Exclusive Breastfeeding in the Community and the Socioeconomic Factors That Influence It

Abstract

Background: Exclusive breastfeeding protects infants, but its coverage varies widely across provinces in Indonesia, and this variation is often attributed to socioeconomic factors. Comprehensive tables on exclusive breastfeeding by province are not publicly available; therefore, this analysis focuses on the provinces with the highest and lowest rates. Objective: To describe the 2022 exclusive breastfeeding coverage in provinces with extreme rates and to assess its association with poverty and the Human Development Index (HDI). Methods: An ecological study involving 19 provinces (9 with the highest and 10 with the lowest rates) for the 2022 exclusive breastfeeding coverage among infants aged 0–5 months, based on data published by the Central Statistics Agency (BPS). The 2022 poverty rates and HDI were obtained from the 2022 Indonesia Health Profile. Groups were compared using the Mann–Whitney test, and associations were assessed using Spearman’s correlation, with 95% Fisher-z confidence intervals (CI), accompanied by a sensitivity analysis excluding West Papua. National figures for 2021–2023 are presented for comparison. Results: National figures were 71.58% (2021) and 72.04% (2022); the 2023 SKI reported 68.6% using a different methodology. The median exclusive breastfeeding rate was 77.0% in the highest-ranking province and 61.7% in the lowest-ranking province; the range was from 53.60% (Gorontalo) to 79.69% (West Nusa Tenggara). Poverty (median 11.44% vs. 7.84%; p = 0.307) and HDI (72.79 vs. 72.04; p = 0.713) did not differ significantly between the two groups. The correlation with poverty was ρ = 0.12 (95% CI −0.35 to 0.55) and with the HDI was ρ = 0.15 (95% CI −0.33 to 0.57). East Nusa Tenggara has a poverty rate of 20.23% but an exclusive breastfeeding rate of 78.56%, while the Riau Islands have a poverty rate of 6.03% and an HDI of 76.46 but an exclusive breastfeeding rate of 62.40%. Conclusion: Based on this limited data, provincial-level poverty and HDI do not explain the differences in exclusive breastfeeding coverage; other factors at the community and service levels need to be examined using individual-level data.