A Qualitative Inquiry into Indonesian Women's Breastfeeding Decision-Making

Abstract

Despite the World Health Organization’s longstanding guidelines encouraging exclusive breastfeeding, less than half of babies are breastfed exclusively in Indonesia, a country experiencing a disproportionately high infant mortality rate believed to be related to inadequate access to clean water and health care. Questions remain concerning women’s decision-making about infant feeding, and we know very little about Indonesian women’s decisions and behaviors regarding breastfeeding. The current research explored Indonesian women’s perceptions about their communication with their support persons as they contemplated the best and most appropriate way to feed their infants. During two trips to Indonesia in 2018, semi-structured qualitative interviews and focus groups were conducted with 84 mothers and 36 breastfeeding support persons including spouses, their infants’ grandmothers, midwives, and lactation consultants on Java, Bali, and Flores Islands. Using the constant comparative method, results revealed infants’ grandmothers and fathers as primary sources of breastfeeding support for mothers. Notably, despite their prominence, grandmothers and fathers were not always perceived to be effective sources of support; rather, mothers often described experiencing support that was unwanted or ineffective. Commonly mothers described a grandmother’s attempted support as being couched in criticism or guided by myths, and a father’s ineffective support as the result of lack of knowledge. Conflict with grandmothers was especially problematic given cultural expectations regarding elders. Findings are discussed in the context of Problematic Integration Theory, a general theory that describes the role of communication in experiencing and managing tensions between expectations and desires. Specifically, findings revealed that breastfeeding challenges fundamentally involve negotiating these dilemmas, which are co-created, exacerbated, transformed, and managed through communication between mothers and their support persons. This study demonstrates the centrality of communication in breastfeeding decision-making, highlights the role of grandmothers and fathers in breastfeeding promotion, and emphasizes the importance of informed social support for new mothers.