Grandmother ' s Social Support in Exclusive Breastfeeding Motivation

Received 13 February 2021 Accepted 4 August 2021 Published 5 September 2021 Grandmother's social support is a form of social interaction in which there is a relationship that gives and receives tangible assistance by grandmothers to mothers in giving exclusive breastfeeding to their babies. This study aims to determine the relationship between grandmother's social support and motivation to exclusively breastfeed mothers at Tomia Utama. The research design was non-experimental quantitative correlational using a proportional stratified random sampling technique with a sample size of 59. The data analysis used was bivariate analysis, chisquare test with α 0.05. The results showed that social support for grandmothers was good as much as 66.1% with high motivation to give exclusive breastfeeding as much as 94.9%, while social support for grandmothers was not good as much as 33.9% who had low motivation to give exclusive breastfeeding as much as 5.1%. The conclusion of the study is that there is a relationship between grandmother's social support and motivation to exclusively breastfeed the mother. Suggestion: The need to provide education about the importance of social support for grandmothers and families for the success of exclusive breastfeeding to families and to form breastfeeding support groups. Keyword:

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INTRODUCTION
Breast milk is a natural first food for babies. Breast milk (breast milk) is the secretion from both sides of the mother's breast glands in the form of an emulsion of fat in a solution of lactos, organic salts and protein, as the main food for babies, which contains a perfect source of nutrition according to the needs for the growth and development of the baby. (Sri Astuti 1955)WHO (World Health Organization) recommends.
exclusive breastfeeding, exclusive breastfeeding is breast milk given to babies from birth to the first 6 months, without adding and / or replacing them with other foods or drinks in order to reduce infant morbidity and mortality (Sandra G. J. Tombokan et al., 2016).
Sustainable Development Goals in the 2030 Agenda For Sustainable Development plans that by 2030 the neonatal mortality rate can be reduced by at least 12 per 1,000 live births and mortality in children under 5 years of age by at least 25 per 1,000 live births. One of these can be achieved by providing exclusive breastfeeding with good implementation (United Nations). WHO and UNICEF are collaborating on the Global Nutrition Targets 2025 to increase the coverage rate for exclusive breastfeeding in the first 6 months of life by at least 50%, this is because globally the exclusive breastfeeding rate is only 40%.So in this target there is a minimum of 1.2% increase in breastfeeding coverage each year. This figure is determined because exclusive breastfeeding can prevent 800,000 under-five deaths or 13% of the total under-five deaths (WHO, 2017). In an effort to preserve the use of breast milk, the percentage of exclusive breastfeeding globally, only 40% of babies under six months of age are arranged exclusively. Based on data from the results of Riskesdas in Indonesia, monitoring data on nutritional status in 2019 shows that the coverage of exclusive breastfeeding for the first 6 months is still very low, which is only 36.7%, meaning that around 65% of babies do not receive exclusive breastfeeding during the first 6 months of birth. This figure is still far from the target of exclusive breastfeeding coverage in 2019 set by WHO and the Ministry of Health, which is 80%.
Based on the results of data and information on Indonesia's health profile (2019), the coverage of exclusive breastfeeding with the highest proportion of breastfeeding for babies aged 0-5 years 2019 is the province of Bangka Belitung Islands (56.7%), while the province with the lowest proportion is West Nusa Tenggara (20 , 3%), Gorontalo at 24.96%, and Southeast Sulawesi at 41.63%. According to (Ratnasari et al., 2017) Several factors influence the success of exclusive breastfeeding both as a support and a barrier, including internal factors and external factors. Internal factors such as knowledge and perceptions of mother's comfort regarding exclusive breastfeeding, age and maternal health conditions and promotion of breastfeeding (Oktavianto et al., 2019). While external factors such as husband's trust, family, parental trust, social relations and friendship, social support (Pillitteri& Adelle, 2015).
The results of Agunbiade's (2012) study in West Nigeria stated that a grandmother or mother-in-law is someone who plays a role in children's health production, namely the culture of breastfeeding (Wibowo Heri, 2019). Exclusive breastfeeding coverage requires the support of fathers, family and relatives such as grandparents and grandparents who are the closest family members to the mother. The importance of grandmother's competence in breastfeeding also greatly affects the success of breastfeeding by mothers to their babies. And as for the results of the initial survey conducted by researchers by interviewing 10 mothers at the Tomia Induk Community Health Center, Waha Village, it was found that out of 10 mothers 6 of them did not exclusively breastfeed their babies for 6 months, babies were given additional food such as sufor or MP-ASI, due to the lack of support from the family for exclusive breastfeeding.
The results of the initial survey conducted by researchers by interviewing 10 mothers at the TomiaInduk Community Health Center, Waha Village, found that out of 10 mothers 6 of them did not exclusively breastfeed their babies with breast milk for 6 months, the babies were given additional food such as sufor and complementary foods, by reason of the lack of support from the family for exclusive breastfeeding. Based on the results of a preliminary study conducted in early September 2020 at the TomiaInduk Community Health Center, Waha Village, through interviews with grandmothers or mothers-in-law who live with their grandchildren from 6 months to 1 year of age. Grandmothers are visitors to the PosbinduPuskesmasTomia. Of the 20 grandmothers or mothers-in-law who were interviewed, there were 10 grandmothers or mothers-in-law who did not support exclusive breastfeeding. However, the grandmother or mother-in-law further recommends and encourages early complementary feeding. Some grandmothers have the habit of giving additional food to their grandchildren early and think that their grandchildren will not be fulfilled if they are given breast milk alone. In addition, the baby's grandmother or mother-in-law also plays a role in providing additional food for their grandchildren because the grandmother or mother-in-law takes part in caring for the baby.
The purpose of this study was to determine the relationship between social support and exclusive breastfeeding in the TomiaInduk Community Health Center, Waha Village.

