Maternal Health Literacy Towards the Readiness of Exlusive Breastfeeding
Sri Mulyani
D4 Midwife Lecturer Medical Faculty UNS
*Email: yaniartha@yahoo.com
Abstract
Maternal health literacy can be defined as a cognitive and social abilities that can affect to the health of the mother. The low assembling of exclusive breastfeeding is caused by the lack of preparation in exclusive breastfeeding. The purpose of this study is to know the effect of maternal health literacy toward the readiness of mothers breastfeeding exclusively.This study was conducted on 150 pregnant women with their very first pregnancy by using cross sectional design with cluster random sampling. Enclosed questionnaires were used to measure the respondents literacy about health and the readiness of mothers in exclusive breastfeeding. Data were analyzed by using multiple linear regression model. Statistical testing is performed with a 5% significance level. All of the four indicators of maternal health literacy (knowledge about reproduction health, ability to access health information and analize health problems, and ability to seek health supports) revealed that health literacy is a positive factor for the mothers‘ readiness in exclusive breastfeeding. From all of these indicators, knowledge about reproductive health is the most contributed factor. Based on these results we conclude that health literacy is a positive factor for the readiness of mothers breastfeeding exclusively, the higher the mother's health literacy score the higher the readiness of mothers in exclusive breastfeeding.
Keywords : exlusive breastfeeding, health literacy, readiness Introduction
United Nations Children's Fund (UNICEF) estimates that exclusive breastfeeding till six months could prevent the deaths of 1.3 million children under five year. While based on the WHO in six developing countries, the risk of death of infants aged 9-12 months increased by 40% if the baby is not breastfed, and for infants under two months, the death rate is increased to 48% . According Soetjiningsih, the process of establishing breastfeeding include prolactin reflex, and let down reflex in order to get the quality and quantity of milk the mother needs optimal preparation before feeding the baby.
The failure mothers in breastfeeding exclusively caused by disruption of the process of formation of the milk, so milk production is less or even stopped, it could have been prevented if the mother prepare early. During pregnancy is a good time to make preparations in exclusive breastfeeding and therefore the role of the mother, in this case the pregnant women is very important (Renkert, 2001). According to Lin-lin et all, (2007) the low of maternal health literacy will cause various complications either during pregnancy, childbirth and infant care as the occurrence of anemia, hypertension, bleeding, low birth weight babies and a failure to provide exclusive breastfeeding.
Literacy is the ability to read and count. Literacy is not only the ability to read and count, but also about the social, cultural, community empowerment and community development (Kickbusch, 2001). In the sphere of health care literacy refers to the ability to read, understand and act on
118 In health literacy includes knowledge about health, nutrition, disease prevention, decision, action, have a first-aid skills and the ability to obtain information (Jorm, 2000). Obstetrics health literacy and gynecology is a skill to recognize, make decisions and anticipate problems during pregnancy (Kohan et all, 2007). Labor and after labor, in addition the skills that mentioned above, the ability to detect risk factors and taking steps to lifestyle healthier and better nutrition during pregnancy and childbirth is very necessary (Kohan et all, 2007).
The factors that affect in maternal health literacy include: education, the inability to read, understand, make decisions and problems identify during pregnancy, childbirth and take care the baby. The corelation between health literacy and health result, found that people who have low health literacy have a number of hospitalization 29% to 52% higher (Baker et all, 2002., Sudore, 2007).
Several studies have shown the importance of health literacy during pregnancy and after birth, such as Kohan research that examines the influence of health literacy of the mother to prenatal care and pregnancy state that mothers who have adequate health literacy have significant differences in starting early and antenatal care frequency, birth weight, maternal hematocrit, consumption of iron tablets and folic acid, weight gain during pregnancy, gestational age at birth, method of labor and breastfeeding (Kohan et all, 2007). The same thing also delivered by Ohnishi, Kakamura and Takano found that mothers who have a good maternal health literacy , will be less to give birth with low birth weight, premature infants, infant mortality and and failure in exclusive breastfeeding compared with the group with low maternal health literacy. Lin-Lin, in their study examined whether prenatal breastfeeding education course or postpartum lactation support increasing rates of exclusive breastfeeding compared with routine care at the hospital. They found that women who received antenatal education are more likely to give exclusive breastfeeding up to six months after labor. A study conducted by Endres et al, to literacy and readiness of pregnancy in people with diabetes conclude that low prenatal maternal health literacy with pre-pregnancy diabetes is associated with several factors that could adversely affect to labor result
Some of the literature above express problems about the impact of the low maternal health literacy, therefore the problem of this research was to determine whether maternal health literacy affect the readiness of mothers in exclusive breastfeeding during pregnancy.
