds was still high. The modifiable covariates associated with pre-lacteal feedings, such as early initiation of breastfeeding, parity, and birth size were the major factors discouraging this practice.

Indonesia is among the five countries with the highest burden of stunting. Food insecurity reflecting the availability of food in the household is one of the indirect causes of undernutrition. This study examines the relationship between food insecurity and stunting in Indonesia. We used data from the 2021 Indonesian Nutrition Status Survey (SSGI) with a sample size of 82,777 under-five children selected using multistage random sampling. The relationship between food insecurity and stunting was calculated using cox regression to obtain crude and adjusted prevalence ratios (PR) considering strata and weights. Children from households with moderate food insecurity had a (PR unadj)  1.24 (1,18 – 1,31) times higher risk of stunting, and the risk rose in households with severe food insecurity (PR unadj) 1.39 (1,27 – 1,53). Subgroup analysis based on regional categories showed that the association between food insecurity and stunting was only significant in rural areas. Children in rural regions who experienced moderate food insecurity had a 1.09 (95% CI 1.02-1.16) times greater risk of stunting and an increased risk of 1.15 times (95% CI 1.03 – 1.28) in households with severe food insecurity. Interventions are needed to prevent stunting by improving household food security, particularly in rural areas. Further research is needed with better study designs to prove a causal relationship between food insecurity and stunting.