A Maternal Empowerment, Family Support, and Breastfeeding Practices: A Mixed-Methods Study in Pematangsiantar, Indonesia
Abstract
Early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) are vital infant-feeding practices, but their implementation can be influenced by clinical factors, healthcare routines, maternal confidence, and family environment. However, the extent to which maternal empowerment interventions improve breastfeeding outcomes in community settings remains uncertain. This study aimed to evaluate a maternal empowerment intervention in relation to EIBF, EBF, breastfeeding knowledge, and self-efficacy, and to explore perceived barriers to breastfeeding and sources of family. This convergent mixed-methods study was conducted in Pematangsiantar, Indonesia, from March to November 2024. The quantitative component used a quasi-experimental pretest–post-test control-group design involving 54 pregnant women: 27 received breastfeeding counseling, a pocketbook, video-based education, and follow-up support, while 27 received only the pocketbook. The qualitative component involved semi-structured interviews with 14 mothers. Quantitative findings were analyzed using between-group comparisons and logistic regression; interview data were examined thematically. EIBF was reported by 74.1% of the intervention group and 85.2% of the control group (p=0.311). EBF proportion was 70.4% in both groups (p=1.000). Between-group differences in post-intervention knowledge and breastfeeding self-efficacy were not significant. Cesarean delivery was associated with lower adjusted odds of EIBF (aOR = 0.047, 95% CI 0.006–0.377; p=0.004), while EIBF was associated with earlier lactation onset (OR = 9.0, 95% CI 2.07–39.19; p=0.004). Interviews identified delivery-related barriers, perceived insufficient milk, family influence, employment demands, and supportive family involvement. The intervention didn’t demonstrate statistically significant improvements in breastfeeding outcomes. Breastfeeding promotion should integrate maternal education with supportive maternity-care practices and family engagement.
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