Exclusive breastfeeding in family with early marriage

Abstract

Background: Breast milk is the best nutrient for infant, providing everything the babies need to survive and drink plenty of fluids during the first six months and that is perfect combination of various nutrients. Besides that, breast milk is the best way to reduce infant morbidity and mortality from infectious diseases, which often affect toddlers in developing countries who are not getting the appropriate developmental nutrition. Meanwhile, the level of national initiation is checked according to mother’s age. Young mother (< 19 years old) tends to rarely breastfeed (83.6 percent) compared with the older one (88.5 percent- 92.7 percent). Therefore, the scoping review aims to explore the description about exclusive breastfeeding on mother with early marriage. Method: the method of this scoping review used Arksey & O’Malley framework consisting of five stages such as identifying scoping review question by framework PEOs; identifying relevant article through relevant database, such as Pubmed, Proquest, ScienceDirect and finding Grey literature through Google Scholar; selecting the article with Prism Flowchart that is used to draw the article search flow, doing critical appraisal to assess the quality of article; doing data charting.

Full text

How to Cite
Kadatua, M. H., Djannah, S. N., & Rosida, L. (2022). Exclusive breastfeeding in family with early marriage. International
Journal of Health & Medical Sciences, 5(3), 240-252. https://doi.org/10.21744/ijhms.v5n3.1931
ISSN 2632-9433
Submitted: 09 May 2022 |Revised: 27 June 2022 | Accepted: 18 July 2022
240
Exclusive Breastfeeding in Family with Early Marriage
Marwa Hasan Kadatua
Universitas ‘Aisyiyah Yogyakarta, Yogyakarta, Indonesia
Corresponding author email: marwahasankadatua@gmail.com
Sitti Nur Djannah
Universitas Ahmad Dahlan, Yogyakarta, Indonesia
Luluk Rosida
Universitas ‘Aisyiyah Yogyakarta, Yogyakarta, Indonesia
Abstract---Background: Breast milk is the best nutrient for infants, providing everything the babies need to survive
and drink plenty of fluids during the first six months and that is the perfect combination of various nutrients. Besides
that, breast milk is the best way to reduce infant morbidity and mortality from infectious diseases, which often affect
toddlers in developing countries who are not getting the appropriate developmental nutrition. Meanwhile, the level
of national initiation is checked according to the mother’s age. Young mother (< 19 years old) tends to rarely
breastfeed (83.6 percent) compared with older one (88.5 percent- 92.7 percent). Therefore, the scoping review aims
to explore the description of exclusive breastfeeding on mother with early marriage. Method: the method of this
scoping review used Arksey & O’Malley framework consisting of five stages such as identifying scoping review
questions by framework PEOs; identifying relevant articles through the relevant database, such as Pubmed,
Proquest, ScienceDirect and finding Grey literature through Google Scholar; selecting the article with Prism
Flowchart that is used to draw the article search flow, doing critical appraisal to assess the quality of article; doing
data charting; result: based on ten (10) articles obtained, it was obtained that there were nine (9) articles having
Grade A and one (1) article having grade B. Conclusion: Breastfeeding is an important base for children’s
development by giving essential nutrients and protection needed for their growing as well as their early
development. If their fulfillment is given optimally, breastfeeding could prevent children's death in every year,
meanwhile, young mothers (19 years old) may have decreased in experiencing breastfeeding compared to mature.
Keywords---early marriage, exclusive breastfeeding, mother married early, young mother
Introduction
A social phenomenon relate to early marriage and childbirth an early age is happening, this case causes women
marrying an early age could have early pregnancy in their age which is still unstable. Pregnancy is a worrisome
problem for women an early age due to this case correlate to bad pregnancy results for mother and their children in
the future. For instance, breastfeeding from mother to baby is not optimal due to the mother’s age factor that cannot
be able to receive their physical and phycological condition causing the young mother to feel difficult in applying
breastfeeding exclusively to their baby (Efevbera et al., 2017). (Batyra & Pesando, 2021). Indonesian Government
Regulation number 33 of 2012 stated that breastfeeding can enhance the nutritional status of babies and children and
also affect the next degree of health so all mothers giving birth must be exclusively breastfed to their babies at 6
months of age (Hidayah et al., 2020).
Breast milk is an excellent source of food and fluids for a baby during the first six months of life, and it is a
perfect blend of various nutrients. Breast milk is the most effective and affordable way to reduce the morbidity and
mortality of infants from infectious diseases that disproportionately affect children under five in developing
countries. (Siraneh et al., 2021). WHO and UNICEF themselves jointly recommend that women should breastfeed

241
their babies within 1 hour of birth, where the baby should be breastfed exclusively for the first 6 months and be able
to continue breastfeeding along with the right complementary foods until the age of 2 years (Zhang et al., 2018).
