A Qualitative Systematic Review of Exclusive Breastfeeding Practices in Indonesia: The Role of Family, Community Leaders, and Health Workers
DOI:
https://doi.org/10.25217/0020269790800Keywords:
Exclusive Breastfeeding, Bronfenbrenner's, Social Ecology, Decision-Making, IndonesianAbstract
Exclusive breastfeeding (EBF) coverage in Indonesia remains far below the national target at only 20.7%. Understanding how family, community leaders, and health workers interact to influence mothers requires synthesizing qualitative evidence that captures lived experiences, power dynamics, and contextual meanings. This study aims to synthesize qualitative evidence on the roles and interactions of family, community leaders, and health workers in EBF decision-making in Indonesia. This qualitative systematic review was conducted following the PRISMA 2020 guidelines. A systematic search across Scopus, PubMed, and ProQuest for the period 2010-2025 identified 18 qualitative studies meeting the inclusion criteria. Data analysis employed thematic synthesis, which involved line-by-line coding of extracted findings, development of descriptive themes, and generation of analytical themes. These themes were then conceptually mapped based on Bronfenbrenner's socio-ecological theory to illustrate multi-level interactions. The close family (particularly parents/in-laws) played a dominant role as "tradition holders," often recommending early complementary feeding. Husbands demonstrated an ambivalent role, being either supportive or inhibitory. Health workers acted as educators but were often inconsistent and constrained by limited capacity. Community leaders had a dual role as norm-setters, both supporting and hindering EBF based on traditional beliefs and religious authority. The synthesis generated a "line-of-argument" illustrating how these actors interact across ecological levels, creating a complex negotiation process between biomedical knowledge and socio-cultural traditions that shapes EBF outcomes. EBF decision-making in Indonesia results from complex multi-actor interactions within the social ecology.
References
Aiman, U., & Nuraida, N. (2021). Pengaruh dukungan mertua terhadap pemberian ASI eksklusif pada bayi di Puskesmas Tanah Luas. Prepotif : Jurnal Kesehatan Masyarakat, 6(1), 125–130. https://doi.org/10.31004/prepotif.v6i1.2505
Amiruddin, A., Bustami, B., Anasril, A., Herlambang, T. M., Husaini, M., & Gustini, S. (2021). Phenomenology Study of Stunting Nutrition for Babies in the Work Area of Pante Kuyun Health Center, Aceh Jaya District. Open Access Macedonian Journal of Medical Sciences, 9(B), 462–467. https://doi.org/10.3889/oamjms.2021.6000
Astuti, A. W., Kurniawati, H. F., & Kurniawati, H. F. (2021). A Qualitative Study on the Breastfeeding Experiences of Young Mothers. Nurse Media Journal of Nursing, 11(1), 35–49. https://doi.org/10.14710/nmjn.v11i1.33539
Barjie B, A. (2022). Budaya Banjar bahari. Penakita Publisher.
Budiati, T., Setyowati, S., & Gunawijaya, J. (2022). Fathers’ role in sustainability of exclusive breastfeeding practice in post-cesarean-section mothers. Journal of Public Health Research, 11, 2744.