Method
Respondents in this study were 150 first child pregnant women, with cross sectional study design.
The sampling technique used in this study is a cluster random sampling. Enclosed questionnaire was used to measure the respondents about health literacy and readiness of mothers in exclusive breastfeeding. Maternal health literacy was measured by four indicators of reproductive health knowledge, the ability to access information, the ability to analyze her health problems, and the decision to found the aid of her health. Readiness exclusive breastfeeding mother is measured by maternal health, maternal psychological, physical (breast), nutrition and health of the baby. Data were analyzed by using multiple linear regression model. Data processing was performed using SPSS for Windows version 13. Statistical testing is performed with a significance level of 5%.
Result and discussion
Demographic characteristics showed that most respondents are at the beginning of childbearing age is 21-25 years (64.0%). The level of education of most respondents (52.7%) were secondary (senior high school graduate). In addition, a lot of respondents who have been educated up to university level (28.7%). Most respondents (68.0%) were just married less than 2 years.
Description of the characteristics of the respondent can be seen in Table 1.
Table 1. respondents characteristic description
Charateristic F %
Age
16 – 20 th 11 7,3
21 – 25 th 96 64,0
26 – 30 th 38 25,3
31 – 35 th 3 2,0
36 – 40 th 2 1,3
Background study
SD 2 1,3
SMP 26 17,3
SMA 79 52,7
PT 43 28,7
The age of mariage
< 2 th 102 68,0
2 – 5 th 44 29,3
> 5 th 4 2,7
Multiple linear regression model is composed of the readiness of mothers in exclusive breastfeeding as the dependent variable and four indicators of health literacy as the independent variables.
Testing the feasibility of some assumptions underlying the multiple linear regression model gives the following results:
1. Residual otherwise normal distribution. It is characterized by a pattern on a plot of residual normality (p-p normal regression plot of the standardized residuals) which indicates that the dots tend to follow a straight line diagonally.
2. The model does not have symptoms heteroskedastisitas indicated. This is shown by a pattern of dots spread randomly above and below a value of 0 to the y axis on a scatter plot between the predicted value and the standardized regression studentized regression residuals.
3. There is no multicollinearity between independent variables. This is indicated by VIF
<10 or tolerance> 0.1 on all independent variables.
4. No autocorrelation or serial correlation that they showed the scramble sequence data. It is based on a statistical value durbin-watson approaching 2.
Tabel 2. Estimation and Test Statistics Multiple Linear Regression Model
Model Koefisien
B P Collinearity Statistics
VIF Tolerance
Contanst 36,028 < 0,001
Reproduction health ability
The ability to access information
The ability to analyzied health problem
The ability of health seeking
1,511 0,297 0,001 1,175 0,851
0,893 0,059 0,488 1,159 0,863
-0,153 -0,015 0,850 1,064 0,940
1,436 0,086 0,282 1,030 0,971
Explanation: Durbin-Watson = 2,005; Adjusted R Square = 0,085; F = 4,455; p = 0,002.
120 From the four indicators, three of them have a positive regression coefficient. The ability to analyze health problems is an indicator with a negative regression coefficient but relatively small (smallest than other indicators) and statistically doesn‘t the most significant (p
= 0.850). This is based on the contribution of another three indicators has become decisive. The regression coefficient is positive, indicating that health literacy is a positive factor for the readiness of mothers in exclusive breastfeeding. The more high health literacy scores or better knowledge about reproductive health, the more high the readiness score for the mother in exclusive breastfeeding. When analyzed partially, knowledge about reproductive health is the only indicator that has had a statistically significant corelation (p = 0.001) and the most closely related ( = 0.297) with the readiness of mothers in exclusive breastfeeding.
This research has provided empirical evidence that the mother's health literacy is a positive factor for the readiness of mothers in exclusive breastfeeding. Pregnant women with good health literacy will have an impact to prepare better for exclusive breastfeeding during pregnancy, by early preparing mother will be better prepared to breastfeed and get an optimal quality and quantity of breast milk, thus the mother will succeed in exclusive breastfeeding
Multiple linear regression model showed that from the four indicators of health literacy, only knowledge about reproductive health were significantly associated with maternal readiness in exclusive breastfeeding. This indicator also has the closest relation or otherwise has the largest contribution to the maternal readiness breastfeeding exclusively.
Conclusion
Based on the results of this study concluded that health literacy is a positive factor for the readiness in exclusive breastfeeding. Knowledge about reproductive health is an indicator that has the most contributed.
References
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