LOW EXCLUSIVE BREAST MILK IN BABIES AGED 0-6 MONTHS

Knowledge and culture have an important role in increasing the coverage of exclusive breastfeeding for infants aged 0-6 months. Based on the results of the survey directly obtained in the field, the coverage of exclusive breastfeeding for infants aged 0-6 months is low. The purpose of this study was to examine the low coverage of exclusive breastfeeding in the working area of the Meutulang Health Center, Panton Reu District, West Aceh Regency. The research method used is a qualitative method with an exploratory descriptive approach, namely conducting in-depth interviews, which aims to explore the reasons why mothers do not exclusively breastfeed their babies until the age of 6 months. The results showed that the knowledge of breastfeeding mothers was still lacking regarding understanding in exclusive breastfeeding, the attitude of breastfeeding mothers was still not sure about giving only breast milk. culture is very closely related to exclusive breastfeeding, where mothers hold on to ancestral cultures that are passed down from generation to generation such as the peucicap culture and the provision of complementary feeding is given to infants before the age of 6 months, which should only be given breast milk. The conclusion is that exclusive breastfeeding in the working area of the Meutulang Public Health Center is still low, as evidenced by the results of research that has been carried out where knowledge and culture have a strong influence which is then followed by the attitude and work of the mother. Suggestions are expected for health centers and related agencies to more often conduct counseling, outreach and education to the community, especially mothers about the importance of exclusive breastfeeding aged 0-6 months.


INTRODUCTION
Mother's Milk is the first liquid food that is produced naturally by the mother's breast which contains various nutrients that are naturally formulated in the mother's body, which is useful for growth and development in addition to providing complete nutrition for a child as well as providing protection to the baby from infection and illness.Marniati, et al 2022).Breast milk is an emulsion of fat in a solution of protein, lactose and inorganic salts secreted by the mother's mammary glands, which is useful as food for her baby.Breast milk in sufficient quantities is the best food for infants and can meet the needs of infants up to the first 6 months (WHO, 2020).
According to WHO, it is recommended that all infants need to be exclusively breastfed in order to overcome nutritional problems in infants and prevent infectious diseases in infants.Mothers who exclusively breastfeed will get guaranteed nutritional adequacy of the baby so that the baby does not experience nutritional problems such as stunting, babies with low birth weight, and other malnutrition problems as well as increasing the baby's immune system to infectious diseases.Exclusive breastfeeding can be felt in the long term, namely improving the quality of the next generation because breastfeeding can increase children's intellectual and emotional intelligence (do Nascimento, et al, 2010).
Exclusive breastfeeding plays an important role in saving children in developing countries, especially Indonesia, where breastfeeding acts as the first step in reducing the infant mortality rate (IMR) which is still relatively high and nutritional problems in infants can be handled from the start with breastfeeding.According to a UNICEF study, the risk of infant mortality (IMR) can be reduced by 22% with exclusive breastfeeding and breastfeeding for 2 years and neonatal mortality can be reduced by 55% -87% if each baby performs IMD (Early Initiation of Breastfeeding) and exclusive breastfeeding.
In 2020 WHO again presented data in the form of exclusive breastfeeding rates globally, although there has been an increase, this figure did not increase significantly, namely around 44% of infants aged 0-6 months worldwide who received exclusive breastfeeding during the 2015-2020 period. of the 50% target of exclusive breastfeeding according to WHO.
The low level of exclusive breastfeeding will have an impact on the quality and lifestyle of the next generation.Globally in 2019, 144 million children under five are estimated to be stunted, 47 million are estimated to be underweight and 38.3 million are overweight or obese (WHO, 2020).
In Indonesia, based on Riskesdas data, the coverage of exclusive breastfeeding nationally in 2018 decreased significantly from the previous year, which was 37.3%.In 2019 there was an increase of 67.74% (Kemenkes RI, 2020).Exclusive breastfeeding in 2020 decreased again by 66.06%, although it decreased from the previous year of 1.68%, the figure was not in accordance with the target set by the Ministry of Health of the Republic of Indonesia, which was 80% so that the achievement of exclusive breastfeeding coverage at the national level was still low.and have not met the target set.The achievement of exclusive breastfeeding coverage that is far from the target is a sign that exclusive breastfeeding by mothers to their babies is still very low and needs to be increased (Kemenkes RI, 2021).
Aceh Province, according to the Aceh Provincial Health Office, the coverage of exclusive breastfeeding in 2019 was 55%, in 2020 this figure has increased by 59%.According to data from the Research and Development Agency of the Ministry of Health of the Republic of Indonesia, exclusive breastfeeding in Aceh Province will decline in 2021, which is 41.0%.The data shows that the coverage of breastfeeding in Aceh Province is still very low and has not reached the target set by the Indonesian Ministry of Health, which is 80%.(Aceh Health Profile, 2020).West Aceh in 2019 exclusive US coverage only reached 65%, while in 2020 it decreased to 44% (West Aceh District Health Profile, 2021).From these data, including the Meutulang Health Center, in 2019 the coverage of exclusive breastfeeding was 0%.In 2020 the number of exclusive breastfeeding coverage is 13.4%.Meanwhile, in 2021 the coverage of exclusive breastfeeding is the same in 2020, which is 13.4%.Exclusive breastfeeding coverage, although it has increased in 2019 and 2020, is still far from the target set by the Indonesian Ministry of Health, which is 80%, so that more extra and focused handlers are needed in dealing with exclusive breastfeeding (Meutulang Health Center Data, 2021).
Based on the results of a preliminary survey interviewed by 5 mothers of babies aged 6-11 months, 1 of these mothers gave exclusive breastfeeding, while the other 4 mothers found that mothers did not give exclusive breastfeeding because they did not know about exclusive breastfeeding, while other mothers said they did not give exclusive breastfeeding.breast milk only.Other mothers also do not give exclusive breastfeeding because mothers find it difficult to divide their time at work, and one mother said that she has been giving food for generations as long as the baby does not cry.
According to research (Susin, L. R, et al, 2020) although increasing mother's knowledge about breastfeeding can increase the frequency and duration of breastfeeding, little is known about the effect of knowledge, the purpose of this study was to examine mother's and father's knowledge about breastfeeding before and after receiving postpartum counseling and its relationship with the frequency of breastfeeding.
Research (Haghighi, et al, 2016) says that attitudes have a relationship with exclusive breastfeeding, although mothers' attitudes about exclusive breastfeeding are good, mother's knowledge about breastfeeding is still low.In line with research (Yulidasari, et al, 2017) the average 3 months maternity leave is very short and now many mothers are working, so mothers stop breastfeeding for work reasons and feel unable to exclusively breastfeed due to limited time and busyness.Research (Hvatum et al, 2017) also says that cultural beliefs and practices contribute to what women consider normal feeding practices, for example in Ireland many mothers view formula feeding as the normal way to feed babies.
Based on the background and the initial survey that the researchers conducted directly in the field, it is necessary to conduct research on "The low level of exclusive breastfeeding for infants aged 0-6 months in the Meutulang Health Center Work Area, Panton Reu District, West Aceh Regency in 2022".

