Study on Policy and Implementation of Exclusive and Early Initiation of Breastfeeding in Indonesia

In Indonesia, the Ministry of Health has set an Exclusive Breast Feeding [EBF] target of 80%, which is considered as unrealistic, especially where the current trend of EBF is showing a decline. The aim of this paper is to review the implementation and the policy of EBF and Early Initiation of breastfeeding (EI) in Indonesia based on existing studies. The policy, as stated in Kepmenkes No. 237/1997, PP No. 69/1999, and Kepmenkes No. 450/2004, was analysed using content, context, process and actor models, and triangulated by an advocacy coalition framework. Review on implementation shows that EBF practice in Indonesia is still very low and midwives have not been facilitating EI optimally. Policies on EBF are not complete and not comprehensive. EI has not been included explicitly and several aspects of policy content should have been updated. The advocacy coalition framework analysis confirms the findings of earlier analysis by emphasizing weaknesses in the external system as well as policy sub-system in the development of EBF policy. It is suggested to update and renew the existing EBF policy as to be more relevant in terms of content, context, process, and actor. An EBF policy should always include an Early Initiation component. The new policy should also include sanction, reward, and monitoring and evaluation to strengthen the implementation of the policy in community.