Breastfeeding Practices and Stunting: A Cross-Sectional Study Among Children Aged 24-59 Months in Indonesia

Document Type : original article

Authors

1 Department of Nursing, Faculty of Nursing, Universitas Jember, Jember, East Java, Indonesia.

2 Department of Community Family and Geriatric Nursing, Faculty of Nursing, Universitas Jember, Indonesia.

3 Nursing Council, Indonesian Health Council, Jakarta, Indonesia.

Abstract

Background: Stunting is a chronic nutritional problem that remains a major global public health concern. Inadequate breastfeeding practices, such as delayed early initiation of breastfeeding (EIB), non-exclusive breastfeeding, and early cessation of breastfeeding, can contribute to nutritional deficits that lead to stunting.
Methods: This descriptive correlational study with a case-control approach analyzed the correlation between breastfeeding practices and the incidence of stunting among toddlers aged 24–59 months in Jember Regency. A total of 174 mother–toddler pairs participated, comprising 87 stunted (case group) and 87 non-stunted toddlers (control group). Data on breastfeeding practices (EIB, exclusive breastfeeding, and continued breastfeeding) were collected using researcher-assisted questionnaires and verified through Maternal and Child Health (KIA) books when available. Nutritional status was assessed via direct anthropometric measurements and analyzed using World Health Organization (WHO) Anthro software.
Results: All toddlers in the case group were classified as stunted (100%), with 70.1% moderately stunted and 29.9% severely stunted. Chi-square analysis showed a significant correlation between breastfeeding practices and stunting incidence. Toddlers who received EIB had 2.278 times greater odds of normal height (p = 0.022). Those exclusively breastfed had 2.554 times greater odds (p = 0.004), and those with continued breastfeeding had 2.514 times greater odds of normal height (p = 0.003).
Conclusion: There is a significant association between delayed initiation of breastfeeding, non-exclusive breastfeeding, and early cessation of continued breastfeeding with the occurrence of stunting among toddlers. Strengthening breastfeeding practices from birth through two years of age, supported by families and health institutions, is essential to promote optimal growth and prevent stunting.

