Socioeconomic and Cultural Disparities in the Early Breastfeeding Initiation among Working Mothers in Indonesia

Abstract

Background: The low implementation of Early Breastfeeding Initiation (EBI) among working mothers is often linked to their dual burden of domestic and economic responsibilities. Cultural norms, traditional values and social structures also shape EBI related practices. Certain cultural beliefes such as giving pre-lacteal milk liquids and extended family decisions in the birth process, can hinder the implementation of EBI. This study examined socioeconomic disparities in EBI practices among working mothers in Indonesia, emphasizing the cultural factors that specifically affect the likelihood of initiating breastfeeding in the first hour of life.Methods: This cross-sectional study analyzed data from 46,130 children. EBI served as the independent variable, while socioeconomic status was the dependent variable, with seven controls: residence, mother’s age, education, marital status, antenatal care, birthplace, and child’s gender. Socioeconomic position was measured using wealth quintiles ranging from the poorest to the richest. Binary logistic regression assessed the association between EBI and socioeconomic status, with interpretation of findings considering cultural differences across social groups.Results: The result showed that 59.7% of working mothers in Indonesia had implemented EBI. Socioeconomic status was a significant predictor of EBI. Poorer mothers were 1,146 times more likely to initiate EBI than wealthier mothers (95% CI: 1,134-1,159). Conversely, the richest mothers had a 1.422-fold higher likelihood of achieving EBI compared with the poorest (95% CI: 1.288-1.315), while working mothers had a 1.399-fold higher chance (95% CI: 1.385-1.414). EBI was also more common among mothers who had antenatal care, lived in rural areas, were older, married, and had higher levels of education. These variations indicate that beyond economic status, access to health information and cultural values strongly influence EBI practices among working mothers.Conclusion: Socioeconomic disparities significantly influence EBI among working mothers in Indonesia. Wealthier mothers are more likely to initiate breastfeeding within the first hour, highlighting the role of socioeconomic position in shaping maternal health behaviors. Cultural norms further contextualize these differences, affecting decisions and practices surrounding early breastfeeding. Strengthening EBI coverage therefore requires strategies that go beyond structural and economic improvements, incorporating cultural considerations and family support.