The World Health Organization (WHO) believed that breastfeeding is one of the most important ways to reduce
child mortality rates, especially in developing countries. Exclusive breastfeeding provides several protective benefits
for both the child and the mother. For instance, breastfeeding for a longer period of time can enhance sensory and
cognitive development, protect the baby from infectious and chronic diseases, and reduce infant mortality from
childhood diseases such as diarrhoea and pneumonia. (Thet et al., 2016), based on data from the Indonesian Ministry
of Health in 2020, it is said that pneumonia and diarrhoea are still the main problems that cause 73.9 percent of
deaths due to pneumonia and 14.5 percent of deaths due to diarrhoea in children aged 29 days-11 months, so
indirectly by not giving breast milk exclusively can have an impact with an increase in mortality rates in new-borns
(Indonesia, 2021).
There are various factors that can obstruct breastfeeding practices among others mothers’ education, employment
status, type of residence, childbirth mode and place, and the lack of breastfeeding counseling. Even though all of the
factors influence women from all reproductive age however in the research (Benova et al., 2020), were mentioned
that young mothers tend not to begin breastfeeding, have shorter breastfeeding duration and more likely to stop
breastfeeding prematurely. This thing is able to caused by increasing the early marriage.
The prevalence of early marriages globally in Indonesia ranks 2nd in ASSEAN after Cambodia and ranks 10th
highest in the world according to the National Development Planning Agency in 2020. Meanwhile, in Indonesia
based on data from the Central Statistics Agency (BPS, 2020) the number of early marriages in 2020 was 10.18
percent. This achievement is far from the government's target of specifically targeting a reduction in the early
marriage rate from 10.18 percent (2020) to 8.74 percent by the end of 2024.
This early marriage is a problem that has occurred for a long time but until now has not been solved. This is
considered worrying because the government has clearly regulated in law number 16 of 2019 concerning changes to
law number 1 of 1974 concerning marriage which stated that marriage is only permitted if both the man and woman
are at least 19 years old, while according to WHO, early marriage is a marriage conducted by a couple who is still
categorized as children or under the age of 19 years (Telaumbanua, 2019). Meanwhile, when the national initiation
rate is checked according to the mother's age, adolescent mothers (<19 years) begin to breastfeed less frequently.
(83.6 percent) compared to those older or older than them. (88.5 percent – 92.7 percent). (Nesbitt et al., 2012).
Some results of previous studies related to breastfeeding, (Agho et al., 2021), stated that young mothers are
lacking in terms of experience, education, attitudes, and social support needed for proper breastfeeding practices. In
another study conducted by (Hidayah et al., 2020), discussed that the absence of rooming in is one of the factors
impeding the success of exclusive breastfeeding, lack of frequency of direct breastfeeding, lack of understanding
about breast milk and breast milk production and family support. Meanwhile, (Buckland et al., 2020), explained
about interventions and programs to promote breastfeeding: such as counselling strategies, online support, antenatal
education, breastfeeding-friendly hospital practices, breastfeeding-friendly workplaces, and leave policies for the
elderly. But despite these studies, most young mothers are underrepresented in previous studies.
In the practice of breastfeeding, there are many factors that support the success of breastfeeding. As a result, it is
critical to know what things can help in terms of breastfeeding exclusively, especially in mothers of early age, so that
based on the facts and phenomena that exist related to early marriage in terms of breastfeeding, it is necessary to
explore based on the picture of breastfeeding and find out the factors that support and hinder breastfeeding for
mothers at early age (Wahhaj, 2018; Mulyani et al., 2017).
Aim
To explore about the description of exclusive breastfeeding, supported and unsupported determinants of exclusive
breastfeeding in mothers at early marriage.
Method
Scoping review is one of the increasingly popular approaches to summarize research evidence that aims to map the
literature in interest, find information about research activities related to the topic and investigate the existence of
problems or gaps in the research area that will be a research reference (Arksey & O'Malley, 2005). (Pham et al.,
2014). The steps that the researcher will use in this scoping review are as follows:

242
Identifying scoping review question
The first step in compiling scoping review is by identifying research questions to be discussed as a blend of literature
search strategies. The question in this study is "how is exclusive breastfeeding in mothers with early marriage?" For
the purposes of this study, a scoping review is defined as a type of research summary that aims to map the literature
on a specific topic or area of research and provide an opportunity to identify key concepts, gaps in research, types,
and sources of evidence to inform practice, policymaking, and research (Pham et al., 2014).
