The social context of exclusive breastfeeding among mothers in Bulukumba, Indonesia: The role of the theory of planned behavior

Fairus P. Idris, Suchi A. Sharief, Dedy Atmajaya, Andi Asrina

Abstract

Exclusive breastfeeding is scientifically known to reduce child mortality; however, coverage remains low in Bulukumba Regency, which has the lowest rates in South Sulawesi Province, Indonesia. This study aimed to examine the influence of the Theory of Planned Behavior (TPB) on exclusive breastfeeding behavior among mothers in the region. A quantitative cross-sectional study was conducted with 161 mothers of infants aged 6–12 months. Data were collected using a validated and reliable questionnaire and analyzed using Structural Equation Modeling-Partial Least Squares (SEM-PLS). The findings indicate that maternal attitudes towards exclusive breastfeeding (β=0.619) and perceived control (β=0.338) had significantly positive effects on breastfeeding intention, whereas subjective norms were not significantly associated with breastfeeding intention (p=1.000). Furthermore, attitudes, subjective norms, perceived control, and intentions did not have a significant direct effect on exclusive breastfeeding behavior (p>0.05). The results highlight a gap between intention and actual breastfeeding practice, suggesting that strong intentions alone are insufficient to ensure exclusive breastfeeding. These findings underscore the importance of strengthening maternal attitudes and perceived control while addressing contextual and social barriers to behavior change.

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References

World Health Organization, Global nutrition targets 2025: breastfeeding policy brief, 2014; Available from: https://www.who.int/publications/i/item/WHO-NMH-NHD-14.7.

Word Health Organization, Exclusive breastfeeding for optimal growth, development and health of infants, 2023; Available from: https://www.who.int/tools/elena/interventions/exclusive-breastfeeding.

D.D. Walters, LTH Phan, R. Mathisen, The cost of not breastfeeding: Global results from a new tool, Health Policy Plan, vol. 34, no. 6, 2109; 407–417: 10.1093/ heapol /czz050.

World Health Organization, Breastfeeding, 2025; Available from: https://www.who.int/health-topics/breastfeeding#tab=tab_1.

World Health Organization, Infant and young child feeding, Geneva: World Health Organization; 2023, Available from: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding.

Ministry of Health of the Republic of Indonesia, Indonesia Health Profile 2020, Jakarta: Ministry of Health of the Republic of Indonesia 2020.

Ministry of Health of the Republic of Indonesia, Indonesia Health Profile 2021, Jakarta: Ministry of Health of the republic of Indonesia; 2021.

Ministry of Health of the Republic of Indonesia, Indonesia Health Profile 2022, Jakarta Ministry of Health of the republic of Indonesia, 2022.

Ministry of Health of the Republic of Indonesia, Indonesia health profile 2023, Jakarta: Ministry of Health of the Republic of Indonesia, 2023.

Statistics Indonesia (Badan Pusat Statistik), Maternal and Child Health Profile, Jakarta: Statistic Indonesia, 2024.

Government of the Republic of Indonesia, Presidential Decree No. 72 of 2021 on accelerating the reduction of stunting, Jakarta: Government of the Republic of Indonesia, 2021.

South Sulawesi Health Office, 2023 Performance Report, Makassar, 2023.

Rahmawati Rumalean, Andi Asrina, Fairus Prihatin Idris, Description of Breast Milk Provision in the Sub-district Community Bajeng, Gowa Regency, vol.2, no.3, 2021.

Fairus Prihatin Idris, Benefits of culture-based Community Participation Programs in increasing exclusive breastfeeding, Central Java: Pena Persada, vol. 1, Banyumas, 2020.

Sri Sarah, Damayanti Rita, Socio-cultural analysis of Exclusive breastfeeding, Tambusai Health Journal, Vol.5 No.02, 2024; 4483-4489: doi: https://doi.org/10.31004/jkt.v5i2.29448

C. Bicchieri, U. Das, S. Gant, R. Sander, Examining norms and social expectations surrounding exclusive breastfeeding: Evidence from Mali, World Dev, vol.153, 2022; doi: 10.1016/j.worlddev.2022.105824.

