Maternal and Child Health Journal

, Volume 19, Issue 7, pp 1515–1525 | Cite as

What Works to Improve Duration of Exclusive Breastfeeding: Lessons from the Exclusive Breastfeeding Promotion Program in Rural Indonesia

  • Kun Aristiati SusiloretniEmail author
  • Hamam Hadi
  • Yayi Suryo Prabandari
  • Yati S. Soenarto
  • Siswanto Agus Wilopo


The aim of the study was to identify determinants of exclusive breastfeeding (EBF) at the individual, family, community, and organizational level. This study was a secondary analysis of data from a multilevel promotion of EBF program in two rural public health centers (PHCs) in the Demak district, Central Java, Indonesia. The program was a quasi-experimental study with a pretest–posttest control group. A total of 599 participants were enrolled, consisting of 163 mother infant pairs, 163 fathers, 163 grandmothers, 82 community leaders, and 28 midwives. EBF duration and its determinants were measured and analyzed using Cox proportional-hazard model. Mothers with a high level of breastfeeding knowledge had the greatest EBF duration. Mothers who had a knowledge score >80 had a 73 % (HR 0.27, 95 % CI 0.15, 0.48) greater chance of EBF compared to mothers who had a knowledge score of <60. Factors which shortened EBF duration were grandmother’s lack of support for EBF (HR 2.04, 95 % CI 1.33, 3.14), received formula samples at discharge (HR 1.99, 95 % CI 1.25, 3.16), and maternal experience of breast engorgement (HR 1.97, 95 % CI 1.32, 2.94). High maternal breastfeeding knowledge was the only factor associated with longer duration of EBF. Barriers to EBF were breast engorgement, receiving formula samples at discharge, and a grandmother’s lack of support for EBF.


Exclusive breastfeeding Determinant Maternal knowledge Breast engorgement Formula samples Grandmother’s lack of support for EBF 



We would like to express our thanks and appreciation to all the participants of this study. We would like also to thank Prof. Blami Dao,  Dr. Agus Suryawan, Dr. Amy Koerber, Dr. Margaret Triyana and Dr. Brian D Johnston from AuthorAID for editing, input, and valuable suggestions. Support for manuscript preparation and critical analysis was received from the Faculty of Medicine of Universitas Indonesia and the Higher Education Network Ring Initiative (HENRI). HENRI is a partnership supported by a grant from the United States Agency for International Development-Indonesia (Cooperative Agreement AID-497-A-11-00002) to the Harvard School of Public Health in collaboration with, and with contributions from, SEAMEO Regional Centre for Food and Nutrition of Universitas Indonesia, Summit Institute of Development, University of Mataram, and Andalas University.

Supplementary material

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Kun Aristiati Susiloretni
    • 1
    Email author
  • Hamam Hadi
    • 2
  • Yayi Suryo Prabandari
    • 3
  • Yati S. Soenarto
    • 4
  • Siswanto Agus Wilopo
    • 3
  1. 1.Department of NutritionSemarang Health Polytechnic MoH RISemarangIndonesia
  2. 2.Faculty of Medicine, Center for Health and Human NutritionGadjah Mada UniversityYogyakartaIndonesia
  3. 3.Department of Public Health, Faculty of MedicineGadjah Mada UniversityYogyakartaIndonesia
  4. 4.Department of Paediatrics, Faculty of MedicineGadjah Mada UniversityYogyakartaIndonesia

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