Framework PEO
To develop review focus and search strategies, the researcher use Population, Exposure, and Outcome frameworks
(PEOs) and study design in managing and solving review focus. The use of PEOs will help in identifying key
concepts in the focus of review, developing appropriate search terms to describe the problem as well as being able to
determine the criteria for inclusion and exclusion. The focus of the article search is qualitative research. Therefore,
PEOs are considered appropriate for use (Bettany-Saltikov, 2012).
Table 1
Framework PEOs
P (Population)
E (Exposure)
O (Outcomes)
s (Study Design)
− Early Marriage
− Children Marriage
− Married in early age
− Married in teenage age
− Mother getting married in
early age
− Mother of early marriage
− Young mother
− Teenage mother
− Exclusive
breastfeeding
− Exclusive breast
milk
− Inhibiting
factors
− Supporting
factors
Qualitative and
Quantitative Studies
Identifying relevant article
The criteria for articles that will be searched and will be used as a source for this scoping review are the inclusion
and exclusion criteria as follows:
Table 2
Inclusion criteria and exclusion criteria
Inclusion Criteria
Exclusion Criteria
a) Article published between 2011-2021
b) Article published in English and Indonesian
languages.
c) National and international article
d) Article using qualitative and quantitative method
e) Article that discusses about women in early
marriage and exclusive breast milk
a) Articles that cannot be accessed full text
b) Articles published under 2011
c) Article review
Article selection by prism-flowchart
Starting with searching the databases that will be used, such as PubMed, ProQuest, and ScienceDirect, the ability to
enter predetermined keywords into each of these databases, then each database will be filtered such as full text and
publish 10 years. The use of keywords in the search for articles is early marriage or child marriage or early marriage
or married adolescents or mother married early or mother married young or young mother or teen mother and

243
exclusive breastfeeding or exclusive breastfeeding or exclusive breastfeeding and exclusive breastfeeding and
inhibiting factors and supporting factors and qualitative studies (Coutinho et al., 2005; Kakute et al., 2005).
In this article selection process, researcher used flowchart prism to transparently describe the article selection
process to be carried out. Flowchart prisms are considered appropriate to use because it can improve the quality. The
stages of article filtering are as follows:
Figure 1. Prisma FlowChar
Table 3
Data extraction
No
Author Year,
Place
Aim
Collecting Data
Informant/Sample
and Recruitment
Theme
Result
1.
(Agho et
al., 2021)
Bangladesh
The objective of
this research is
to estimate
breastfeeding
indicator and
factor related to
the chosen
feeding practice
The data sets were taken
in a combined starting
from 2004, 2007, 2011
and 2014 from the
Demographic and Health
Survey in Bangladesh
(BDHS).
The final analysis
included 2.554
adolescent
mothers aged 12-
19 years included
in the final
analysis.
(2004:n=614,
2007:n=521,
2011:n=693,
2014:n=726)
1. Breastfeeding indicator
2. Factor of Age
3. Husband’s Support
4. Lack of vising the
health service
5. Educational factor
6. Working mother
7. The use of mass media
42.2 percent of adolescent
mothers began breastfeeding
within the first hour of birth,
and 53 percent exclusively
breastfeed their babies, 17.3
percent, breastfeed
predominantly while 15.7
percent gave bottle milk to
their children. Teenage
mothers aged 12 to 18 years
who watched television did
not postpone starting
breastfeeding within the first
hour of birth.
Then, teen mothers who give
birth at home and have a
postpartum examination
within two days have a
significant delay in
breastfeeding.
2.
(Hackett et
al., 2015)
Bangladesh
It aims to assess
knowledge,
attitudes, and
1. FGD (6-8 people) in
a group
2. Interview (18
1.Unmarried
teenage
mothers
1. Initiation of
breastfeeding
2. Knowledge and
The results that qualitative
indicators which appropriate
with international

244
perceptions
regarding
breastfeeding
and
complementary
food among
young women
and adolescent
mothers.
informants) this
case is done to
ensure coverage of
relevant topics that
may not appear in
the FGD.
2. the married
without
children
3. married with
informant’s
child
recruited
using
purposive
sampling
perception of exclusive
breast milk and
colostrum
3. Duration of feeding,
gender of the child and
religion
4. The timing of the
introduction of
complementary foods
5. Confidence in
breastfeeding
6. Perceived generational
shift in breastfeeding
knowledge
recommendations
(WHO/UNICEF 2003) show
that knowledge of adolescent
girls and mothers of
adolescent age is limited, in
several cases, the participants
realize that breastfeeding
recommendation however
their interpretation of the
deviated recommendation
from the intended public
health message.
3.
