Depresi Pascapersalinan dan Pemberian ASI Eksklusif pada Bayi Usia 0Ae5 Bulan Postpartum Depression and Exclusive Breastfeeding In Infants Aged 0-5 Months Old Enka Nur Ishmatika1.
Azmi Wijayati1 Republic Indonesia Defense University Korespondensi Penulis : enka.
ishmatika@gmail.
ABSTRACT
Exclusive breastfeeding is the most essential period for the early life of an infant.
Various factors influence the motherAos initiation and behavior of breastfeeding.
Including postpartum depression as maternal mental health issue.
This study aims to analyze the relationship of postpartum depression with exclusively breastfeeding in infants .
-5 month.
in Indonesia.
This research is quantitative using secondary data from the National Health Research (Indonesian Basic Health Researc.
with cross sectional research methods and were processed in 2020.
The sample of this study was women aged 15-49 years with infants aged 0-5 months in Indonesia, totaling 2332 people.
Bivariate analysis with Chi Square test was found that the relationship of postpartum depression towards exclusive breastfeeding was not significant with p value 0.
911 (OR 0.
946, 95% CI : 0.
While the multivariate test results obtained maternal age, work status, residence and early initiation breastfeeding status .
value <0.
with each OR respectively 0.
% CI
, 0.
% CI 0.
, 0.
% CI 0.
, and 0.
% CI 0.
as the confounding variables.
This study concludes that a need to evaluate the early initiation breastfeeding, exclusive breastfeeding program and maternal mental health problems screening during the postpartum period.
Keywords: postpartum.
ABSTRAK
Masa menyusui eksklusif merupakan periode penting dalam kehidupan awal bayi.
Berbagai faktor memengaruhi inisiasi dan perilaku menyusui ibu, termasuk depresi postpartum sebagai bagian dari masalah kesehatan mental maternal.
Penelitian ini bertujuan menganalisis hubungan antara depresi postpartum dengan praktik menyusui eksklusif pada bayi usia 0Ae5 bulan di Indonesia.
Penelitian ini menggunakan pendekatan kuantitatif dengan data sekunder dari Riset Kesehatan Dasar (Riskesda.
dan desain potong lintang, yang diolah pada tahun 2020.
Sampel penelitian mencakup 2.
332 perempuan usia 15Ae49 tahun dengan bayi usia 0Ae5 bulan.
Analisis bivariat dengan uji Chi Square menunjukkan bahwa tidak terdapat hubungan yang signifikan antara depresi postpartum dan menyusui eksklusif .
= 0,911.
OR = 0,946.
95% CI: 0,355Ae2,.
Namun, hasil analisis multivariat menunjukkan bahwa usia ibu, status pekerjaan, tempat tinggal, dan status inisiasi menyusu dini memiliki hubungan signifikan .
< 0,.
sebagai variabel perancu.
Studi ini merekomendasikan evaluasi terhadap program inisiasi menyusu dini, promosi menyusui eksklusif, serta skrining kesehatan mental ibu pada masa nifas.
Kata Kunci : postpartum.
INTRODUCTION
Exclusive breastfeeding or EBF is the most essential thing in the early life of a baby.
By optimally breastfeeding, it can reduce newborn mortality and prevent infant illnesses such as diarrhea, pneumonia, infections and reduce the risk of degenerative diseases in the future such as obesity and diabetes (Edmond et , 2006.
Gilmour & Shibuya, 2013.
Jones et al.
, 2003.
Victora et al.
, 2.
However, data from the World Health Statistics or WHS in 2013 reported that the global prevalence of exclusive breastfeeding for under 6 months was only around 38%(Organization, 2.
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Azmi Wijayant.
This is in line with national reports in Indonesia that the rate of exclusive breastfeeding for infants under 6 months ranges from 38% to 74% (Badan Penelitian dan Pengembangan Kesehatan.
Badan Pusat Statistik Indonesia, 2.
Various historical, socio-economic, cultural and individual factors play a role in influencing mothers in the decisions and behaviour of breastfeeding initiation [(Rollins et al.
