Patterns of breast-feeding practice in Semarang, Indonesia : comparison between women in peri-urban area and urban area
Like many women in other developing countries, Indonesian women face cultural and gender inequalities; and high rates of maternal mortality and malnutrition are prevalent amongst Indonesian women. UNICEF (2000) showed that an estimated 450 women in Indonesia die every 45 minutes because of complications during delivery, late referral to hospital or maternity services and poor treatment, as a result of poorly trained health staff, including midwives, and a lack of emergency facilities and transport. The economic crisis which hit Indonesia in 1997 has worsened these conditions. A study conducted by Helen Keller International showed that as a result of the crisis both iron deficiency and vitamin A deficiency were increasing amongst women and their children (Helen Keller International, 2000). Indonesia also still has many problems regarding infant malnutrition and infant mortality, although the child survival rate has been improving over the past two decades. UNICEF (2000) reported that 7 per cent of Indonesian children die before their fifth birthday. According to WHO and UNICEF, breast-feeding is the best way to feed babies. In developing countries, breast-feeding has been the subject of rapidly growing interest, not just because breast milk is sterile and safe and beneficial to the health of children, but can also lower fertility. In Indonesia, an exclusive breast-feeding campaign was introduced more than 20 years ago. Although UNICEF reported that 95 to 97 per cent of Indonesian babies are initially breastfed, the 2004 Indonesian Demographic and Health Survey (IDHS) showed that the rates of bottle-feeding practice have increased sharply. This thesis documents patterns of breast-feeding practice in Semarang, Indonesia, focusing upon Indonesian women living in peri-urban and urban areas in Semarang and their attitudes towards and practice of breast-feeding, and also examines the various factors which influence breast-feeding, such as health services, socioeconomic factors and cultural values from within the community. Lintang village (a pseudonym), which is located 15km from the city centre of Semarang, is a developing industrial zone of Semarang, and is used to represent a peri-urban area. The city of Semarang is used to represent an urban area. The sample group in the peri-urban area included pregnant women, mothers with babies less than 2 years old, a few husbands and a small number of women of reproductive age. For the urban area, the sample group included pregnant women who were undergoing ante-natal care and mothers/breastfeeding women who were attending the mother/children health care centre at Melati Hospital (a pseudonym) in Semarang. A combination of qualitative and quantitative data collection methods were used in this research. This research found that peri-urban and urban women had different attitudes towards ante and post-natal treatments. The Puskesmas or public health centre was where mothers in the peri-urban area went for ante-natal treatment. By contrast, mothers in the urban area with a higher socio-economic status had access to better ante-natal care. For post-natal treatment, women in the peri-urban area still preferred the traditional services of the dukun bayi (traditional midwife) for post-natal treatment. There were no dukun bayis in the urban area and a higher level of education and income seemed to influence the women in the urban area to turn away from traditional practices; they preferred the services of midwives or obstetricians for post-natal treatment. This research also found that most mothers in both areas stated that breast-feeding was healthy, cheap, practical and natural. However, this research found that there were differences in breast-feeding practices for mothers in both areas, and that most of the working mothers in both areas had experienced difficulties in continuing to breast-feed their babies after their maternity leave was over.