(Rahman et
al., 2020)
Bangladesh
It aims to
determine the
prevalence of
exclusive
breastfeeding
in adolescent
mothers to
identify
factors
affecting
breastfeeding
practices.
For reaching the purpose
of this research, this
research used data from
Health and Demographic
Surveillance System
Centre, Bangladesh
There were 2,947
breastfed children
of adolescent
mothers involved
in this research.
1. Breast milk
definition
2. The advantage of
breast milk
3. Mother’s
knowledge
4. Determinants of
breastfeeding
practices
There were 2.947 cases of
adolescent mothers
breastfeeding the children in
the HDSS region throughout
2007 till 2015. By using the
live birth rate as a
denominator in both regions,
the average EBF percentage
in the ISA area is 42 percent,
while for the GSA area it is
44 percent.
4.
(Muelbert
&
Giugliani,
2018)
Brazil
The objective of
this research was
to investigate
factors related to
breastfeeding
maintenance for
at least 6, 12, and
24 months of
adolescent
mother.
The collecting data
occurs in different time.
At first by using
interview and
questionnaires then
participants are contacted
again by phone, mail, or
social network. If
necessary, the family was
looked for by using
provided address.
There were 257
(80%)
participated in 6
months of follow-
up, 237 (73%)
constantly till 12
months, and 207
(64%) were
available for final
evaluation (4-7
years). In total,
there are 323 of
adolescent
mother.
1. The use of
pacifier
2. Family’s support
3. Husband’s
support
4. Duration of
breastfeeding
We believe that the result of
this study can contribute to
the challenge of increasing
the duration of breastfeeding
with an individual-centered
approach, that is, considering
the related factors identified
during the planning and
execution of strategies
targeted on adolescent
mothers.
5.
(Hackett et
al., 2015)
Bangladesh
Rural Area
Investigating
the barrier in
feeding,
breastfeeding,
and caring of
baby between
young
mothers and
daughters who
have not given
birth.
1. Focus Group
Discussion (FGD)
six times dicussi
2. open semi-
structured
interviews with a
total of 18
interviews by using
the experienced
local translators
1. Unmarried
teenage
mothe
2. Married
without
children
3. Married and
have
children
informants are
recruited using
multilevel
sampling
techniques
1. Early marriage
2. Pregnancy and teenage
birth
3. Conflicts of women's
time and work
4. Special challenge in
breastfeeding
5. Educational need
6. Self-efficacy to be a
mother
There are five main
contextual factors which is
associated with parenting
difficulties including: the
early marriage, the conflict of
mother time allocation, rural
life, the short birth distance,
and poverty. There are many
daughters and adolescent
mother face difficulties in
breastfeeding and caring of
the children in the early age
and before becoming mother.
6.
(Benova et
al., 2020)
Nigeria
Investigating the
distinction
between
adolescents (<20
years) and
young women
(20-24.9 years)
and for
investigating the
relation between
mothers’ age
group
(adolescent and
young women)
By using nationally
representative with
questionnaire model
adapted by each country,
namely four household
surveys 2003, 2008,
2013, and 2018.
The sample was
in women from
three age groups
including:
1. Young
teenagers (<18
years old)
2. Old teenagers
(18-19.9 years
old)
3. Young women
(20-24.9 years
old)
1. Definition of
breastfeeding
2. Breastfeeding practice
3. ANC visiting
4. Childbirth experience
5. Undesirable pregnancy
The adolescent mothers have
higher prevalence than young
women so the adolescent
mothers have chance to
continue breastfeeding at the
age of 1 and 2. In
multivariate analysis showed
that the mothers’ age group is
not related to early initiation
of breastfeeding or by giving
exclusive breastfeeding.

245
and two primary
indicators of
breastfeeding
(early initiation
of breastfeeding
and exclusive
breastfeeding)
7.
(Sipsma et
al., 2013)
New York
For
investigating
the intention
between
adolescent
pregnant
women and
young adults
and the male
couple to
enhance the
intention of
breastfeeding
in young
mothers.
Using questionnaires
From 413 eligible
couples, 296
couples were
registered in this
research.
Pregnant women
and the couples
were recruited
between July
2007 and
February 2021
from obstetrics,
gynecology, and
ultrasound.
1. The advantage of
breastfeeding
2. Intention to breastfeed
3. Do not want to
breastfeed
There are about 73%
women were reported have
intention to breastfeed and
80% men were reported
want the couple to
breastfeed, because “it is
healthier for baby” and
“the more natural way to
feed baby.”
8.
(Lee et al.,
2013)
Laos
To identify
the reason
and the
influence
which
become the
background
for deciding
to breastfeed
first-time
mothers in
Laos.