IMPLEMENTATION METHOD
The method used in this research is a qualitative method with an exploratory descriptive approach, conducting in-depth interviews, which aims to explore the reasons why mothers do not exclusively breastfeed their babies until the age of 6 months.According to Moleong in (Wijaya, 2020) states that qualitative research is research that intends to understand the phenomenon of what is experienced by the research subject (for example behavior, perception, etc.) holistically, and with in-depth interviews in the form of words and language.in a specific natural context and by utilizing various natural methods.

Knowledge
Knowledge is a highly valued state in which a person is in cognitive contact with reality in relation to something else.On the one hand the relationship is a conscious subject, and on the other hand it is a part of reality that is known to be related directly or indirectly.While directness is a matter of degree, it is easier to think of knowledge of things as a direct form of knowledge as opposed to knowledge of things that is indirect.
The results showed that the knowledge of breastfeeding mothers was still lacking because they thought that babies who were given complementary feeding would grow rapidly, the exclusive breastfeeding activity program had been going quite well by conducting counseling and mother classes and providing counseling to pregnant women in at the end of the 7,8,9 month, but the awareness and knowledge of breastfeeding mothers is very low due to the definition of not being allowed to give additional food other than breast milk and sometimes giving people additional food such as rice porridge, banana and formula milk, as well as obstacles.which causes mothers not to give exclusive breastfeeding because people are difficult to direct and do not understand exclusive breastfeeding and the benefits of colostrum.
Based on the observations of researchers, there is still a lack of knowledge of breastfeeding mothers on exclusive breastfeeding for 0-6 months, namely mothers think that if their babies are breastfed it can be said to be good, although not exclusively, where mothers only give breast milk for 6 months without giving their babies food and drinks other than breast milk.Likewise, mothers who have good knowledge but do not exclusively breastfeed, this happens because mothers trust the recommendations or personal experiences of others in raising their children and the culture that develops in their environment so that the practice of exclusive breastfeeding fails even though the Multidiciplinary Output Research For Actual and International Issue |MORFAI JOURNAL E-ISSN: 2808-6635 | https://radjapublika.com/index.php/MORFAImother has good knowledge.Good knowledge of mothers plays an important role in influencing the behavior of mothers to exclusively breastfeed their babies for 0-6 months.Mother's knowledge about exclusive breastfeeding will be the basis for mothers to know and understand the correct behavior in exclusive breastfeeding so that they will realize good behavior according to their knowledge.Mother's good knowledge is also supported by mother's access to available information and support from the environment around her.
According to Notoatmodjo (2010) knowledge is a result possessed by a person thanks to the search process and curiosity after a person has sensed a certain object, namely the senses of sight, hearing, smell, taste and touch.In providing exclusive breastfeeding, knowledge plays an important role in the mother's behavior because through knowledge it will achieve a deep understanding of the mother about the pros and cons of exclusive breastfeeding so that this understanding will affect the mother and become the basis for mothers to exclusively breastfeed their babies.
The results of this study are supported by research (Marniati, M. (2016, December) where the knowledge of mothers about exclusive breastfeeding is very minimal or these mothers do not know about exclusive breastfeeding according to the results in the field that the researchers did.This research is also supported by research (Triatmi Andari Yanuarini et al, 2014) shows that mothers who have poor knowledge are an obstacle in exclusive breastfeeding and most of them do not exclusively breastfeed until the baby is 6 months old.