I. Ajzen, The theory of planned behavior, Organ Behav Hum Decis Process, vol. 50, no. 2, 1991; 179–21, doi: 10.1016/0749-5978(91)90020-T.

S. Marisa, C.Nony, A. Bratajaya, Mother's Intention to Provide Exclusive Breastfeeding Based on Theory of Planned Behavior, Faletehan Health Journal, vol. 11, no. 03, 2024; 338–344: doi: 10.33746/fhj.v11i03.449.

E. Sutisna Sulaeman, B. Murti, H. Setyawan, S. Rinawati, Application of Theory of Planned Behavior on Exclusive Breastfeeding Behavior: A Case Study of Theory of Planned Behavior Application on Exclusive Breastfeeding Behavior : A Case Study, Vol.10, N0.10, 2018; 10(10): 35-35: 10.5539/gjhs.v10n10p35

D. Rohmatussolichah, M. Triharini, NR Laili, The Effect of Brainstorming Method on Giving Exclusive Breastfeeding to Attitudes, Subjective Norms, Perceived Behavioral Control, and Breastfeeding Intention Among Pregnant Women, Pediomaternal Nursing Journal, vol. 6, no.1, 2020; 10-20: doi: 10.20473/pmnj.v6i1.14884.

PS Russell, DM Smith, MD Birtel, KH Hart, SE Golding, The role of emotions and injunctive norms in breastfeeding: a systematic review and meta- analysis, Health Psychol Rev. vol. 16, no. 2, 2022; 257–279: 10.1080/17437199.2021.1893783.

J. Charlesworth, T. McAlpine, A. Martin, J. Scott, B. Mullan, Development, psychometric assessment, and predictive validity of a breastfeeding subjective norms scale among an Australian prospective cohort of first time parents, Br J Health Psychol, vol. 28, no. 3, 2023; 690–704, doi: 10.1111/bjhp.12648.

C.G. Victora, R. Bahl, A. JD Barros, G. Fraca VA, S. Harton, J. Krasevec, S. Murch, M. Sankar Jeeva, N. Walker, N. Rollins C, Lancet Breastfeeding Series Group, Breastfeeding in the 21 Century: epidemiology, mechanisms, and lifelong effect, National Library of Medicine, 30;387, 2016,475-90, doi: 10.1016/S0140-6736(15)01024-7.

S. Okhovat, M. Janighorban, A. Kazemi, Impact of theory of planned behavior based intervention on breastfeeding patterns of the mothers with premature infants : a randomized trial, BMC Public Health, vol.24, no.1, 2024; doi: 10.1186/s12889-024-20059-x.

F. Yazdanpanah, M. Nasirzadeh, H. Ahmadinia, M. Abdolkarimi, Application of the Extended Theory of Planned Behavior to Predict Exclusive Breastfeeding Intention, In Pregnancy Nulliparous Women. A Cross-Sectional Study,Invest Education Enferm, vol. 40, no.2, 2022; doi: 10.17533/udea.iee.v40n2e04.

R. Huang, H. Han, L. Ding, Y. Zhou, Y. Hou, X. Yao, C. Cai, X. Li, J. Song, S. Zhang, H.Jiang, Using the theory of planned behavior model to predict factors influencing breastfeeding behavior among premature mothers at week 6 postpartum: the mediating effect of breastfeeding intention, Front Psychol, vol. 14, 2023; doi: 10.3389/fpsyg.2023.1228769.

F. Naja, A. Chatila, J. Ayoub, N.Abbas, A. Mahmoud, M. Abdulmalik, L. Nasreddine, “Prenatal breastfeeding knowledge , attitude and intention , and their associations with feeding practices during the first six months of life: a cohort study in Lebanon and Qatar, International Breastfeed J, vol.17, no.1, 2022; doi: 10.1186/s13006-022-00456-x.

S. Khairinisa, RR Darwita, DA Maharani,F. Setiawati, Application of the extended theory of planned behavior to predict dentist intention and behavior in providing caries preventive care for preschool children, BMC Oral Health, vol.23, no.1, 2023; doi: 10.1186/s12903-023-03694-5.