1. Deep interview
individually (7
people)
2. Focus Group
Discussion (2 FGD)
using a semi-
structured interview
guide
informants
consist of
mothers that were
first-time
intentionally
identified, health
staff including
midwives,
parents, and key
informants.
1. The advantage of
breastfeeding
2. Early breastfeeding
initiation
3. The reason of
breastfeeding initiation
4. Family’s support
5. Duration of
breastfeeding
6. Working mom
7. Breast milk is not
sufficient
8. Nipples go inside
The participants showed
positive attitude and
realized the importance of
breastfeeding.
Nevertheless the
breastfeeding practices are
less than optimal. Several
of them give exclusive
breastfeeding during six
months of babies’ life and
most of mothers who
followed the sample for the
first time have stopped or
plan to stop breastfeeding
when the babies are 18
months.
9.
(Sipsma et
al., 2013)
New York
To describe
the
experience
and attitude
of
breastfeeding
between
young
women group
and the
initiation test
predictor and
breastfeeding
duration.
The data collection was
conducted by interview
and taken from pregnant
adolescent mother cohort
and the couple. The
research was observed
from pregnancy to six
months postpartum. This
couple was recruited
between July 2007 and
February 2011 from
obstetric and gynecology
clinic of four university
in Connecticut.
296 women who
completed the
initial assessment
during pregnancy
(on average, 29
weeks of
pregnancy), then
225 mothers
participated in the
second interview
(76.0 percent),
approximately 6
months after the
date of delivery.
samples are
recruited based
on inclusion
criteria
1. The advantage of
breastfeeding
2. Common obstacle
3. Sociodemographic
4. Partner’s attitude
5. Health worker’s
support
There are 84%
breastfeeding adolescent
mother begin to stop at six
months postpartum, the
average breastfeeding is 5
weeks. The participants
who provide exclusive
breastfeeding have longer
duration than participants
who had faced intimate
partner violence. The fat
women and women who
face breastfeeding
difficulties have lower
chance to provide
breastfeeding exclusively.
10.
(Monteiro
et al.,
2014)
Brazil
For
characterizing
breastfeeding
practices in
adolescent
and
identifying
the need of
breastfeeding
1. The first phase was
gathered from
online database
2. The second phase
was 10 adolescent
mother, were
recruited from the
primary health care
unit with the highest
prevalence of
adolescent mother,
who will to
1. 2028 people
participated
in the
survey,
including
229 (11
percent)
adolescent
mothers with
an average
age of 17
years.
1. Concern for the health
of the baby
2. Difficulty in
breastfeeding
3. The support from
family and health
worker
Breastfeeding relates to the
babies’ needs. In this case,
there is an ambiguity of the
adolescent mother
statements. They realize
the importance of
breastfeeding for their
babies’ health but they do
not feel safe regarding
their breastfeeding ability.
It leads to other food
introduction and it causes

246
participate and
convey the
breastfeeding
experience.
2. The 10
teenage
mothers
interviewed
were <19
years old.
Informant
recruited
based on
inclusion
criteria
early stopping of
breastfeeding.
Discussion
The concept of early marriage
Early marriage
Usually, early marriage i.e. (before the age of 18). Domestic law prohibits early marriage, but the practice continues
to this day. Married girls are often seen as a financial burden on the family and marriage in early adolescence seems
to reduce the financial stress on the family. The perception that girls are valuable to the family is related to the
practice of brides (goods or money that the brides give to the groom’s family) which encourages early marriage as
the bride’s prices increase with age of the daughter. According to the United Nations, adolescents (10 to 19 years) is
an important step for all kinds of human development, as poor adolescents and women become poor children, and in
the next generation, poverty and injustice will be sent to this country. In low-income environments, teens do not
marry at an early age and do not lead to early childhood and risk of death of mother and illness (Hackett et al., 2015).
Adolescent’s pregnancy and childbirth
Teenage pregnancy is associated with various negative health consequences for mothers and children. A study in
Bangladesh found that pregnancy and breastfeeding during adolescence can slow linear growth and lead to lower
weight, fat and body mass in young people. In addition, early pregnancy is associated with premature birth and low
birth weight, which pose a significant threat to infant illness and mortality. Despite these risks, research shows that
inadequate or insufficient maternal care can negatively affect breeding, including breastfeeding, and the results of
feeding babies. (Hackett et al., 2015).
The scope of exclusive breast milk
Definition of exclusive breast milk
The World Health Organization (WHO) defines exclusive breastfeeding as getting only breast milk without
additional food or drink. WHO recommends exclusive breastfeeding for the first six months of a child's life. Breast
milk is recognized as the main food that saves life, prevents disease and ensures healthy growth in the first 1,000
days of life. Exclusive breastfeeding has well-documented benefits for both mother and baby (Rahman et al., 2020).