Attitude
Human attitudes are the main predictors of everyday behavior (actions), although there are other factors, such as one's environment and beliefs.This means that sometimes attitudes can determine a person's actions, but sometimes attitudes do not manifest into actions.Consideration of all the positive and negative impacts of an action helps determine whether a person's attitude becomes a real action.
According to the results of the study, the attitude of breastfeeding mothers was less supportive of exclusive breastfeeding due to environmental factors, but the efforts made by health workers and methods to increase the target of exclusive breastfeeding at the Metulang Community Health Center were maximal enough to provide socialization and motivation.Obstacles in implementing the exclusive breastfeeding program are due to lack of support from husbands and do not allow their children to be exclusively breastfed, so mothers provide additional food such as bananas, porridge, formula milk and others.Children grow up quickly, breastfeeding mothers prefer formula milk products in Overcoming the inability of breastfeeding and not trying to find ways to make breastfeeding smooth for the baby's needs and working mothers have the attitude that breastfeeding alone makes the child less fussy and practical.
Based on the observations of the researchers, the attitude of breastfeeding mothers is very less supportive of exclusive breastfeeding, the mother's attitude in breastfeeding is influenced by other factors, namely the trust held by the mother so that the mother can act according to what she believes, the mother's personal experience, and encouragement from those closest to the mother.The failure of exclusive breastfeeding where mothers in the field behave according to what they believe and see as giving MP-ASI before 6 months is not a big thing because they have also given it to their previous children, or see their relatives who do not show any problems the baby and the participation of parents in providing advice and direction to the mother, so that the mother is confident that the breastfeeding practice she has done is correct.
According to the theory, the mother's positive attitude towards exclusive breastfeeding is not always followed by the mother's implementation of exclusive breastfeeding.Attitude does not necessarily manifest in an action.The realization of attitudes to become real actions requires support from certain parties such as health workers, family, culture and personal experience (Notoatmodjo, 2012).
The results of this study are supported by research (M.I Hanafi et al, 2021) that attitudes affect exclusive breastfeeding where negative attitudes about exclusive breastfeeding are thought to be related to the condition of knowledge that is still low.The results of this study are supported by research (ankaya, S., & Ataş, A. (2022).)that attitudes have an influence on exclusive breastfeeding where attitudes and beliefs that are not fundamental to the meaning of breastfeeding make mothers not do exclusive breastfeeding for 6 months