Keywords

References

  1. World Health Organization. Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old [Internet]. 2019. Available from: https://www.who.int/publications/i/item/9789241515559
  2. Kemenkes BKPK. Survei Kesehatan Indonesia (SKI) 2023 dalam Angka. Kementerian Kesehatan Badan Kebijakan Pembangunan Kesehatan.2023.
  3. Perkab Jember. Keputusan Bupati Jember Tentang Penetapan Desa/Kelurahan Lokasi Percepatan Penurunan Stunting Tahun 2025. 2024.
  4. UNICEF. From The First Our Life : Making the case for improved infant and young child feeding everywhere [Internet]. 1st ed. New York: United Nations Children’s Fund (UNICEF); 2016. Available from: https://data.unicef.org/resources/first-hour-life-new-report-breastfeeding-practices/
  5. Sunartiningsih S, Fatoni I, Ningrum NM. Hubungan Inisiasi Menyusu Dini Dengan Kejadian Stunting Pada Balita Usia 12-24 Bulan. Jurnal Kebidanan. 2020;10(2):66-79.
  6. Sari EN, Dewanti L, Fatmaningrum W. Risk Factor of Exclusive Breastfeeding and Infective Diseases on Stunting Incindance. Indones Midwifery Heal Sci J. 2022;6:410–422.
  7. World Health Organization. Indicators for assessing infant and young child feeding practices: definitions and measurement methods [Internet]. 2021. Available from: https://iris.who.int/bitstream/handle/10665/340706/9789240018389-eng.pdf?sequence=1
  8. Dinkes Kabupaten Jember. Profil Kesehatan Jember Tahun 2023. 2nd ed. Jember: Dinkes Kabupaten Jember; 2024.
  9. Perbawati D. Peningkatan kapasitas ibu menyusui melalui kelas ASI di PMB Mumbulsari Kota Jember [Internet]. 2022. Available from: https://www.kompasiana.com/dinarperbawati2928/639eb89c08a8b54948709a64/
  10. Yanti EM, Fatmasari BD. Buku psikologi kehamilan, persalinan, dan nifas. Penerbit NEM; 2023 Feb 9.
  11. Friedman MM, Bowden VR, Jones EG. Buku ajar keperawatan keluarga: Riset, teori, dan praktek. Jakarta: Egc. 2010;5.
  12. Nuraini Y, Agrina A, Jumaini J. Hubungan Dukungan Keluarga Dengan Sikap Ibu Dalam Pemberian Asi Eksklusif. Jurnal Ilmu Keperawatan. 2022 Apr 20;10(1):116-32.
  13. Taha Z, Ali Hassan A, Wikkeling-Scott L, Papandreou D. Factors associated with delayed initiation and cessation of breastfeeding among working mothers in Abu Dhabi, the United Arab Emirates. International journal of women's health. 2021 Jun 2:539-48.
  14. Mudhawaroh M, Ningtyas SF, Bherty CP, Kolifah K, Prihartanti NG. The relationship between family support and the implementation of Early Breastfeeding Initiation (IMD) at PKU Muhammadiyah Mojoagung Hospital Jombang Regency. Science Midwifery. 2023 Oct 28;11(4):684-91.
  15. Alrasheedi AT. Factors associated with early initiation of breastfeeding in central Saudi Arabia: a hospital-based survey. International Breastfeeding Journal. 2023 Nov 16;18(1):62.
  16. Emagneneh T, Mulugeta C, Alamrew A, Ejigu B, Abebe W. Early cessation of exclusive breastfeeding and associated factors in Ethiopia: a systematic review and meta-analysis. Frontiers in Nutrition. 2025 Apr 25;12:1500077.
  17. Witten C, Claasen N, Kruger HS, Coutsoudis A, Grobler H. Psychosocial barriers and enablers of exclusive breastfeeding: lived experiences of mothers in low-income townships, North West Province, South Africa. International Breastfeeding Journal. 2020 Aug 26;15(1):76.
  18. Alsada F, Sebastian T, Alzayer Z, Alabbas H, Alhaddad N, Shahin HA, et al. Determinants of infants and young children feeding practices among mothers living in Saudi Arabia: a cross-sectional study. BMC Public Health. 2025 Jan 30;25(1):388.
  19. Tumaji T, Mahmudiono T, Laksono AD, Kusumawardani HD, Khairunnisa M. Exclusive Breastfeeding Among Adolescent Mothers in Indonesia: Does Maternal Education Level Matter?. Journal of Population and Social Studies [JPSS]. 2025;33:562-76.
  20. Hu L, He W, Zhou L. Association Between Family Support and Breastfeeding Self‐Efficacy in a Cross‐Sectional Study. Nursing Open. 2025 Apr;12(4):e70210.
  21. Nie J, Ye J, Wu S, Wang N, Li Y, Liu Y, et al. Beyond mothers: the crucial role of family caregivers’ knowledge on exclusive breastfeeding in rural western China. International Breastfeeding Journal. 2023 Nov 6;18(1):58.
  22. Yasuda S, Fukuda T, Toba N, Kamo N, Imaizumi K, Yokochi M, et al. Risk factors for discontinuation of exclusive breast feeding within 1month: a retrospective cohort study in Japan. International breastfeeding journal. 2022 Mar 5;17(1):20.
  23. Paramashanti BA, Dibley MJ, Huda TM, Prabandari YS, Alam NA. Factors influencing breastfeeding continuation and formula feeding beyond six months in rural and urban households in Indonesia: a qualitative investigation. International Breastfeeding Journal. 2023 Aug 31;18(1):48.
  24. Hackman NM, Schaefer EW, Beiler JS, Rose CM, Paul IM. Breastfeeding outcome comparison by parity. Breastfeeding Medicine. 2015 Apr 1;10(3):156-62.
  25. Mekonen EG. Variation of continued breastfeeding by age of the child among children aged 12–23 months: evidence from 21 sub-Saharan African countries. Nutrition & Metabolism. 2025 Apr 11;22(1):31.
  26. WHO. Childhood Stunting : Context, Causes, and Consequences [Internet]. World Heal. Organ. 2016. Available from: https://www.who.int/publications/m/item/childhood-stunting-context-causes-and-consequences-framework
  27. Briend A. The complex relationship between wasting and stunting. The American Journal of Clinical Nutrition. 2019 Aug 1;110(2):271-2.
  28. Thurstans S, Sessions N, Dolan C, Sadler K, Cichon B, Isanaka S, et al. The relationship between wasting and stunting in young children: A systematic review. Maternal & Child Nutrition. 2022 Jan;18(1):e13246.
  29. Susanto T, Rasni H, Susumaningrum LA. Perawatan keluarga dalam pemenuhan kebutuhan nutrisi balita: aplikasi keperawatan keluarga dalam konteks agronursing. Jakarta: Trans Info Media; 2022. xiv, 190 p.
  30. Rahmadiyah DC, Sahar J, Widyatuti, Sartika RA, Hassan H. Family Resilience With Stunted Children Aged Below 5 Years: A Qualitative Study in Depok City, Indonesia. Global Qualitative Nursing Research. 2024 Jan;11:23333936231221753.
  31. Susianto SC, Suprobo NR, Maharani M. Early breastfeeding initiation effect in stunting: A systematic review. Asian Journal of Health Research. 2022 Mar 4;1(1):1-6.
  32. Hapsari FR. Exclusive Breastfeeding and Its Correlation with Stunting in Children under Five in Indonesia: A Meta-Analysis. InThe International Conference on Public Health Proceeding 2023 Sep 6 (Vol. 7, No. 01, pp. 21-21).
  33. Campos AP, Vilar-Compte M, Hawkins SS. Association between breastfeeding and child stunting in Mexico. Annals of global health. 2020 Nov 17;86(1):145.
Journal of Pediatric Perspectives
Volume 13, Issue 8
August 2025
Pages 19605-19617

Files

Share

How to cite

Statistics