According to (Benova et al., 2020), breastfeeding is an important foundation for a child’s survival and health,
providing essential nutrients and protection necessary for early growth and development. Optimal breastfeeding
could prevent 823,000 baby deaths a year. This makes it a very effective remedy to prevent infant mortality,
breastfeeding is also important for the mother’s reproductive health, increases uterine contractions immediately after
delivery, protects against breast and ovarian cancer and provides more effective protection against postpartum
contraception due to amenorrhea during breastfeeding. In addition, breastfeeding improves other CUS, including
CUS 4, 5 and 6, in which (the impact of breastfeeding on intelligence, economic growth and improvement of human
resources) and reduces the inequality between the rich and the poor. To improve these benefits, it recommends dairy
for 6 months for 1 hour birth and makes dairy up to 2 years (Benova et al., 2020).
The advantage of breast milk
Breastfeeding is beneficial for both mother and child. For babies, breast milk is a very nutritious and excellent source
of energy, protein, iron and vitamin A, and also provides antibodies and various biological components to protect
against disease. Babies who are breastfed have a lower risk of life-threatening diseases such as diarrhoea, ear and

247
respiratory infections, and a lower risk of chronic diseases later in life. For nursing mothers, if breastfeeding begins
shortly after delivery, it helps the mother’s uterus contract to expel the placenta and reduces the risk of postpartum
bleeding and infections. Other benefits include a reduced risk of breast and ovarian cancer (Lee et al., 2013).
According to a review (Sipsma et al., 2013), exclusive breastfeeding can have significant benefits over
breastfeeding, especially among young mothers, including financial and health savings. Additionally, breastfeeding
due to milk amenorrhea, increased postpartum weight loss and fewer visits to the pediatrician due to decreased ear
infections may increase the interval / interval between pregnancies. and urinary tract infections Breastfeeding
improves the bond between mother and child and reduces the risk of postpartum depression. There are many
advantages of breastfeeding, as follows: breastfeeding is estimated to prevent 13% of death among children, the low
of postnatal mortality, sudden death syndrome, the lower risk of childhood infection, and lower of diabetes. There
also have advantages for mother including the lower risk of developing breast and ovarian cancers, weight recovery,
and lactational amenorrhea (Rahman et al., 2020).
The illustration of exclusive breastfeeding
Concern for baby’s health
In this research, the participants expressed the importance of breastfeeding because it is beneficial to the health and
development of their babies. The women describe breastfeeding as something positive, focusing on the well-being of
the baby. They stated that breastfeeding provides more protection to their children, which is everything they need,
breastfeeding helps them to become fatter, smarter, more active. So that, by focusing on breastfeeding can be
beneficial for the baby, mothers say if they have a baby they will still breastfeed and will not stop. mothers will allow
their babies to breastfeed because breast milk contains proteins that they eat, all these things are in their milk and it
also contains vitamins (Monteiro et al., 2014).
Perception of breast milk and colostrum
In a study conducted by (Hackett et al., 2015), based on data collected on the concept of breast milk, according to
study participants, it was clarified that the term exclusive breastfeeding includes more than breast milk alone. But
also, other liquids. Then other participants said that in summer one should eat like water. Water is a non-lactating
liquid and is given to babies up to 6 months, after which they have cow’s milk followed by fruit juice. According to
the participants, young babies should always be given water with breast milk because “too much heat” dries the
baby’s throat and breast milk is not enough to quench thirst. Fruit juices that are given to children up to 6 months are
mango and orange. Participants noted that fresh homemade juices are more useful for children than those packaged
in a store (Delprato & Akyeampong, 2017; Mulyani, 2018).
At the same time the participants expressed different opinions about colostrum. Many participants considered
colostrum as the “first yellow milk” and some noted that it is “rich in vitamins” and should be given because it is
good for the health of babies. But some participants argue otherwise, insisting that colostrum is “bad milk” and
should not be given to babies. It is said that children do not digest it and get diarrhea or cholera. These different ideas
explain that mothers should delay breastfeeding until the main milk comes so that they can feed their children with
formulas for some time, and other participants in the recent generation of cholesterol, older mothers have their first
milk or cholesterol. Rejected but young mothers knew there were vitamins so they gave him a child (Hackett et al.,
2015).
The perception that colostrum was once discarded but is now commonly given to babies suggests that recent
efforts to promote first-time feeding/colostrum in infants have been made. It demonstrates that this case is effective
in changing some suboptimal colostrum administration practices. These findings are consistent with recent data from
Bangladesh, which show that 92 percent of Bangladeshi babies received first milk or colostrum during the study
(NIPORT, Partners and Associates & Macro International 2009) (Hackett et al., 2015).
