Exclusive breastfeeding and the acceptability of donor breast milk for sick, hospitalized infants in Kupang, Nusa Tenggara Timur, Indonesia: a mixed-methods study

Background: The eastern Indonesian province of Nusa Tenggara Timur (NTT) has an infant mortality rate of 45 per 1000, higher than the national average (28/1000). Exclusive breastfeeding, important for improving newborn and infant survival, is encouraged among hospitalized infants in Kupang, the provincial capital of NTT. However, barriers to hospitalized infants receiving breast milk may exist.

Objectives: This study explored the barriers and enablers to exclusive breastfeeding among sick and low birth weight hospitalized infants in Kupang, NTT. The attitudes and cultural beliefs of health workers and mothers regarding the use of donor breast milk (DBM) were also explored.

Methods: A mixed-methods study using a convergent parallel design was conducted. A convenience sample of 74 mothers of hospitalized infants and 8 hospital staff participated in semi-structured interviews. Facility observational data were also collected. Analysis was conducted using Davis’s barrier analysis method.

Results: Of the 73 questionnaires analyzed, we found that 39.7% of mothers retrospectively reported exclusively breastfeeding and 37% of mothers expressed breast milk. Expressing was associated with maternal reported exclusive breastfeeding χ² (1, N = 73) = 6.82, P = .009. Staff supported breastfeeding for sick infants, yet mothers could only access infants during set nursery visiting hours. No mothers used DBM, and most mothers and staff found the concept distasteful.

Conclusions: Increasing mothers’ opportunities for contact with infants is the first step to increasing exclusive breastfeeding rates among hospitalized infants in Kupang. This will facilitate mothers to express their breast milk, improve the acceptability of DBM, and enhance the feasibility of establishing a DBM bank.