Cultural Influences of Early Food Introduction on Exclusive Breastfeeding Rates in the Nias Islands, Indonesia.

Abstract

Background & aims: Despite the WHO and UNICEF recommending exclusive breastfeeding for the first six months of a child's life, global coverage remains low, with only about 44% of infants receiving exclusive breastfeeding during this period. In Indonesia, particularly in the Nias Islands, which have high stunting rates, social and cultural dimensions significantly influence this practice. This study aims to explore in depth the social dimensions behind early infant feeding practices. By understanding these social issues, effective interventions can be developed in the future.

Methods: This study was conducted in three remote villages in the Nias Islands using a qualitative approach. The research locations were selected based on District Health Office data about areas with low exclusive breastfeeding coverage or high stunting rates. In each location, the village midwife assisted in identifying and selecting suitable informants for the study. Data were collected through in-depth interviews with 15 mothers, Focus Group Discussions (FGD) with three groups of mothers, and interviews with village midwives and community leaders to understand the influence of social norms and cultural factors. The data were analyzed using thematic analysis.

Results: The findings indicate that the low knowledge about the benefits of exclusive breastfeeding, along with socio-cultural perceptions supporting early food introduction, significantly influence this practice. This study also reveals that social pressure and entrenched cultural norms, including the roles and expectations of women, play a significant role in the early introduction of food before six months of age.

Conclusion: This study identifies that the combination of inadequate knowledge and a strong socio-cultural landscape contributes to the low prevalence of exclusive breastfeeding in the Nias Islands. This situation necessitates more targeted educational strategies and the inclusion of social and cultural elements in promoting exclusive breastfeeding.