Research participants
The sample in this study were mothers who have children from the age of 6 months -2 years, mothers who are physically and mentally healthy and mothers who live with the baby's grandmother.
Research procedure the study was only conducted on mothers who have children aged 6 to 2 years who live with their grandmothers.

Instrument
The research instrument used a measuring tool in the form of questions in the form of a questionnaire about the relationship between grandmother's social support and motivation to exclusively breastfeed the mother. The questionnaire used in this study is the result of previous research that refers to a conceptual framework based on a literature review of variables related to the relationship between grandmother social support and motivation to exclusively breastfeed mothers.

Data analysis
This study uses bivariate analysis to find the relationship between two variables, namely the independent and dependent variables using the chi-square statistical test, the data is processed using SPSS. To determine the relationship, the p value is compared with the level of significance or error used (α = 0, 05). From the results of research at the Tomia Induk Health Center, Waha Village that based on the analysis of the relationship between grandmother's social support and motivation to give exclusive breastfeeding to mothers, it can be seen that the grandmother's social support has an effect on the motivation to provide exclusive breastfeeding to mothers with p-value 0.035 and α 0.05 results. Data analysis using SPSS with the chi-square test with the Pearson chi-square approach shows that there is a relationship between grandmother's social support and motivation to exclusively breastfeed mothers at the Tomia Utama Puskesmas, Waha Village.

RESULTS AND DISCUSSION
The results of this study are in line with research conducted in Sentani Papua by Florince (2020) which states that there is a relationship between grandmother's social support and motivation to provide exclusive breastfeeding to mothers. Mothers who received support from grandmothers and their families were 4 times more likely to breastfeed exclusively with breastfeeding compared to mothers who received less support from their grandmothers and families. It can be seen that the birth mother (baby grandmother) will really love her child who has given birth to her grandchild so that the experience of the birth mother will be transmitted to her child both in caring for the child, providing examples of breastfeeding and caring for the child (Florince et al., 2020).
The exploration of factors that influence the success of mothers in exclusive breastfeeding are maternal psychological factors, maternal physical factors, maternal occupation, maternal knowledge, family support (Tenri Figures, 2019). For that every breastfeeding mother needs social support from the surrounding environment. Social support is a factor in every individual that can determine a person's health behavior. In this case the health behavior in question is exclusive breastfeeding, exclusive breastfeeding is included in health behavior because it has a positive effect and provides benefits for both the health of the mother and the baby. Social support can be obtained from a number of people who are considered important (significant others) such as parents or grandmothers of babies, husbands, children, relatives or close relatives and friends. People who get social support will experience positive things in their life, have self-esteem, and have a more optimistic outlook (Marwiyah & Khaerawati, 2020). This is also in accordance with research by (Yuliana & Nulhakim, 2019) that the support of grandmothers as the closest woman makes mothers more confident about their decision to provide exclusive breastfeeding. The existence of grandmother's support such as encouraging her to always give exclusive breastfeeding, giving practical and concrete help to mothers has an effect on the success of giving exclusive breastfeeding. Grandmothers play a role in influencing the decision to breastfeed, so it is not uncommon for grandmothers to attend grandmother classes which aim to support exclusive breastfeeding by mothers (Yuliana & Nulhakim, 2019).
Research in Depok, West Java by (Natalia & Rustina, 2020) also states that mothers who get good support from grandmothers and other families will have the opportunity to provide exclusive breastfeeding 3.7 times better than mothers whose grandmother's social support is lacking. The support of a grandmother who firmly thinks that breastfeeding is the best will make it easier for mothers to give exclusive breastfeeding to their babies (Natalia & Rustina, 2020). The role of grandmothers and their families is proven to be significant in the success of providing breastfeeding practices and increasing the rate of exclusive breastfeeding. The social support provided by grandmothers and families has a positive impact on mothers. The positive impact that is felt is that the breastfeeding is getting smoother, more enthusiastic in giving breast milk to their children, feeling the comfort and burden faced is reduced. This includes how far the skills of each mother and each other in managing themselves, by practicing self-organization physically and mentally, milk production becomes smoother with better quality. It should be remembered that breast milk produced for mothers cannot be separated from the harmony of mind and spirit of both parents. Therefore, the involvement of grandmothers from the beginning of breastfeeding will certainly make it easier and easier for couples. Grandmothers and families can carry out their roles well for breastfeeding mothers by always providing moral support by accompanying mothers when breastfeeding. The support provided will motivate mothers and feel more confident so that breast milk production will also increase (Widiastuti et al., 2019).
With this study, it can be concluded that grandmother's social support with the motivation to provide exclusive breastfeeding has a relationship with the success of exclusive breastfeeding. The participation of grandmothers and families in the form of support to mothers during this period is a success of a mother during breastfeeding, namely giving exclusive breastfeeding. Grandmothers and families play a very important role in reducing the anxiety of nursing mothers in caring for their children with breast milk.

Limitation of The Study
Research must consider the involvement of the husband. because the husband also has a role in the success of breastfeeding.

CONCLUSIONS AND RECOMMENDATION
The conclusion of this study is that there is a relationship between grandmother's social support and motivation to exclusively breastfeed mothers at TomiaInduk Public Health Center, Waha Village.