Concha, N., & Jovchelovitch, S. (2021). Grandmothers: Central scaffolding sources impacting maternal and infant feeding practices in Colombia. Maternal & Child Nutrition, 17(S1). https://doi.org/10.1111/mcn.13162
Critical Appraisal Skills Programme. (2025). CASP Qualitative Studies Checklist. https://casp-uk.net/casp-checklists/CASP-checklist-qualitative-2024.pdf
Damus, O. (2023). Le rôle des savoirs des matrones dans la promotion de la santé, l’éducation à la santé et la prévention en Haïtï. Anthropologie Des Savoirs Des Suds, (1), 30–49. https://doi.org/10.17118/11143/20530
De la Llana Pérez, E., Cortez Méndez, R. J., & Cruzata, W. J. (2022). Una mirada a la salud desde una perspectiva antropológica. Más Vita, 4(4), 259–268. https://doi.org/10.47606/ACVEN/MV0184
Februhartanty, J., Muslimatun, S., Shankar, A. H., Djakababa, N., & Suradi, R. (2020). Paternal Roles in Breastfeeding in Jakarta, Indonesia: A Mixed-method Approach. Indonesian Journal of Human Nutrition, 7(1), 31–43. https://doi.org/10.21776/ub.ijhn.2020.007.01.4
Fitriyati, Y., Samsudin, M., Laksono, A. D., Khairunnisa, M., Anggrimulya, E. Y., & Latifah, L. (2025). “If the Nipple Cracked in a Cross, the Breastmilk Will Be Poisonous”: The Barrier to Exclusive Breastfeeding in Indonesia’s Islands Area. Journal of Population and Social Studies, 34, 118–133. https://doi.org/10.25133/JPSSv342026.007
Flaherman, V. J., Chan, S., Desai, R., Agung, F. H., Hartati, H., & Yelda, F. (2018). Barriers to exclusive breast-feeding in Indonesian hospitals: a qualitative study of early infant feeding practices. Public Health Nutrition, 21(14), 2689–2697. https://doi.org/10.1017/S1368980018001453
Gross, F. de M., Van der Sand, I. C. P., Girardon-Perlini, N. M. O., & Cabral, F. B. (2011). Influência das avós na alimentação de lactentes: o que dizem suas filhas e noras. Acta Paulista de Enfermagem, 24(4), 534–540. https://doi.org/10.1590/S0103-21002011000400014
Guy-Evans, O. (2025). Bronfenbrenner’s EcologicalSystems Theory. SimplyPsycology. https://www.simplypsychology.org/bronfenbrenner.html
Hahn, R. A., & Schoch-Spana, M. (2021). Anthropological foundations of public health; the case of COVID 19. Preventive Medicine Reports, 22, 101331. https://doi.org/10.1016/j.pmedr.2021.101331
Hervilia, D., & Munifa, D. (2016). Pandangan Sosial Budaya terhadap ASI Eksklusif di Wilayah Panarung Palangkaraya (Social and Cultural Aspect toward Exclusive Breastfeeding in Panarung Palangkaraya). Indonesian Journal of Human Nutrition, 3(1), 63–70. https://doi.org/10.21776/ub.ijhn.2016.003.Suplemen.7
Ichsan, B., Probandari, A. N., Pamungkasari, E. P., & Salimo, H. (2021). Barriers and support to exclusive breastfeeding in Sukoharjo district, Central Java province, Indonesia: a qualitative study. Journal of Health Research, 35(6), 482–492. https://doi.org/10.1108/JHR-12-2019-0274
Ji, R., & Cheng, Y. (2021). Thinking global health from the perspective of anthropology. Global Health Research and Policy, 6(1), 47. https://doi.org/10.1186/s41256-021-00233-z
Joseph, F. I., & Earland, J. (2019). A qualitative exploration of the sociocultural determinants of exclusive breastfeeding practices among rural mothers, North West Nigeria. International Breastfeeding Journal, 14(1), 38. https://doi.org/10.1186/s13006-019-0231-z
Kemenkes RI. (2024). Laporan Tematik Survei Kesehatan Indonesia (SKI) Tahun 2023: Potret Indonesia Sehat. Kemenkes RI.