Work
Work is an activity that a person must do, especially to support his life and family life.The entry of women into the world of work has more or less affected the role of mothers in child care.People's perceptions are influenced by one's view of a situation, fact, or action.In the context of the perception of working mothers, the response to exclusive breastfeeding can be in the form of giving or not giving exclusive breastfeeding to their babies.
According to the researcher that work has a relationship with exclusive breastfeeding, the average mother breastfeeding a housewife if a career woman is not up to 30%.For breastfeeding mothers who work are also always given counseling and information about exclusive breastfeeding by pumping breast milk.However, there are still nursing mothers who do not give exclusive breastfeeding because they are busy at work and they give formula milk as a substitute for breast milk.
Observations of researchers in the field regarding work greatly affect breastfeeding mothers not to give exclusive breastfeeding to their babies.Because most mothers work, they take less time to care for their babies, which allows mothers not to exclusively breastfeed their babies.Actually, if working mothers can still provide exclusive breastfeeding to their babies by pumping or expressing breast milk, then it is stored and given to their children later, but they think that pumping breast milk is very troublesome and time consuming.Working mothers also give breast milk and other food and liquids to their babies, including formula milk.The reason is that if babies are given formula milk at work, it makes mothers not bothered at work and they also feel they don't have time to always give exclusive breastfeeding to their children.There are also various factors that can cause mothers not to give exclusive breastfeeding even though the mother does not have a job outside the home, namely the first factor is education, knowledge and culture, the higher a person's education, the easier it is to receive information so that the more knowledge he has.
For mothers who are actively working, efforts to exclusively breastfeed often experience obstacles because the short period of maternity and maternity leave means that before the exclusive breastfeeding period ends they have to return to work, this is what makes babies not exclusively breastfed, and many working mothers assume that The breast milk is not sufficient for the baby's needs when the mother is working so mothers provide additional breast milk in the form of formula milk (Azzisya, 2010in (Fitriyani, et al, 2017) (Tutuk sulistiyowati et al., 2014) that work affects the achievement of exclusive breastfeeding, working mothers show low ability in exclusive breastfeeding.

Culture
Community culture is formed through a long history, winding journey, step by step, trial and error.At certain points there are relics that exist or are suppressed until now which later become cultural heritage.Cultural heritage, can be defined as 'products or results of physical culture from different traditions and spiritual achievements in the form of values from the past which are the main elements in the identity of a group or nation'.So cultural heritage is the result of physical culture (tangible) and cultural values (intangible) from the past Based on interviews conducted by researchers that the culture of breastfeeding mothers is closely related to exclusive breastfeeding, the culture of those who are the oldest person is still a role model in terms of consuming food during pregnancy and while breastfeeding.However, as medical personnel or midwives, they come down to provide counseling and even go to homes or home visits and many mothers provide complementary foods to their babies, but breastfeeding mothers think that if babies are given MP-ASI it makes children grow fast and provides food such as bananas.it has become a hereditary habit while waiting for breast milk to come out, which is only 2 months old because of the mother's ignorance of the benefits of exclusive breastfeeding.Mothers who have just given birth have more confidence in the habits of their family or parents that have been passed down from generation to generation rather than applying information from health workers.
Based on the observations of community cultural researchers in Panton Reu District, it can be said that they still hold fast to the beliefs circulating in the community, especially in exclusive breastfeeding.In this case the culture of breastfeeding is still attached and believed by the local community, including the culture that is still used by the community where if there is a newborn baby, it is better to taste the baby or in the local language called "Peucicap" which is given to the baby various kinds of food and the taste to be tasted by the baby with certain intentions and meanings that are believed by the local community with the aim of welcoming the newborn with certain hopes and prayers for the good of the baby so that in the future the baby will behave well and in accordance with the expectations of the mother and father.The failure of exclusive breastfeeding is also inseparable from the mother's habit where the mother assumes that the baby who is fussy and keeps crying is the baby's reaction to the breast milk given by the mother is not enough so that the mother confidently and confidently begins to give food and other drinks to the baby so that the baby cannot exclusively breastfeed.
Culture is normal behavior, habits, values and the use of resources in a society will produce a way of life which is generally called culture.This culture is formed in a long time as a result of the life of a community together.Culture is always changing, both slowly and quickly, according to human civilization.The culture or lifestyle of the people here is a combination of all that has been mentioned above (Notoatmodjo, 2010).
Culture is a factor related to the values and views of society that are born from existing habits, and ultimately encourages people to behave in accordance with cultural demands (Marniati, M. (2017, November).The results of this study are supported by research (Rhokliana, et al, 2011) that culture has a very close relationship in exclusive breastfeeding where they have more confidence in the habits of parents giving MP-ASI.
The results of this study are supported by research (Yulidasari et al, 2017) that culture influences exclusive breastfeeding where the habit of giving foods such as honey, coconut water, papah rice, bananas and giving formula milk and also trust in the community such as giving sweet liquids when a new baby born as a way of religion.

CONCLUSION
The conclusion from the results of the research that has been done is that breastfeeding mothers are still lacking knowledge about exclusive breastfeeding for 0-6 months, they assume that babies who are given MP-ASI before the age of 6 months grow big and fat fast.The attitude of breastfeeding mothers is very lacking and they think that giving MP-ASI before the age of 0-6 months makes children less fussy and hungry, and giving formula milk will be able to help mothers not to be bothered.Jobs have a relationship with exclusive breastfeeding where they give formula milk so they don't bother.Culture is very closely related to exclusive breastfeeding where the peucicap culture is considered very good to pray for their children with a specific purpose, and breastfeeding mothers also still give MP-ASI before the baby is 6 months old, which should only be given breast milk.