Motivation and exclusive breastfeeding among mothers in employment

Background: Exclusive breastfeeding is breastfeeding without another additional food and drinks given to babies for six months. Exclusive breastfeeding can provide many benefits both for the mother and the baby. The Indonesian government is targeting coverage of exclusive breastfeeding for about 80%. However, based on the data taken from the Indonesian health profile in 2014, it shows that the coverage of exclusive breastfeeding only reached 52.3%. Some problems were encountered in the effort of giving exclusive breastfeeding, one of which is that many breastfeeding mothers have to go back to work. This factor is associated due to the lack of motivation for working mothers to exclusively breastfeed their infants. Objectives: This research aims to determine the relationship between motivation and the practice of exclusive breastfeeding mothers who work in companies in the Bantul Regency. Methods: This cross-sectional study recruited working mothers employed in medium and large companies in Bantul District, Daerah Istimewa Yogyakarta, Indonesia. The study participants were 158 working mothers whose children were aged 6-12 months, and they were selected using the probability proportional to size technique. The data were analyzed using descriptive statistics and chi-square tests. Results: the majority of mothers have good motivation in providing exclusive breastfeeding, precisely reaching 61.4%. The result of the chi-square test shows that p=0.011 with a significant value of p<0.05. Therefore, there is a relationship between motivation and the practice of exclusive breastfeeding given by mothers who work in companies of Bantul Regency. Indonesian Journal of Nutrition nd Dietetics Vol. 7, No. 1, 2019: 16-22 Av ilable online at: http://ejournal.almaata.ac.id/index.php/IJND DOI : http://dx.doi.org/10.21927/ijnd.2019.7(1).16-22 Motivation and exclusive breastfeeding among mothers in employment 17 impact they may have on the success of exclusive breastfeeding (7). Therefore, according to the background and the previous study, research to figure out the relations between motivation and the practice exclusive breastfeeding on working mothers who work in companies in Bantul Regency is conducted. MATERIALS AND METHODS The research isanalytic observational study with cross-sectional design. It is conducted at medium and large companies in Bantul Regency from October 2016 until February 2017. The subjects of this study are some working women with certain inclusion criteria: mothers who have 6-12 months old and still working actively in medium or large companies. Then, the exclusion criteria were mothers who did not attend the data collection process. The total sample in this research was 158 respondents taken by using a probability proportional to size (pps) technique.The data was collected through the questionnaire and interview. The independent variable is motivation, while the dependent variable is the practice of exclusive breastfeeding. The validity and reliability of the motivational questionnaire and breastfeeding were tested to 40 mothers who work in companies and have similar characteristics to the sample. Based on the reliability test, it was discovered that the value of alpha cronbach’s motivational questionnaire and exclusive breastfeeding is 0.856 and 0.734. With the total sample of 40 respondents, so i the r table 0.312 was achieved. According to these calculations, it can be seen that there was one invalid item (r< 0.312). In the next stage, invalid items were not involved. The data processing was conducted by using computer through several phases: editing, cleaning, coding, and tabulating. The chi-square test was used to figure out the relation between independent Conclusion: There is a relationship between motivation and the practice of exclusive breastfeeding given by mothers who work in companies located in Bantul Regency.

impact they may have on the success of exclusive breastfeeding (7).
Therefore, according to the background and the previous study, research to figure out the relations between motivation and the practice exclusive breastfeeding on working mothers who work in companies in Bantul Regency is conducted.

MATERIALS AND METHODS
The research isanalytic observational study with cross-sectional design. It is conducted at medium and large companies in Bantul Regency from October 2016 until February 2017. The subjects of this study are some working women with certain inclusion criteria: mothers who have 6-12 months old and still working actively in medium or large companies. Then, the exclusion criteria were mothers who did not attend the data collection process. The total sample in this research was 158 respondents taken by using a probability proportional to size (pps) technique.The data was collected through the questionnaire and interview. The independent variable is motivation, while the dependent variable is the practice of exclusive breastfeeding.
The validity and reliability of the motivational questionnaire and breastfeeding were tested to 40 mothers who work in companies and have similar characteristics to the sample. Based on the reliability test, it was discovered that the value of alpha cronbach's motivational questionnaire and exclusive breastfeeding is 0.856 and 0.734. With the total sample of 40 respondents, so i the r table 0.312 was achieved. According to these calculations, it can be seen that there was one invalid item (r< 0.312). In the next stage, invalid items were not involved.
The data processing was conducted by using computer through several phases: editing, cleaning, coding, and tabulating. The chi-square test was used to figure out the relation between independent

