A Causal Model of Breastfeeding Duration among Working Muslim Mothers in Central Java Province, Indonesia

Mekar Dwi Anggraeni, Busakorn Punthmatharith, Wongchan Petpichetchian


This study aimed to develop and test a causal model predicting breast feeding duration in this population. A cross-sectional, predictive study was conducted to test the proposed causal model predicting breastfeeding duration among working Muslim mothers. The predictors specified in the model were selected based on findings from an extensive review of the literature. The study was conducted in Central Java, Indonesia. Two hundred forty Muslim mothers participated in the study. Self-reported questionnaires were used. A model testing using path analysis was performed to examine the hypothesized relationships. The study results were 1) hypothesized model did not fit the data and was modified based on the statistical and theoretical considerations and the modified model did fit the data, 2) intention to exclusively breastfeed affected breastfeeding initiation, 3) breastfeeding knowledge and attitude toward breastfeeding affected intention to exclusively breastfeed, 4) breastfeeding knowledge, family support, workplace support, attitude toward breastfeeding, sufficient milk supply, and intention to exclusively breastfeed affected breastfeeding duration, 5) breastfeeding problems affected breastfeeding duration, 6) intention to exclusively breastfeed mediated breastfeeding knowledge and attitude toward breastfeeding on breastfeeding duration and breastfeeding initiation, 7) breastfeeding initiation did not mediate breastfeeding knowledge, family support, and intention to exclusively breastfeed on breastfeeding duration. This results of this study provides empirical evidence regarding a causal model of breastfeeding duration among working Muslim mothers. Future studies should test the model in the other context and involve mothers from all occupation particularly that have night shift.


causal model, breastfeeding duration, working Muslim mothers


S. Verick, Female labor force participation in developing countries, IZA World Labor. (2014).

S. Indonesia, Angka partisipasi kerja di Indonesia [Indonesian labor force], (2012).

F. Shuhaimi, N.D. Muniandy, The association of maternal employment status on nutritional status among children in selected kindergartens in Selangor, Malaysia, Asian J. Clin. Nutr. 4 (2012).

K.L. Tan, Factors Associated with Non-exclusive Breastfeeding among 4-Week Post-partum Mothers in Klang District, Peninsular Malaysia., Malays. J. Nutr. 15 (2009).

S. Indonesia, Survey demografi dan kesehatan Indonesia [Indonesia Demographic and Health Survey], (2012). http://dhsprogram.com/pubs/pdf/ FR275/FR275.pdf.

I.M. of Health, Indonesian health profile 2013, (2014). www.depkes.go.id/resources/download/pusdatin/profil-kesehatan-indonesia/profil-kesehatan-indonesia-2013.pdf.

U. Shaikh, O. Ahmed, Islam and infant feeding, Breastfeed. Med. 1 (2006) 164–167.

D.A. Inayati, V. Scherbaum, R.C. Purwestri, E. Hormann, N.N. Wirawan, J. Suryantan, S. Hartono, M.A. Bloem, R.V. Pangaribuan, H.K. Biesalski, Infant feeding practices among mildly wasted children: a retrospective study on Nias Island, Indonesia, Int. Breastfeed. J. 7 (2012) 3.

R.M. Amin, Z.M. Said, R. Sutan, S.A. Shah, A. Darus, K. Shamsuddin, Work related determinants of breastfeeding discontinuation among employed mothers in Malaysia, Int. Breastfeed. J. 6 (2011) 4.

R.L. Biswas, Family support on exclusive breastfeeding practice among mothers in Bangladesh, Prince of Songkla University, 2011.

S. Khatun, The influence of breastfeeding attitude and subjective norm on intention to exclusive breastfeeding of mothers in Dhaka, Bangladesh, Prince of Songkla University, 2010.

A. Wicitra, Pengaruh pengetahuan dan dukungan keluarga terhadap pemberian ASI eksklusif pada ibu pekerja swasta di Jakarta [The effect of breastfeeding knowledge and family support on exclusive breastfeeding duration among working mothers in Jakarta], Universitas Indonesia, 2009.

Y. Bai, C.-Y.J. Peng, A.D. Fly, Validation of a short questionnaire to assess mothers’ perception of workplace breastfeeding support, J. Acad. Nutr. Diet. 108 (2008) 1221–1225.