Illustration of breastfeeding duration
Relates to a broad opinion in the reported duration or the planned duration of breastfeeding from one month to two
years, or when the babies stop on their own. The first advice that mother received from health workers and the oldest
female family about the optimal duration of breastfeeding was also inconsistent. Some reported that it depended on
the baby, one of them was told 18 months, and others said they were not given any advice at all (Lee et al., 2013).

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Most participants believed that all babies should be breastfed frequently, on demand or when crying. However, a
large difference in opinion regarding the duration of breastfeeding was reported. According to most participants in
the study, many participants of Islamic law emphasized Hadis's book, expressed the age of boys and girls. At this
age, there were many differences, and many participants asked boys and girls to feed 2 and 2.5 years of breast milk,
while others believed that the boys should be longer than girls. Boys tend to breastfeed longer to make money and
care for the elderly, while girls go out earlier. Despite reports of sex discrimination during breastfeeding, most
participants were clear that a mother cannot intentionally discriminate against her child during breastfeeding and that
all children should be treated equally (Hackett et al., 2015).
Supported determinant
The use of mass media
The use of mass media is useful in delivering information in community circle. A teenage mother that watch
television has higher possibility to make a useful decision about breastfeeding. This case can be related to the fact
that teenage mother has higher possibility to practice breastfeeding properly since they get information from
television (Agho et al., 2021).
Education
A teenage mother having higher level education has little possibility to give formula milk for her baby compared to
those having lower-level education. This founding is in line with the cross-sectional study community based
conducted among mothers that have poor economic condition in Karachi, Pakistan. It was found that mother with
low level of education has high possibility to give formula milk to her baby compared to those having higher level
education.
Increased breastfeeding among out-of-school adolescent mothers, driven by maternal economic resources and
higher education, increases decision-making in relation to child health. This finding includes the proper use and
practice of breast milk, which can improve the mother’s attitude toward receiving support from significant health
professionals to gain knowledge regarding proper breastfeeding practices (Agho et al., 2021).
Partner’s support
A previous study conducted in Bangladesh showed that most of women visiting ANC were accompanied by their
husband to a health facility. Couples/husbands play an important role in increasing breastfeeding because the
information is obtained on time in the antenatal and postnatal periods. Besides that, they use social media such as
Facebook to improve their knowledge so that it can be applied by encouraging and supporting mothers to breastfeed
(Agho et al., 2021).
The characteristics of mate can influence the teenage mother’s attitude of breastfeeding since they tend to be
influenced by their mate. The support of their husbands about breastfeeding becomes a strong predictor for
breastfeeding attitude. Meanwhile, if they have domestic violence, it will have negative impact to breastfeeding
because the victim feels shame, hopelessness and unconfident because of the domestic violence they have (Sipsma et
al., 2013).
Grandmother/family’s support
Family’s support including grandmother to breastfeed shows a crucial relationship in breastfeeding preservation at
least for six months and twelve months, as they receive support to breastfeed from various sources, mainly from
parents. This case is considered could encourage breastfeeding practice. A systematic observation shows that the
grandmother from female side about breastfeeding affect mother’s positive decision. It can increase 12 percent of the
possibility for mother to begin to breastfeed (Muelbert & Giugliani, 2018).
Besides the health professional and the mother's own belief, elders in the family (usually the mother of the
mother herself or mother-in-law) were identified as an important influence in the practice of breastfeeding. As one of
the participants explained "my mother was the first person that motivate me to breastfeed, she talked about
breastfeeding before the doctor did it". So that mothers already have provisions related to breastfeeding practices
(Lee et al., 2013).

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Health worker’s support
Several studies have cited support from health professionals describing positive support for overcoming obstacle and
refusal reinforcement and burden for early breastfeeding (Giles et al., 2010). Mothers who begin long-term
breastfeeding may live in environments where breastfeeding is considered the normal way to feed a baby (Brown et
al., 2011). This case shows how important it is to support and encourage breastfeeding for teen mothers to overcome
the uncertainty and fulfill the breastfeeding needs.
According to Wambach & Cohen (2009), stated that the influence of individual and professional support is
significantly important for initiating and maintaining breastfeeding. The needs of adolescent mother are emotional
support, praising, and useful information. Besides, the other needs are the certainty from health worker that the baby
has breastfed correctly and provide enough breast milk. In addition, the desire of technical and emotional support are
also needed. Health professionals need to know how to effectively promote the practice of breastfeeding.
Recognition of the adolescent mother’s intent to breastfeed, care for breastfeeding, and involvement of family and
friends in support and promotion of adolescent breastfeeding (Monteiro et al., 2014).