INTRODUCTION
Exclusive breastfeeding refers to items that is very important at the beginning of infants' life. The practice of exclusive breastfeeding means that babies are only being breastfed without additional liquid or solid food except for vitamins and minerals for six months. Word Health Organization (WHO), UNICEF, American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), The recommendation for mother to breastfeed their babies for 6 months can be continued until the age of two year (1).
Globally, less than 40% of children under six months are being breastfed in 2013 (2). In Indonesia, the number of exclusive breastfeeding only reached 54,3 % in 2013 (3). The scope of exclusive breastfeeding in Yogyakarta Province, especially in Bantul regency, up to 2015 only reached 74.73% (3). The low level of exclusive breastfeeding scope is caused by several factors, one of which is mothers who work outside the house (4). Based on the previous study conducted in October 2016 in Bantul Yogyakarta, there are 19.816 working women who are categorized as reproductive age. Precisely, there are 17124 women who work in companies (5).
Mothers who work in a company are likely to be more difficult in giving exclusive breastfeeding compared to those who work outside company or work in non formal institutions. This is related to the lack of knowledge of lactation management while working, lack of time andfacilities to do breast pumping, limited maternity leave and the lack of the director's support (6).
A working mother will be successful in providing exclusive breastfeeding if there is good motivation.The emergence of motivation can be derived from intrinsic factors such as desire and interest and the extrinsic factors such as the relationship between man and big environmental 18 Fithri Hidayati, Eka Nur Hayati, Rosma Fyki Kamala, Hamam Hadi, Vol 7 No. 1, 2018: 16-22 variables and dependent variable.The degree of meaning in this study is determined by p<0.05.

Characteristics of respondents by age and education
From Table 1, it can be seen that the majority of mothers are in the range of 20-35 year-old with a total of 142 people ( 89.9%) and most of them have already graduated from high school with a total of 97 people (61.4%).

Frequency Distribution of Motivation on Working Mother
Based on the test conducted to 158 mothers working at companies in Bantul Regency, the result related to motivation can be shown in Table 2 as follow.  Table 3. Shows that most mothers do not give exclusive breastfeeding to their babies at the age 0-6 with a total of 123 people (77.8%).  Table 4 shows that out of 123 mothers, there are 104 people who give formula milk to their <6 months infants (84.6%). Based on Table 5 It appears that the majority of mothers give non-breastmilk liquid to their children at the age of three months.

Motivation in providing exclusive breastfeeding based on age and education
Based on Table 6, there are 88 out of 158 respondents that can be categorized as possessing good motivation (62.1%), precisely at the age of 20-35 years old. Meanwhile, Table 7 shows that there are 64 high school graduate mothers who also possess good motivation(66.1%).

Motivation and exclusive breastfeeding among mothers in employment 19
The acts of the exclusive breastfeeding based on the availability of lactation room at work Based on Table 8, it was discovered that mothers who are neither facilitated nor are not facilitated by a lactation room have asimilar result: most of them did not give exclusive breastfeeding. Meanwhile, Table 8 shows that out of 92 mothers from six companies provided by lactation room, there are only 28 (30.4%) of those who provide exclusive breastfeeding. Table 9 describes that there are 28 respondents (28.9%) who provide exclusive breastfeeding and also possess high motivation. Meanwhile, there are 69 people (71.1%) who do not give exclusive breastfeeding but possess good motivation.

The relation between motivation and the acts of providing exclusive breastfeeding by mothers who work in companies in Bantul Regency
Statistical test was done by applying chisquare to figure out the relation between motivation and the practice of exclusive breastfeed and the  result shows: probability (p)=0.011, the OR value of good motivation (OR=3.13) and less motivation (OR=1.24). It means that there is a significant relationship between motivation and the practice exclusive breastfeeding in working mother who works in companies in Bantul Regency.