, 2.
This includes the mental health of mothers which affects mothers in breastfeeding and the practice of feeding their babies.
Maternal symptoms of anxiety and depression are reported to be associated with shorter length of breastfeeding, tend to force children to eat and provide little or much unhealthy food (Haycraft et al.
, 2013.
Lindsay et al.
, 2017.
Ystrom et al.
, 2008,
Internationally, the prevalence of postpartum depression or PPD is between 12% and 18% In other studies, it is stated that an estimated 12 to 20% of mothers who give birth for the first time (Bascom & Napolitano, 2.
Indonesia reports that around 18% to 27% occur sequentially in the first three months after delivery based on studies from 4 Public Health Centers in Indonesia (Nurbaeti et , 2.
The results of this study indicate that postpartum depression in Indonesia is at a rate that needs Several studies reported that 6% of mothers with postpartum depression stop exclusive breastfeeding in the first 3 months of infant life (Cato et , 2019a.
Holbrook et al.
, 2013.
Mathisen et al.
, 2013.
Silva et al.
, 2.
breastfeeding in the first 6 months (Cato et al.
, 2019b.
Feldens et al.
, 2012.
Islam et al.
, 2017.
Orr PhD et al.
, 2018.
Silva et al.
, 2.
Other studies have also reported that women with PPD tend to lower rates of exclusive breastfeeding, complementary foods earlier (Hajeebhoy et al.
, 2.
, and lack of early or late (Gagliardi et al.
, 2.
thus associated with increased infant mortality, recurrent diarrhea in infants (Organization, 2.
and an increased risk of malnutrition (Hajeebhoy et al.
or excess weight in infants.
Research depression has been carried out in several countries and certain areas in Indonesia, while research on postpartum depression as a whole through national data with exclusive breastfeeding for infants has not been done much so that it is the background for the authors to see the relationship of postpartum depression to exclusive breastfeeding in infants aged 05 months in Indonesia based on secondary data analysis of the 2018 Indonesian Basic Health Research.
METHOD
Two theories that underlie the concept of this research are the interactive theory of breastfeeding (Primo & Brandyo, 2.
and the conceptual breastfeeding (Hector et al.
, 2.
The interactive theory of breastfeeding postulates that several concepts have an influence on breastfeeding, modulating in a wider range of views including women's body image.
nursing room.
mother's role.
protection, promotion and organizational support for breastfeeding.
as well as breastfeeding (Primo & Brandyo, 2.
Meanwhile, the conceptual theory of factors affecting breastfeeding shows three levels of factors that influence individual, group and community factors (Hector et al.
, 2.
The data used in this study is secondary data, namely the 2018 Basic Health Research data by the Health Research and Development Agency and the research was carried out in March Then the researcher made a request to use the data on the Research and Development Agency.
After being permission to use the given data set.
This study uses a cross-sectional The factors analyzed in this study are limited, according to the data breastfeeding for infants aged 0-5 months in Indonesia as well as socioeconomic and Jurnal Dunia Kesmas.
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Azmi Wijayant.
demographic factors, medical history of mothers and babies.
The population in this study were mothers aged 15-49 years and babies aged 0-5 respondents Indonesian Basic Health Research in 2018 with a sample of mothers aged 15-49 years who had a history of giving birth in the last 1 year who had the smallest biological child aged 0-5 months who were born normally and low birth weight.
The number of samples analyzed was 2332 respondents.
The data in this study were analyzed multivariate analyzes.
The bivariate test used the Chi square test and the multivariate test used the Multiple Logistic Regression Test.
found that a small proportion of mothers experienced Postpartum depression was 4% and most of the others .
6%) did not show depression.
demographic factor, it was found that most of the mothers resided in the city .
5%) with most of them at the reproductive age, namely 20-35 years .
9%).
Most of the mothers who had babies aged 0-5 months had higher education .
4%).
Most of them are not working .
%) and are at the lowest economic level, namely 62.
As well as factors from the medical history of the mother and baby.
It was found that most of the mothers had 1 to 3 live births .