Lokat, W. S. P. R., Riwu, R. R., Nur, M. L., & Ndun, H. J. N. (2020). The Strategy of Successful Exclusive Breastfeeding of Policewomen in Regional Police Department, East Nusa Tenggara. Journal of Nutritional Science and Vitaminology, 66(Supplement), S107–S110. https://doi.org/10.3177/jnsv.66.S107
López, A., & González, M. C. (2024). Socio antropología de la salud. Ideas para el debate. Pacha. Revista de Estudios Contemporáneos Del Sur Global, 5(14), e240312. https://doi.org/10.46652/pacha.v5i14.312
Ma, A., Merçon-Vargas, E. A., Chambers, B. D., Nyambe, M., & Williams, T. A. (2018). Context of Breastfeeding among Latina Mothers using a Social-ecological Approach: An Exploratory Study. Journal of Public Health Issues and Practices, 2(2). https://doi.org/10.33790/jphip1100124
Mawaddah, S., Barlianto, W., & Nurdiana, N. (2018). Pengetahuan Ibu, Dukungan Sosial, dan Dukungan Tenaga Kesehatan terhadap Keputusan Memberikan ASI Eksklusif. Indonesian Journal of Human Nutrition, 5(2), 85–95. https://doi.org/10.21776/ub.ijhn.2018.005.02.3
Meher, C., & Zaluchu, F. (2024a). Cultural Influences of Early Food Introduction on Exclusive Breastfeeding Rates in the Nias Islands, Indonesia. Journal of Multidisciplinary Healthcare, Volume 17, 5653–5663. https://doi.org/10.2147/JMDH.S478448
Meher, C., & Zaluchu, F. (2024b). Scoping Review Peran Konteks Sosial dalam Pemberian ASI Ekslusif. Inovasi, 21(2), 79–89. https://doi.org/10.33626/inovasi.v21i2.908
Mgongo, M., Hussein, T. H., Stray-Pedersen, B., Vangen, S., Msuya, S. E., & Wandel, M. (2019). Facilitators and Barriers to Breastfeeding and Exclusive Breastfeeding in Kilimanjaro Region, Tanzania: A Qualitative Study. International Journal of Pediatrics, 2019, 1–7. https://doi.org/10.1155/2019/8651010
Ministry of Health - Republic of Indonesia. (2023). Stunting in Indonesia and Its Determinants.
Muhani, N., Ririn Wulandari, Nurul Arayastuti, Dhiny Easter Yanti, Dessy Hermawan, Siti Nena Sefililaisya, & Wulan Angraini. (2020). The relationship between maternal psychology, family, and culture with perception of breast milk insufficiency in breastfeeding mothers of sumur batu public health center, lampung indonesia. Malaysian Journal of Public Health Medicine, 20(3), 67–78. https://doi.org/10.37268/mjphm/vol.20/no.3/art.401
Negin, J., Coffman, J., Vizintin, P., & Raynes-Greenow, C. (2016). The influence of grandmothers on breastfeeding rates: a systematic review. BMC Pregnancy and Childbirth, 16(1), 91. https://doi.org/10.1186/s12884-016-0880-5
Nidaa, I., & Krianto, T. (2022). Scoping Review: Faktor Sosial Budaya Terkait Pemberian Asi Eksklusif Di Indonesia. Jurnal Litbang Kota Pekalongan, 20(1). https://doi.org/10.54911/litbang.v20i1.190
Nurullah, N., Zaini, M., & Jamila, C. N. (2024). Raḍā’ah in the Qur’an: The relationship of understanding and practice of breastfeeding among mothers in Ulee Kareng, Banda Aceh, Indonesia. Jurnal Ilmiah Al-Mu’ashirah, 21(1), 62. https://doi.org/10.22373/jim.v21i1.20928
Okinarum, G. Y., & Rochdiat, W. (2022). Breastfeeding Experience During COVID-19 Pandemic in Indonesia: Strengthening and Weakening Elements. Malaysian Journal of Medical Sciences, 29(3), 110–121. https://doi.org/10.21315/mjms2022.29.3.11
Otmani, C., Ibanez, G., Chastang, J., Hommey, N., Cadwallader, J. S., Magnier, A. M., & Hadji, S. (2016). Rôle de l’entourage maternel dans l’initiation de l’allaitement. Santé Publique, Vol. 27(6), 785–795. https://doi.org/10.3917/spub.156.0785
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, n71. https://doi.org/10.1136/bmj.n71
Paramashanti, B. A., Dibley, M. J., Huda, T. M., Prabandari, Y. S., & Alam, N. A. (2023). Factors influencing breastfeeding continuation and formula feeding beyond six months in rural and urban households in Indonesia: a qualitative investigation. International Breastfeeding Journal, 18(1), 48. https://doi.org/10.1186/s13006-023-00586-w
Pinem, M. L. (2022). Breastfeeding Practices of Karo Mothers in North Sumatera Indonesia. HUMANISMA : Journal of Gender Studies, 6(1), 22. https://doi.org/10.30983/humanisme.v6i1.5345
Pramono, A., Smith, J., Bourke, S., & Desborough, J. (2022). How midwives and nurses experience implementing ten steps to successful breastfeeding: a qualitative case study in an Indonesian maternity care facility. International Breastfeeding Journal, 17(1), 84. https://doi.org/10.1186/s13006-022-00524-2
Prastita, N. P. G., Sunjaya, D. K., Syam, H. H., Krisnadi, S. R., Hakim, D. D. L., Anwar, R., & Susiarno, H. (2025). Barriers and facilitators to exclusive breastfeeding among formally employed mothers in urban Indonesia. BMC Public Health, 25(1), 3925. https://doi.org/10.1186/s12889-025-25214-6
Prates, L. A., Schmalfuss, J. M., & Lipinski, J. M. (2014). Amamentação: a influência familiar e o papel dos profissionais de saúde. Revista de Enfermagem Da UFSM, 4(2). https://doi.org/10.5902/2179769210631
Putri, D. T., Nasir, S., Riskiyani, S., & Kasim, S. (2024). Social Support for Exclusive Breastfeeding Behavior in the Bulili Community Health Center Working Area, South Palu District . International Journal of Chemical and Biochemical Sciences , 25(14), 52–59.
