Predictors of early initiation of breastfeeding in Indonesia: A population-based cross-sectional survey.

INTRODUCTION: Commencing breastfeeding within one hour of birth is defined as early initiation of breastfeeding (EIBF). Both the mother and child benefit from EIBF. This study aims to identify the predictors of EIBF among Indonesian women. METHODS: This paper analyses data from a weighted sample of 6,616 women collected at the Indonesia Demographic and Health Survey (IDHS) 2017.The frequency of EIBF is measured by the proportion of children born in the two years preceding the survey who received breastmilk within one hour of birth. The analysis uses bivariate and multivariate logistic regression for complex sample designs, adjusted for confounders to examine the relationship of EIBF with women's individual, household and community level characteristics. RESULTS: Overall, 57% (95% CI: 54.9%-58.2%) of the children born in the two years preceding the survey had EIBF. Statistically significant (p<0.05) predictors of EIBF are women's non-working status, second or higher order of the birth of the most recent child, average or large size of the most recent child at birth, poor status of the household and non-agricultural work of the woman's husband; while statistically highly significant (p<0.01) predictors are skin-to-skin contact with the new-born (OR: 2.62; 95% CI: 2.28-3.00), Caesarean deliveries (OR: 0.47; 95% CI: 0.40-0.56), and skilled birth attendants (OR: 1.83; 95% CI: 1.65-2.08). Caesarean deliveries reduce the likelihood of EIBF by half compared to vaginal deliveries. Women's age, education or rural-urban residence display no statistically significant relationship with EIBF. CONCLUSION: Skin-to-skin contact, mode of delivery and type of birth attendance exert the strongest influence on EIBF in Indonesia in 2017. EIBF should be continuously promoted and supported particularly among mothers who do not have early skin-to-skin contact with their new-born, who have Caesarean deliveries and who have no skilled birth attendant.

Reluctance of women of lower socio-economic status to use maternal healthcare services - Does only cost matter?

In this paper we examine whether it is just the financial cost of maternal healthcare that prevents poor women from utilising free or low-cost government provided healthcare in Dhaka, Bangladesh, or there are other factors at play, in conjunction with poverty. To answer this question, we analyse the perceptions and experiences about the use of maternal health care for childbirth by a group of women residing in poor and lower socio-economic households in Dhaka. Data for this study were collected through in-depth interviews of 34 such women who have already had a child or had become pregnant at least once in the preceding five years. The findings of our analysis suggest that these women have a deeply rooted fear of medical intervention in childbirth for several perceived and practical reasons, including the fear of having to make undocumented payments, unfamiliarity with institutional processes, lack of social and family network support within their neighbourhood, concept of honour and shame [sharam], a culture of silence and inadequate spousal communication on health issues. As a result, even though low-cost health care facilities may be within their reach in terms of physical distance and affordable in terms of financial cost these women and their families are unwilling to deliver their babies at such health facilities. Therefore, in order to allay their perceived fear of hospital-based childbirth, one needs to consider factors other than financial cost and physical distance, and provide these women with factual information and culturally sensitive counselling.