Mothers' Decisions to Exclusively Breastfeed in Indonesia: The Implication of Socio-Economic and Mental Illness Factors

Background: In Indonesia, nearly half of all children aged < 6 months were not exclusively breastfed in 2017. This study aimed to estimate the cost of providing exclusive breastfeeding compared to partial exclusive breastfeeding and use of formula milk. This study also assessed the maternal socio-economic and mental health factors to providing exclusive breastfeeding. Methods: Data were collected in 2018 via a cross-sectional survey of 456 mothers in Bandung City and Purwakarta District who had children aged < 6 months. We used micro-costing to calculate the cost of productivity, equipment, supplies, and training for mothers when providing exclusive breastfeeding, partial exclusive breastfeeding, and formula milk. Logistic regression was used to determine the impact of several independent variables, including the mother's level of depression, on exclusive breastfeeding. Results: To breastfeed exclusively, a family needs to spend $ 116,95, which is less expensive than partial breastfeeding ($ 487,18) and providing only formula milk ($ 531,97). We also found that age, time spent on breastfeeding, and marital status positively influence the decision to breastfeed. On the other hand, working status, the number of children, and the total cost of the child’s nutrients negatively impact the decision. Finally, severe maternal depression symptoms were significantly negatively associated with the decision to exclusively breastfeed. Conclusion: The total cost of providing only formula milk is 3-times higher than the cost of exclusively breastfeeding, even after including the cost of providing breastfeeding time. The total cost and presence of severe depression symptoms are related to the mother’s decision to not exclusively breastfeed. This study found that exclusive breastfeeding is economically preferable to other methods and supports policies to reduce the time cost of exclusive breastfeeding and address the importance of the mother's mental health to ensure successful breastfeeding.