Influence of Husbands’ Attitudes Versus Knowledge on Maternal Breastfeeding Self-Efficacy Following Caesarean Section

Self-efficacy predicts a mother’s decision to breastfeed, the level of effort invested in breastfeeding, and the responses to challenges faced during the process. This study aims to determine the relationship between a husband’s knowledge and attitude towards exclusive breastfeeding and the self-efficacy of mothers who have undergone cesarean sections. The design of this research is correlational with a cross-sectional framework. The sample consisted of 38 mothers post-cesarean section and their husbands, obtained through a Non-Probability Sampling technique using sequential sampling in the Al Aqsha 4th room of Haji Hospital, East Java Province. The analysis in this study employs Spearman’s rho. The instrument assessed husbands’ knowledge and attitudes regarding exclusive breastfeeding and the short form of breastfeeding self-efficacy (BSE-SF). The study results indicated that the knowledge level of most husbands fell into a suitable category, at 89.5%. Most husbands exhibited positive attitudes, at 65.8%. Meanwhile, the majority of post-cesarean section mothers recorded high levels of breastfeeding self-efficacy, at 78.9%. The results of the Spearman rho test regarding the knowledge and self-efficacy of breastfeeding mothers following cesarean sections yielded p=0.141 (>0.05). In contrast, the relationship between husbands’ attitudes and the self-efficacy of breastfeeding mothers post-cesarean section was p=0.022 (<0.05). While the knowledge and attitudes of husbands regarding exclusive breastfeeding are categorized mainly as good, their knowledge does not influence the self-efficacy of mothers breastfeeding after cesarean delivery.

INTRODUCTION

Exclusive breastfeeding for the first 6 months of a child’s life is part of implementing the gold standard Infant and Child Feeding (ICF) recommended by World Health Organization (WHO) and UNICEF. UNICEF estimates that breastfeeding exclusively for up to 6 months can prevent the deaths of 1.3 million children under the age of 5 years. However, still, less than half of the world’s population breastfeeds exclusively in their infants (0-5 months), with a global rate of 36%¹¹. UNICEF has set a target of 80% by 2025 for each country to carry out exclusive breastfeeding. Based on data from WHO, the average rate of exclusive breastfeeding worldwide in 2022 is only 44% of the 50% exclusive breastfeeding target²². According to Basic Health Research (RISKESDAS), in 2021, 52.5 percent – or only half of the 2.3 million babies under six months received exclusive breastfeeding in Indonesia, which decreased by 12 percent in 2019²². Only 67.96% of Indonesians were exclusively breastfeeding in 2022, compared to 69.7% in 2021. This indicates that more intensive support is needed to increase this coverage, achieving the national target set by the government, which is as much as 80%²².

In the meantime, in the province of East Java, 66.90% of infants under 6 months old in 2020, 69.61% in 2021, and 69.72% in 2022 experienced exclusive breastfeeding²². Indonesia’s exclusive breastfeeding coverage in 2022 was recorded at only 67.96%, down from 69.7% in 2021, indicating the need for more intensive support to increase, achieving the target set by the government nationally, which is as much as 80%². Meanwhile, in East Java, the percentage of babies under 6 months who receive exclusive breastfeeding is 66.90% in 2020, 69.61% in 2021, and 69.72% in 2022²².

External factors are the family factors, especially the husband. Misperception and inadequate support for breastfeeding are still challenges in many places³³. Internal factors, namely post-caesarean section mothers, are faced with challenges in the recovery of post-cesarean section surgery and its treatment, so they often have difficulty breastfeeding at the beginning of the postpartum period⁴⁴.

Problems surrounding exclusive breastfeeding are always essential to pay attention to. Breastfeeding difficulties, among others, arise in Post-Cephalan Section patients and significantly affect the self-efficacy of breastfeeding mothers. Therefore, it is essential for researchers interested in conducting a study on the relationship between a husband’s knowledge and attitude about exclusive breastfeeding and the self-efficacy of post-caesarian section mothers to survey this relationship.

MATERIALS AND METHODS

This study uses a correlational research design, which is a research design used to reveal the relationship between two or more variables and the strength of the correlation between variables through a correlation test and a cross-sectional research design. The technique used for sampling is Non-Probability Sampling with sequential sampling. Research at Haji Hospital of East Java Province in January-March 2024. This research has been declared ethically feasible by the ethics committee of The Hajj Hospital of East Java Province no. 445/025/KOM. ETIQUE /2024 on February 1, 2024..

Researchers collecting data use questionnaires that contain questions and statements that respondents will answer. The inclusion criteria in this study were post-cesarean section patients, husbands, and patients who were in the treatment room and could read and write. The exclusion criteria were patients who had contraindications to breastfeeding (based on the decision of the pediatrician in the room) or the baby died, patients and/or husbands who left the research location during the research process, and patients whose husbands did not accompany them during the treatment period. The questionnaire consists of a demographic characteristics questionnaire, a husband’s knowledge questionnaire related to exclusive breastfeeding, a husband’s attitude questionnaire related to exclusive breastfeeding, and a breastfeeding self-efficacy questionnaire.

This study’s data analysis was done in univariate and bivariate stages. Univariate analysis is used to obtain a picture of the frequency distribution of each variable studied. Bivariate analysis aims to test the relationship between independent variables and dependent variables. In this study, the scale of knowledge, attitude, and self-efficacy data on breastfeeding are ordinal data. Each variable is then correlated/connected using the Spearman Rho correlation test with a significance level of 0.05.

RESULTS

Respondents in this study were post-cesarean section mothers and their husbands who were in the inpatient room of Al-Aqsha 4, Haji Hospital, East Java Province, Surabaya, Indonesia. Table 1 below shows the characteristics of the respondents in this study.

Table 1.Respondent Characteristics

Characteristics	Category	Frequency (f)	Percentage (%)
Mother’s age	20-35 years	30	78.9
	>35 years	8	21.1
Mother’s education	Lower Education (Elementary, Junior)	14	36.9
	High Education (Senior, University)	24	63.1
Mother’s job	Housewife (IRT)	24	63.2
	Private employee	10	26.3
	Self-Employee	4	10.5
Father’s age	20-35 years	27	71.7
	>35 years	11	28.9
Father’s education	Lower Education (Elementary, Junior)	11	28.9
	High Education (Senior, University)	27	71.1
Father’s job	Civil Servants	2	5.3
	Private employee	23	60.5
	Self-employee	13	34.2
Family Income	< Rp. 1.400.000	7	18.4
	Rp. 1.400.000 – Rp 3.000.000	16	42.1
	> Rp 3.000.000	15	39.5

There were 38 married couples in the study’s sample. According to the demographic data of the study’s respondents, women of healthy reproductive age (20–35 years old) made up the majority (78.9%), with women of at-risk reproductive age (over 35 years old) making up the remaining minor percentage. Among those who fall