8%), made ANC visits at least 2 times during the 3rd trimester, amounting to 6%, as well as routine postpartum visits in both postpartum phases, namely 78% in the postpartum period.
up to 3 days thereafter and 73.
1% in the postpartum period, namely 4 days to 28 days after delivery, but began to decrease in visits to as many as 51.
6% of people in the period 29 days to 42 days after RESULT Univariate Analysis Through the results of univariate analysis it can be concluded that infants aged 0-5 months are given exclusive breastfeeding as much as 53.
7% with the 3% not exclusively breastfed with the distribution of mothers aged 1549 years who were the study sample Bivariate Analysis Variables Table 1.
Bivariate analysis results Exclusive Breastfeeding Yes Postpartum Depression Non-depresive 1222 53,7 Depresive Socioeconomic and demographic factors Place of Residence Rural Urban Age .
20-35 old
1046 54,8
<20 dan >35 old
Education Level Higher
Lower
Occupation Status
Yes
Economic Status
Higher
Lower
Medical History of Mother and Infant
Number of living children
1-3 children
1162 53,7
Value 95% CI
0,911
0,946
0,355-2,522
0,001
1,464
1,177-1,820
0,085
1,267
0,968-1,659
0,082
0,817
0,650-1,026
0,031
1,299
1,024-1,647
0,485
0,915
0,712-1,176
0,989
0,997
0,700-1,422
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Azmi Wijayant.
>3 children
Number of ANC visits Ou2 times <2 times PNC Status 1
Yes
PNC Status 2
Yes
PNC Status 3
Yes
EIBF Status
Yes
0,113
1,346
0,931-1,947
0,387
0,882
0,663-1,173
0,291
0,877
0,686-1,120
0,886
0,983
0,776-1,245
0,0005
1,734
1,353-2,222
The table above shows the results of the analysis of the relationship between postpartum depression and exclusive breastfeeding that mothers who provide exclusive breastfeeding are slightly more mothers who experience PPD, namely 1% compared to mothers who do not experience PPD, namely 53.
Chi Square test results obtained p value 911 .
value> 0.
So it can be concluded that there is no difference in the proportion of postpartum depression incidence with exclusive breastfeeding.
demographic factors, the variables have a significant relationship .
value <0.
with exclusive breastfeeding, namely residence and work status.
Meanwhile, for maternal and infant medical history factors, only the EIBF variable had a significant relationship with exclusive breastfeeding with a p value of 0.
value <0.
Multivariate Analysis Table 2.
Preliminary Modeling of the Multivariate Analysis of Confonding Test
Variabel
P Value AOR
95% CI
PPD
0,963
0,978
0,378-2,525
Education Level 0,430 1,103 0,864-1,409 Number of ANC
0,478-1,003
0,052
0,692
PNC Status 1
0,479
1,122
0,816-1,543
PNC Status 2
0,353
1,142
0,863-1,513
PNC Status 3
0,782
0,964
0,741-1,253
Age .
0,048 0,759 0,578-0,998 Occupation Status
0,036
0,770
0,603-0,984
Place of Residence 0,001 0,681 0,542-0,856 EIBF Status
0,0005
0,565
0,441-0,725
After the confonding test is carried out on several variables with the highest p value and seeing the difference between the old and new ORs, the following is the final model result of the confonding test.
Table 3.
Final Modeling of Multivariate Analysis of Confonding Test
Variabel
AOR
95% CI
Value 0,365PPD 0,963 0,949 2,468 Jurnal Dunia Kesmas.
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Azmi Wijayant.
Age <20 dan >35 old Occupation Status (Occupie.
Place of Residence (Urba.
EIBF Status (N.
After confounding analysis, age, work status, residence and EIBF variables were confounding variables in the depression and exclusive breastfeeding expressed by p value <0.
05 with each AOR, respectively 0.
% CI 0.
, 0.
% CI 0.
% CI 0.
% CI 0.
DISCUSSION
In this study, there are several The data used in this study is secondary data from the results of Indonesian Basic Health Research in 2018, so the variables used in this study are limited to the variables contained in the 2018 Indonesian Basic Health Research data and approved by the data owner for use in this study.