S.O. Lee, A study about breastfeeding knowledge, attitude and problem of breastfeeding in early postpartum period and breastfeeding practice, Korean J. Women Heal. Nurs. 9 (2003) 179–188.

M. Khassawneh, Y. Khader, Z. Amarin, A. Alkafajei, Knowledge, attitude and practice of breastfeeding in the north of Jordan: A cross-sectional study, Int. Breastfeed. J. 1 (2006). doi:10.1186/1746-4358-1-17.

M. Sattari, D. Levine, A. Bertram, J.R. Serwint, Breastfeeding Intentions of Female Physicians, Breastfeed. Med. 5 (2010) 297–302. doi:10.1089/bfm.2009.0090.

K.A. Hidayat, J. Dewantiningrum, Perbandingan Pelaksanaan Inisiasi Menyusu Dini Berdasar Tingkat Pengetahuan Ibu Hamil, Media Med. Muda. 1 (2012). http://id.portalgaruda.org/?ref=browse&mod=viewarticle&article=73710.

N.A. Al-Akour, M.Y. Khassawneh, Y.S. Khader, A.A. Ababneh, A.M. Haddad, Factors affecting intention to breastfeed among Syrian and Jordanian mothers: A comparative cross-sectional study, Int. Breastfeed. J. 5 (2010). doi:10.1186/1746-4358-5-6.

S. Nasution, The association between knowledge and attitude toward exclusive breastfeeding and exclusive breastfeeding duration, in: Int. Conf. Heal. Heal. Harmon. Nurs. Values, 2013.

L.L. Foo, S.J.S. Quek, S.A. Ng, M.T. Lim, M. Deurenberg-Yap, Breastfeeding prevalence and practices among Singaporean Chinese, Malay and Indian mothers, Health Promot. Int. 20 (2005) 229–237. doi:10.1093/heapro/dai002.

F. Azaiza, H. Palti, Determinants of breastfeeding among rural moslem women in israel, Fam. Syst. Heal. 15 (1997) 203–211. doi:10.1037/h0089801.

P.D. Hill, S.S. Humenick, Development of the H & H Lactation Scale, Nurs Res. 45 (1996) 136–140. doi:10.1097/00006199-199605000-00003.

L.M. Chatman, H.M. Salihu, M.E.A. Roofe, P. Wheatle, D. Henry, P.E. Jolly, Influence of knowledge and attitudes on exclusive breastfeeding practice among rural Jamaican mothers, Birth. 31 (2004) 265–271. doi:10.1111/j.0730-7659.2004.00318.x.

E. DiFrisco, K.E. Goodman, W.C. Budin, M.W. Lilienthal, A. Kleinman, B. Holmes, Factors Associated With Exclusive Breastfeeding 2 to 4 Weeks Following Discharge From a Large, Urban, Academic Medical Center Striving for Baby-Friendly Designation, J. Perinat. Educ. 20 (2011) 28–35. doi:10.1891/1058-1243.20.1.28.

L. Gatti, Maternal perceptions of insufficient milk supply in breastfeeding, J. Nurs. Scholarsh. 40 (2008) 355–363. doi:10.1111/j.1547-5069.2008.00234.x.

S.L. Gill, Breastfeeding by hispanic women, JOGNN - J. Obstet. Gynecol. Neonatal Nurs. 38 (2009) 244–252. doi:10.1111/j.1552-6909.2009.01013.x.

L.P. Lewallen, M.J. Dick, J. Flowers, W. Powell, K.T. Zickefoose, Y.G. Wall, Z.M. Price, Breastfeeding support and early cessation., J. Obstet. Gynecol. Neonatal Nurs. 35 (2006) 166–172. doi:10.1111/j.1552-6909.2006.00031.x.

Y. Afiyanti, D. Juliastuti, Exclusive breastfeeding practice in Indonesia, Br. J. Midwifery. 20 (2012) 484–492. doi:10.12968/bjom.2012.20.7.484.

A.D. Camurdan, M.N. Ilhan, U. Beyazova, F. Sahin, N. Vatandas, S. Eminoglu, How to achieve long-term breast-feeding: Factors associated with early discontinuation, Public Health Nutr. 11 (2008) 1173–1179. doi:10.1017/S1368980008001742.