Rasip, Z., Kadri, R., Ramlee, Y., & Yahi, M. (2024). Exclusive Breastfeeding: Its Benefits from Islamic and Scientific Perspective. International Journal of Academic Research in Business and Social Sciences, 14(12). https://doi.org/10.6007/IJARBSS/v14-i12/23763
Sharma, I. K., & Byrne, A. (2016). Early initiation of breastfeeding: a systematic literature review of factors and barriers in South Asia. International Breastfeeding Journal, 11(1), 17. https://doi.org/10.1186/s13006-016-0076-7
Siregar, F. L. S., Darti, N. A., & Nurbaiti, N. (2024). Family and Healthcare Worker Participation in Promoting Exclusive Breastfeeding among Mothers. Jurnal Kesehatan, 15(3), 348–355. https://doi.org/10.26630/jk.v15i3.4723
Spagnoletti, B. R. M., Bennett, L. R., Kermode, M., & Wilopo, S. A. (2018). Moralising Rhetoric and Imperfect Realities: Breastfeeding Promotions and the Experiences of Recently Delivered Mothers in Urban Yogyakarta, Indonesia. Asian Studies Review, 42(1), 17–38. https://doi.org/10.1080/10357823.2017.1407291
Tomori, C., Hernández‐Cordero, S., Busath, N., Menon, P., & Pérez‐Escamilla, R. (2022). What works to protect, promote and support breastfeeding on a large scale: A review of reviews. Maternal & Child Nutrition, 18(S3). https://doi.org/10.1111/mcn.13344
Triwibowo, C., Rangkuti, R., Ridesman, ., Pratiwi, N. L., Tinah, ., Kusumawardani, L. H., & Fauziyah, Y. (2021). Complementary feeding implementation in Pintu Padang Health Centre, South Tapanuli District, Indonesia: a qualitative study. Sri Lanka Journal of Child Health, 50(1), 63. https://doi.org/10.4038/sljch.v50i1.9403
UNICEF, & WHO. (2019). Increasing commintment to breastfeeding through funding and improved policies and programmes.
Victora, C. G., Bahl, R., Barros, A. J. D., França, G. V. A., Horton, S., Krasevec, J., Murch, S., Sankar, M. J., Walker, N., & Rollins, N. C. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475–490. https://doi.org/10.1016/S0140-6736(15)01024-7
Weber, M. B., Palmer, W., Griffin, M., & Welsh, J. A. (2023). Infant and young child feeding practices and the factors that influence them: a qualitative study. Journal of Health, Population and Nutrition, 42(1), 32. https://doi.org/10.1186/s41043-023-00371-9
WHO & UNICEF. (2014). Global nutrition targets 2025: breastfeeding policy brief. WHO & UNICEF.
Yunitasari, E., Umayro, A. H., & Pratiwi, I. N. (2019). Community Empowerment in the Madura Tribe with Exclusive Breastfeeding in the Working Area of Community Health Center Sreseh Sampang Madura. Indian Journal of Public Health Research & Development, 10(8), 2600. https://doi.org/10.5958/0976-5506.2019.02260.5
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