Frequency distribution of the motivation of working mothers
The research shown in Table 2 stated that the majority of respondents possess motivation that falls into good category, precisely 97 people (61.4%). Motivation is an impulse or whim within a person that causes a person to commit a particular activity to achieve a particular goal and in this research, the main purpose of mothers' motivation is to motivate the practice of exclusive breastfeeding.The result of previous studies stated that every mother should have encouragement, desire or volition in giving exclusive breastfeeding (8). Table 4 shows that the majority of mothers, precisely 123 people (77.8%) do not give exclusive breastfeeding when their children are at the age of 0-6 months. The mothers' activities during work hour causing most of them to give complementary brastfeeding (additional foods) when their babies are less than 6 months. Based on Table 4, the result states that the majority of mothers (84.6 %) give formula milk to their children when they are less than six months. Table 6 also describes that most of them provide additional food for their children when they are at the age of 3 months. The practice of additional foods to children at the age of 3 months is related to the mothers' status who work with three months of maternity leave. Shortly, the period of maternity leaves during pregnancy and after giving birth causing those mothers to go back to work before the end of exclusive breastfeeding practice. Previous studies stated that the factor of the risk of failure related to exclusive breastfeeding practice for three months is working mother (OR 4.549; p = 0.0001) (9). Table 6 shows that the majority of respondents who possess good motivation are in the range of 20-35 years old, precisely reaching 88 people or 55.6%. This is related to the productive age. The more mature someone is, the more the experience is. Moreover, it will also increase someone's analytical skill, thus it will also increase her knowledge and motivation (10).

Distribution of motivation in providing exclusive breastfeeding based on age and education
The result of this research also shows that in Table 7, mothers' motivation in providing exclusive breastfeeding mostly were those who have senior high school education background, precisely 64 people or 40.5%. Educational background will affect mothers' level of knowledge and thus it will affect their motivation. During the time they pursue their formal education, a good relationship will be formed both socially and interpersonally that will affect their knowledge (11). A research stated that the higher the mother's education, the better her motivation in providing exclusive breastfeeding (12). Table 8 describes that most mother who works in a company that provides lactation room along with its facilities do not give exclusive breastfeeding, precisely reaching 64 people (52.0%) and there are only 28 people (80.0%) who provide exclusive breastfeeding. It was also stated that six of nine companies chosen in this research have already provided lactation room. It means that there are still many working mothers that have yet to make use of the lactation room maximally. This condition is in line with research conducted by Giri who shows that the availability of lactation room facilities is not related to the practice of exclusive breastfeeding on working mother (12).

The relation between motivation and the practice of exclusive breastfeeding by mothers who work in companies in Bantul Regency Yogyakarta
From Table 9, it is described that this analysis bivariate under the motivation category was divided into two categories. This happened because during analysis there was expected count <5 in a certain cell, thus motivation category was divided into two categories: good motivation (75-100%) and less motivation (<50 % -74%). Table 9 shows that most respondents give exclusive breastfeeding and possess good motivation, precisely reaching 28 people (28.9 %). While those who did not give exclusive breastfeeding and having good motivation were 69 people (71.1%). It means that working mothers who do not give exclusive breastfeeding may have a good motivation good. A working mother was convinced that giving exclusive breastfeeding is considered as a value that they possess within their heart.
Based on the chi-square test result, it can be found that there is a relationship between motivation and the practice of exclusive breastfeeding on mothers who work in companies in Bantul Regency. It can be proved by the p value of 0.011 (p<0.05). From this study, the OR value of both motivation categories are known. The OR value of good motivation obtained was 3.13 and less motivation obtained was 1.24. It means that mothers who possess good motivation are 3.13 times more likely to provide exclusive breastfeeding compared to those who possess adequate motivation.The result of this research is in accordance with the previous studies, where there is a relationship between mother's motivation and the exclusive breastfeeding with OR value=8.00. This means that mothers with good motivation have 8,00 times better opportunities to give exclusive breastfeeding compared to those who have less motivation (13).
This research in line with the research conducted by Hidayanti stating that there is a relationship between mothers' motivation and acts of exclusive breastfeeding practice (p=0.039). This research shows that 87.1% of mothers have high motivation for breastfeeding. From the logistics regression, the R 2 value of 0.031 was obtained. It means that mothers' motivation contributed 31% in providing exclusive breastfeeding (14).

CONCLUSIONS AND RECOMMENDATION
Based on the research, it can be concluded that mothers working in companies in Bantul Regency possess good motivation but they do not provide exclusive breastfeeding. According to the OR value obtained, it can be concluded that those with good motivation have 3.13 times more likely to give exclusive breastfeeding compared to those with adequate motivation (OR=1.24).
T h i s r e s e a r c h c a n b e u s e d a s a recommendation and evaluation for companies which have yet to provide lactation room as well as those which already provide this facility, so they can consider holding a workshop to motivate their employee in giving exclusive breastfeeding. As for the respondents that have already use the lactation room, this research can be used to encourage them to utilize it maximally to support the success of providing exclusive breastfeeding. The last, this research can be used by other researchers as references for their next research by taking the limitation of this research into account. The next research can apply design which is different from this research.