R.O. Meyerink, G.S. Marquis, Breastfeeding Initiation and Duration Among Low-Income Women in Alabama: The Importance of Personal and Familial Experiences in Making Infant-Feeding Choices, J. Hum. Lact. 18 (2002) 38–45. doi:10.1177/089033440201800106.

B. Munro, Statistical methods for health care research, 1997.

A. Hilton, M. Skrutkowski, Translating instruments into other languages: Development and testing processes, Cancer Nurs. 25 (2002) 1–7. doi:10.1097/00002820-200202000-00001.

T.A. Tengku Ismail, Z. Sulaiman, Reliability and validity of a malay-version questionnaire assessing knowledge of breastfeeding, Malaysian J. Med. Sci. 17 (2010) 32–39.

J.S. House, Work stress and social support pdf, (1981).

K.A. Wambach, Breastfeeding Intention and Outcome: A Test of the Theory of Planned Behavior, Res. Nurs. Heal. 20 (1997) 51–59. doi:10.1002/(SICI)1098-240X(199702)20:1<51::AID-NUR6>3.0.CO;2-T.

B. Punthmatharith, J. Singh, A psychometric assessment of the H & H lactation scale in a sample of Thai mothers using a repeated measurement design, Nurs. Res. 54 (2005) 313–323. doi:10.1097/00006199-200509000-00005.

I. Ajzen, The theory of planned behavior, Orgnizational Behav. Hum. Decis. Process. 50 (1991) 179–211. doi:10.1016/0749-5978(91)90020-T.

World Health Organization, Nutrition: exclusive breastfeeding, Geneva Author. Retrieved from Www. Who. Int/ …. 285 (2011) 1–3.

D.K. Nugraheni, Pengetahuan dan Pelaksanaan Inisiasi Menyusui Dini, Pemberian ASI Eksklusif serta Status Gizi Batita di Perdesaan dan Perkotaan [The association of breastfeeding knowledge with breastfeeding initiation, exclusive breastfeeding practice, and nutritional st, Institut Pertanian Bogor, 2011.

L. Duckett, S. Henly, M. Avery, S. Potter, S. Hills-Bonczyk, R. Hulden, K. Savik, A Theory of Planned Behavior-Based Structural Model for Breast-Feeding, Nurs. Res. 47 (1998) 325–336. doi:10.1097/00006199-199811000-00006.

I. Ajzen, N. Joyce, S. Sheikh, N.G. Cote, Knowledge and the prediction of behavior: The role of information accuracy in the theory of planned behavior, Basic Appl. Soc. Psych. 33 (2011) 101–117. doi:10.1080/01973533.2011.568834.

B.P. Nastiti, Faktor-Faktor yang Berhubungan dengan Praktek Inisiasi Menyusu Dini di Wilayah Kerja Puskesmas Pangkah Kabupaten Tegal 2012 [Factors associated with early breastfeeding initiation among mothers in Primary Health Center Pangkah, Tegal], Universitas Negeri Semarang, 2012.

B. Stewart-Knox, K. Gardiner, M. Wright, What is the problem with breast-feeding? A qualitative analysis of infant feeding perceptions, J. Hum. Nutr. Diet. 16 (2003) 265–273. doi:10.1046/j.1365-277X.2003.00446.x.

R. Basrowi, Pemberian ASI eksklusif pada perempuan pekerja sektor formal [Exclusive breastfeeding practice among working mothers in formal sector], Universitas Indonesia, 2012.

N. Ratananugool, Factors influencing breast-feeding behavior among Thai adolescent mothers: a nursing predictive model., 2001.

J.M. Wojcicki, R. Gugig, C. Tran, S. Kathiravan, K. Holbrook, M.B. Heyman, Early Exclusive Breastfeeding and Maternal Attitudes Towards Infant Feeding in a Population of New Mothers in San Francisco, California, Breastfeed. Med. 5 (2010) 9–15. doi:10.1089/bfm.2009.0003.


  • There are currently no refbacks.


Online ISSN: 2228-835X


Last updated: 17 May 2019