Inhibitory determinants
Age factor
According to the result of research, it was found that teenage mother that is in age of <18 years old have a decrease
to practice breastfeeding compared to those that are in 18 to 19 years old. This founding is consistent with cross-
sectional study conducted in Nigeria founding that 36 percent of teenage mothers in age 12 to 18 years old have little
intensity in breastfeeding compared to teenage mother in age 20 to 24.9 years old. Younger mother has less
experience, education and social support needed to practice breastfeeding (Agho et al., 2021).
Working mother
Work is one of the main reasons for mothers to stop the practice of breastfeeding before 6 months and even for 2
years. As one participant explained, "work is the biggest breastfeeding challenge and it is inconvenient for mothers
to combine breastfeeding and work". Some mothers feel that they do not have time to work if they breastfeed (Lee et
al., 2013). The low duration of breastfeeding relate to the duration of off work since teenage mother should be back
to work full time, as most of them are in low level of economic condition. Moreover, other reasons are the lack
intervention program of effective breastfeeding among working mother as well as the lack of breastfeeding room for
mother in their working place i (Agho et al., 2021).
The use of dot
The evidence suggests that the use of dot has a negative effect on the duration of breastfeeding. This study showed a
negative association between the use of dot and breastfeeding maintenance in adolescent mothers in Brazil. infants
who do not use dot in our population could maintain breastfeeding for at least 6 months with the possibility for the
maintenance of breastfeeding for 12 or 24 months. In some countries, although the use of a point to reduce sudden
death or sudden death (SID), the Academy of Child and Grandmother in the United States and other politicians in
Canada, England, New Zealand and Ladon must delay at 4 or 6 years of Australia. However, the method of security
point of the parties is unclear, so pay attention to the signs of using the point to avoid the negative effect on
breastfeeding (Muelbert & Giugliani, 2018).
Type of childbirth
A pregnant woman tends to have antenatal and intrapartum challenge that needs medical intervention. The baby who
was born by caesarean delivery has less possibility to be fed in one hour after childbirth compared to baby who was
born by normal delivery (Brown et al., 2011; Budiati, 2019). Another finding stated that caesarean delivery reduces
the possibility to early breastfeeding initiation due to anaesthesia effect and stress or the anxiety during difficult
childbirth or other complication. In overall, this case focuses that intrapartum or childbirth experience is an
important determinant of early breastfeeding initiation. However, the increase of health worker involvement after
postpartum period related to higher possibility of exclusive breastfeeding to baby (Benova et al., 2020).

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Self-Efficacy to be a mother
The result of study showed that self-efficacy becomes crucial factor for early mother. It can be associated with
several dimensions in social context with negative perception of mothers and the less hope become early mothers,
such as breastfeeding and caring of children. The lack of self-efficacy is caused by life pressure including poverty.
The low of mothers’ self-efficacy related to bad breastfeeding of babies. This can interfere the relationship between
mother and baby. That also causes anxiety, depression, and motivation for mother. The self-efficacy of mother has
been linked with the mothers’ ability in providing society stimulation and nurturing in raising the children (Hackett
et al., 2015).
Undesired pregnancy
The Baby born with undesired pregnancy has little possibility to be breastfed early. An unplanned pregnancy can
make the mother unwilling to use maternal health services and not receive the breastfeeding counseling provided,
therefore, it affects the practice of breastfeeding in their later babies (Benova et al., 2020).
Special challenge in breastfeeding
In this research, respondents described some perceptions for breastfeeding. They conveyed that mother with the
higher social economic status tend to feel uncomfortable if breastfeeding in front of others. Therefore, they provide
formula milk to preserve social status and save the presige. Besides that, mothers do not breastfeed their children for
the sake of maintaining prestige (Hackett et al., 2015).
Conclusion
Based on the results of the scoping review, it was found that although national laws prohibit early marriage, this case
has continued to happen today. Adolescents do not tend to continue their study since they must marry at an early age
that leads them to have early childbirth and an increased risk of mother death and morbidity, therefore, it has an
impact on breastfeeding from the mother to her baby. Breastfeeding is an important foundation for the survival and
health of children, providing essential nutrients and protection necessary for early growth and development. Optimal
breastfeeding can prevent one baby from dying a year, while young mothers under 19 or first-time mothers are less
likely to breastfeed than older mothers. Moreover, younger mothers are lacking in terms of experience, education,
attitudes, and social support necessary for proper breastfeeding practices. For further research, it can be observed
deeply into mother knowledge, mother intentions, special challenges, and maternal traditions/habits about exclusive
breastfeeding, especially in mothers who get married at an early age.
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