Some of the variables that were not analyzed were due to the missing values after the cleaning process, namely the problem of breastfeeding and the age In addition, there is data uniformity on the status variable having been given breast milk and researchers cannot control when data collection in the Overview of Exclusive Breastfeeding in Indonesia The results of data analysis regarding exclusive breastfeeding in Indonesia for infants aged 0-5 months with normal birth weight and normal birth weight from the 2018 Indonesian Basic Health Research report showed that 4 out of 10 .
%) infants aged 0-5 months in Indonesia do not receive breastfeeding (Badan Penelitian Pengembangan Kesehatan, 2.
This data is consistent when compared to what was found in the 2017 Indonesian Demographic Health Survey (IDHS) 0,048 0,770 0,036 0,766 0,001 0,671 0,0005 0,568 0,5881,008 0,6020,976 0,5370,837 0,4430,728 In this multivariate selection, it can also be explained that mothers who have postpartum depression have a 0.
times greater chance of not exclusively breastfeeding compared to mothers who have postpartum depression.
Even if it is seen from the p value, this study has not been able to prove the relationship between postpartum depression and exclusive breastfeeding for infants aged 0 - 5 months in Indonesia.
report for infants under 6 months of age that 48% of babies in Indonesia do not receive exclusive breastfeeding (Badan Pusat Statistik Indonesia, 2.
In the world, infants aged less than 6 months who are exclusively breastfed are only 37% in low and middle economic countries have a shorter duration of Based measurements of exclusive breastfeeding data, there are still many researchers who use the questionnaire method that measures the status of exclusive breastfeeding the day before, namely 24 hour recall so that the measurement results represent an excessive proportion if it is assumed to be exclusive Exclusive Breastfeeding Rate (EBR) for 6 months.
infant age (Greiner, 2.
None of the indicators can provide complete and accurate data in measuring the duration of exclusive breastfeeding that has been achieved at 6 months of The best indicator for measuring EBR depends on the objectives of each study.
For measurement, 1 simple question about when was first given additional food or drink during this time and at what age was given a main indicator of when exclusive breastfeeding ended and when the predominant breastfeeding started even though the respondent mentioned only breastfeeding so far (Aidam et al.
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Azmi Wijayant.
Anderson et al.
, 2005.
Merten et , 2005.
Ssenyonga et al.
, 2.
Postpartum Depression in mothers aged 15-49 years in Indonesia in According to the results of the data analysis of this study, the postpartum depression picture was 2.
4% of all In contrast to research conducted by (Nurbaeti et al.
, 2.
that the prevalence of PPD varies between 37%, 15.
19% and 26.
15% of 283 respondents respectively at 1 month, 2 months and 3 months postpartum (Nurbaeti et al.
, 2.
However, the prevalence of PPD varies in different countries based on a review of 143 studies in 40 countries, there is a PPD prevalence ranging from 0% to 60% (Halbreich & Karkun, 2.
and the greatest prevalence is in middleincome (Almond.
Another study states that in the world the prevalence of PPD varies from 10% to 20% (Bolak Boratav et al.
, 2016.
OAohara & McCabe, 2013.
Werner et al.
, 2.
This variation is due to several differences in the PPD diagnostic tool used, the measurement time period, the cutoff score in determining the diagnosis, and the population characteristics (Halbreich & Karkun, 2.
The Relationship Postpartum Depression Exclusive Breastfeeding in Infants aged 0-5 months in Indonesia In this study, the results of the Chi Square test showed that there was no or insignificant difference in the proportion of PPD to exclusive breastfeeding.
This can be due to various things related to measuring survey data taken only at one This is in line with several studies which reported that there is no depression and exclusive breastfeeding even with the same type of questionnaire, namely EPDS (Balogun et al.
, 2016.
Fallon et al.
, 2018.
Helle et al.
, 2018.
Holbrook et al.
, 2013.
Rose et al.
, 2.
