PROVISION OF LACTATION CLINIC IN COMPANIES IN SEMARANG CITY: A REVIEW OF POLICY IMPLEMENTATION
Background: As of 2022, Semarang City has 4,083 companies. However, according to the Labor Office of Semarang City, only 109 out of 529 companies provide lactation clinics. In addition, based on previous research in Pedurungan, Semarang City, most of the women (83,3%) who work do not practice exclusive breastfeeding (EBF), one reason being the lack of lactation clinics in companies.
Aims: This study examines the implementation of lactation clinic policies in companies in Semarang City.
Methods: This study used a qualitative method with a descriptive approach. The research variables included effectiveness, consistency, relevance, organizational structure, resources, sociocultural environment, economic environment, organizational culture, geographic environment, knowledge and skills, communication, and political support. Informants were selected based on purposive criteria, involving eight key informants and 18 supporting informants from eight companies in Semarang City.
Results: Lactation clinic policies were ineffective because companies were unaware of their contents and perceived them as recommendations only. On the contrary, working mothers who breastfed recognized the benefits of the policies and considered them relevant. Three out of eight companies provided lactation clinics. The people in charge had yet to be appointed due to the different capacities of the companies. Due to a lack of support from the sociocultural environment, working mothers needed more awareness of the importance of breastfeeding. However, the companies' economic and geographic environments and organizational culture were relatively favorable. Meanwhile, adequate dissemination could have helped communication. In addition, most companies do not provide lactation clinics or recommend formula milk.
Conclusion: The current policies have not adequately supported the provision of lactation clinics in companies in Semarang City. To address this issue, lactation clinics should be classified according to the companies' capacities. It is also necessary to develop a leading sector that is transparent and responsible for supervising the provision of lactation clinics.
Keywords: exclusive breastfeeding in workplace, lactation clinic, policy implementation
Introduction
The average proportion of female employees in Indonesia between 2020 and 2022 was projected at 35.47% out of 71,570,465 women of childbearing age.(Indonesia, 2022). Women of childbearing age may experience pregnancy, childbirth, postpartum, and breastfeeding during employment. One factor that influences the lack of exclusive breastfeeding (EBF) is the type of maternal employment(Rahmawati, 2014).
Mothers employed at companies or other industries often have limited breaks and demanding schedules, which can significantly impact their ability and motivation to breastfeed exclusively due to fatigue. Despite the implementation of workplace policies regarding breastfeeding practices, these challenges persist(Faradila, 2021). Companies can provide lactation clinics to increase the productivity of female employees. Breastfeeding can strengthen children’s immune systems, reducing the likelihood of illness. Meanwhile, formula milk can be expensive and affect the well-being of working mothers.
The Government of Indonesia has implemented regulations to support exclusive breastfeeding and provide lactation clinics. These regulations are outlined in the Law of the Republic of Indonesia Number 33 of 2012 on Exclusive Breastfeeding and the Regulation of the Ministry of Health Number 15 of 2013 on the Procedures for Providing Special Breastfeeding Facilities and Expressing Milk. These regulations require all workplaces and public spaces to provide lactation clinics that meet established standards. These facilities should enable working mothers to breastfeed and express milk during working hours.
Semarang City has also implemented regulations to support exclusive breastfeeding and provide lactation clinics at workplaces, such as the Regional Regulation Number 2 of 2015 on Maternal and Child Safety and the Regulation of the Mayor of Semarang City Number 7 of 2013 on Increasing the Provision of Breast Milk.
A study conducted in Semarang City showed that most working mothers did not practice exclusive breastfeeding. The study also found that the employment status of mothers was associated with exclusive breastfeeding(Dahlan et al., 2013).
According to the government website of Semarang City, the number of companies in Semarang City increased from 4,072 in 2021 to 4,083 in 2022. However, only 20% of the 529 registered companies in the Labor Office of Semarang City provide lactation clinics. According to a preliminary qualitative study, the Health Office of Semarang City lacks standard operating procedures (SOPs) for providing lactation clinics despite the Regulation of the Mayor of Semarang City Number 7 of 2013. In addition, the coordination between the Health Office and the Labor Office of Semarang City has not been established.
Furthermore, there are no clear technical guidelines for providing lactation clinics, and no verbal or written administrative sanctions are imposed on companies that fail to provide them as stipulated in the Regulation of the Mayor of Semarang City Number 7 of 2013.
Based on interviews with three working mothers who breastfed from different companies, only one of the three mothers had access to a lactation clinic at her workplace. However, the condition of the lactation clinic did not meet her needs as the door could not be locked, there were no sink, tables, or chairs, and other employees often used the lactation clinic to rest and sleep. The two remaining mothers expressed breast milk in a prayer room or an unoccupied room separated by a cupboard. None of the three companies provided counseling on breastfeeding or expressing breast milk.
Based on the background above, this study aims to examine the implementation of the lactation clinic policies to meet the needs of working mothers who breastfed in companies in Semarang City.
Methods
This study used a qualitative method with a descriptive approach through indepth interviews. It was conducted in Semarang City between July and December 2023. Eight companies were included, with criteria for large and small companies in the mountain and coastal areas that have and don’t have lactation clinics.
These companies were selected based on the number of workers and accessibility based on geographic condition consideration. Informants were selected based on purposive criteria with consideration of being directly or indirectly involved and knowing information about providing lactation clinics in Semarang City companies.
The eight main informants handled the implementation of the policy of providing lactation clinics in each company, which consists of the person responsible for managing the lactation clinic or HRD (Human Resource Development) in the company. Meanwhile, the triangulation informants were 18 with criteria of company leaders and working mothers who breastfed in the eight companies, the Health Office of Semarang City, and the Labor Office of Semarang City.
Weimer and Vinning’s theory on policy implementation was used to analyze the data, which analyzed policy effectiveness, consistency, relevancy, the organizational structure of companies and institutions, resources of companies and institutions, the social environment of companies, the organizational culture of companies, and communication and political support from companies' perspectives.
Result and Discussion
Policy Implementation
Semarang City has implemented policies regarding the provision of lactation clinics. These policies are outlined in the Regulation of the Ministry of Health Number 15 of 2013 on the Procedures for Providing Special Breastfeeding Facilities and Expressing Breast Milk and the Regulation of the Mayor of Semarang City Number 7 of 2013 on Increasing the Provision of Exclusive Breast Milk.
These policies support the exclusive breastfeeding program, which ensures that newborns have the right to receive breast milk and that mothers have the obligation to breastfeed. However, many large and small companies have not yet fully implemented these policies due to a lack of awareness of the policies regarding
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