J. Xu , H. Liu, X. Liu, C. Gao, Extended theory of planned behavior to explain the influence mechanism of low-speed driving behavior,PLoS One, vol.18, no.10, 2023; doi: 10.1371/journal.pone.0287489.

Q. Rachmah, J. Astina, DR Atmaka , and L. Khairani, “The Effect of Educational Intervention Based on Theory of Planned Behavior Approach on Complementary Feeding : A Randomized Controlled Trial, International Journal of Pediatrics (United Kingdom), vol. 2023; doi: 10.1155/2023/1086919.

K. Hamilton, L. Daniels , K. M. White, N. Murray, and A. Walsh, Predicting mothers' decisions to introduce complementary feeding at 6 months, An investigation using an extended theory of planned behavior, Appetite, vol. 56, no.3, 2011; 674–681, doi: 10.1016/j.appet.2011.02.002.

SO Ajike, OO Ogunsanmi, AE Chinenye -Julius, JM Dangana, and AM Mustapha, Effect of a breastfeeding educational program on fathers' intention to support exclusive breastfeeding: A quasi-experimental study,Afr J Reprod Health, vol. 24, no.3, 2020; 59–68, doi: 10.29063/ajrh2020/v24i3.7.

Bandura Albert, Self_Efficacy_The_Exercis of Control, Standford University, 1925.

Bandura Albert, Social Cognitive Theory of Self-Regulation, Organizationa Behaviorand Human Decision Processes,1991; 248-287.

Hafifa Aulai, Hadi Cipto, “The Relationship Between Subjectie Norm and Self Efficacy with Learning Behavior Intentions of Student SMA X in Siak, Psychology Student Research Journal Vo.2 No.2, 2023.

S.M Amin, E.S Mahrous, I. Alrimawi, A.A. Elbialy, The effectiveness of an interactive digital- based educational program in improving breastfeeding knowledge , attitudes and self-efficacy among primiparous women in Egypt, Afr J Reprod Health, vol. 26, no. 11, 2022; 79–91: doi: 10.29063/ajrh2022/v26i11.8.

P. Shaky, M.K. Kunieda, M. Koyama, S.S.Rai, M. Miyaguchi, S. Dhakal, S. Sandy, B.F. Sunguya, M.Jimba, Effectiveness of community-based peer support for mothers to improve their breastfeeding practices : A systematic review and meta- analysis, PLoS One, vol. 12, no. 5, 2017; doi: 10.1371/journal.pone.0177434.

W. Wu , X. Wang, Risk factors and predictive modeling of exclusive breastfeeding failure in mothers separated from their infants, African Journal of Reproductive Health, vol. 29, no. 6, 2025; 29–39, doi: 10.29063/ajrh2025/v29i6.3.

A. Al -Jawaldeh, D. Matbouli, D. Itani, S. Diab, M. Taktouk, S. Naalbandian S, L.Nasreddine, Applying the theory of planned behavior to examine breastfeeding determinants in countries of the Gulf Cooperation Council : a systematic review, BioMed Central Ltd, 2025; doi: 10.1186/s13006-025-00739-z.

P. Sheeran, TL Webb, The Intention – Behavior Gap, Soc Personal Psychol Compass, vol. 10, no. 9, 2016; 503–518: doi: 10.1111/spc3.12265.

W. Budi Atmoko, F. Mahaestri Noor, A. Yulandari, "Bridging Intention-Behavior Gap On Green Products Consumption", Publikasiku Academic Solution, Study of Management, Economic and Business, Vol. 2(3), 2023; 251-259

Oktarianita, RD Wulandari, S. Supriyanto, Exploring the determinants of exclusive breastfeeding practices among first time Mothers : A narrative review, Women's Health and Action Research Centre 2024; doi: 10.29063/ajrh2024/v28i10s.28.

K. Feil, J. Fritsch, R. E. Rhodes, The intention-behaviour gap in physical activity: a systematic review and meta-analysis of the action control framework, British Journal of Sport Medicine, Volume 57, issue 19, https://doi.org/10.1136/bjsports-2022-106640.

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