In addition, postpartum depression is a psychological problem that makes it difficult to express it if it is not in a conducive, private and in-depth interview environment.
Other factors that should also be examined are a history of previous depression, complications of pregnancy and childbirth, the health of the baby and the method of delivery where these factors can be predictors for the depression and exclusive breastfeeding (Adams et al.
, 2012.
Blom et al.
, 2010.
Carter et al.
, 2.
In addition, mothers who have depressive symptoms are reported to have many difficulties in breastfeeding (Edhborg et al.
, 2.
, are dissatisfied with the process of feeding their children (Dennis et al.
, 2.
and lack of confidence in producing breast milk (Flores-Quijano et al.
, 2.
Another factor that can affect the relationship between PPD and exclusive breastfeeding is breastfeeding through other media besides direct breastfeeding.
So that the proportion of mothers with PPD is not clearly known to provide exclusive breastfeeding directly through the breast or through other media.
Through the results of a systematic review design study in Canada (Dennis & McQueen, reported that bottle-feeding babies were positively associated with postpartum depression.
In the variable of maternal age, several studies confirm this result by providing the opinion that maternal age is related to the continuity of exclusive breastfeeding, so that younger mothers have the risk of earlier giving additional food or drinks to their babies (Tarrant et , 2.
This is because older mothers have more experience and knowledge of In addition to not having much experience, younger mothers tend to have lower self-confidence and ability to breastfeed than older mothers so that they have more breastfeeding problems (Monteiro et al.
, 2.
In addition, where the mother lived was found to be a significant factor for not exclusively breastfed.
Another study in China reported that the common factors associated with duration of exclusive breastfeeding and predominant breastfeeding were location of mother's residence and return to work.
Most of the Jurnal Dunia Kesmas.
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8%),
5%) and rural .
8%)) consumed formula milk at 6 months of age (Qiu et , 2.
From this study also found a report that working mothers tend not to exclusively breastfeed their babies.
Bai et found that only one third of mothers continued to breastfeed after two weeks of returning to work (Bai et al.
, 2.
Several other studies also stated that the sooner the mother returned to work, the shorter the duration of breastfeeding (Bai et al.
, 2015.
Ogbuanu et al.
, 2.
more flexible work schedule that includes ease of breastfeeding and ease of access to private lactation rooms significantly affects the duration of breastfeeding (Rozga et al.
, 2.
EIBF was also reported as a significant factor in this study.
This statement is similar to several studies in Ethiopia (Beyene et al.
, 2019.
Gizaw et , 2017.
Lenja et al.
, 2016.
Liben et al.
Setegn et al.
, 2.
that EIBF has a significant relationship with a lower risk of cessation of breastfeeding compared to late initiation of breastfeeding.
This is because initiating breastfeeding in the first 1 hour of birth can increase the initial bond between mother and child and the adequacy of breast milk so that it can delay the initiation of additional food other than breast milk.
CONCLUSION
This study has not been able to prove the relationship between PPD and However, through this study, there are four fundamental factors that can influence exclusive breastfeeding, namely the Early Initiation Breastfeeding (EIBF), work status and mother's residence.
So that the risk of the depression and exclusive breastfeeding cannot be separated from these four fundamental variables.
Some recommendations from this study are to enrich the questions on the Indonesian Basic Health Research questionnaire and collect data on exclusive breastfeeding status preferably through a combination of measurements.
In addition, there is a need for continuous evaluation of the roles and functions of breastfeeding counsellor in implementing EIBF in each health facility, observing the process of breastfeeding mothers and providing targeted education about breastfeeding in the postpartum period.
In addition, routine early detection, follow-up, and support related to psychosocial problems and breastfeeding problems as well as forms of policy to provide flexibility to working mothers with babies under 6 months old not to return to work immediately or to be able to approach child care facilities and breastfeeding rooms for mothers.
SUGGESTION
For researchers who are interested in the same topic to research using cohort methods or case studies to be able to see a clearer causal relationship.
In addition, researchers can expand the determinants of exclusive breastfeeding apart from what has been examined in this study.
DAFTAR PUSTAKA