ANALYSIS OF MOTHER'S KNOWLEDGE AND WORK BY GIVING EARLY WEANING FOOD IN TIRTOUDAN

Women


INTRODUCTION
Weaning food is additional food given to babies after the age of 6 months until the baby is 24 months old.(Sitasari & Isnaena, 2014).However, the reality is that many mothers give weaning food to less than 6 months of age or provide weaning food too early.Giving weaning food too early at less than 6 months of age is an indicator that the mother has failed to provide exclusive breastfeeding, so it also has an impact on the coverage rate of exclusive breastfeeding which is still low.Giving weaning food too early has many impacts on the baby's health, including diarrhea, intestinal infections, constipation, colds and gastric disorders.This is because the baby's digestive system is not ready to accept food other than breast milk, causing a reaction in the digestive system (Utami 2016).This is caused by several reasons, including because mothers' knowledge about the importance of breast milk is still low, mothers work outside the home, and lack of family support to provide exclusive breast milk to babies (Yuliaarti, 2014.Giving weaning food too early is a difficult problem.Because even though it is known that breast milk has advantages in terms of nutrition, immunity, economics, practicality and psychology.However, mothers' awareness of breastfeeding is still low.The practice of giving weaning food too early, namely to babies less than six months old, is a serious concern because the digestive organs in the baby's body have not yet developed fully. Government regulation number 33 of 2012 concerning the provision of exclusive breast milk states that exclusive breast milk is breast milk given to babies from birth for six months, without adding and/or replacing it with other foods or drinks (President of the Republic of Indonesia, 2012).According to a report by the world health organization, World Health Organization (WHO), nutritional problems can be indicated by the high incidence of malnutrition which shows that Indonesia's public health is the lowest in ASEAN, and is ranked 142nd out of 170 countries.WHO data states that Indonesia is classified as a country with a high status of malnutrition in 2015, namely 14.5% of children under five (Kurdaningsih, 2018).
Data in Indonesia in 2017 shows that 35.7% of babies received exclusive breast milk (Ministry of Health of the Republic of Indonesia, 2018).Based on data from the 2017 Indonesian Demographic and Health Survey, it shows that early provision of additional drinks was highest at the age of 2-3 months at 24.7% of the 506 Sriwijaya University children sampled and provision of solid or semi-solid food was highest at the age of 4-5 months at 32 .7% of 488 sample children (BPS, 2018).
Based on data from the Indonesian Ministry of Health in 2017, 3.5% of toddlers had poor nutritional status and 11.3% had malnutrition (Ministry of Health of the Republic of Indonesia, 2019).And data at integrated healthcare center Nusa Indah Tirtoudanpesantren district, Kediri City, there were 12 babies aged 6 months who received exclusive breast milk with a percentage of 30.40%, while the number of toddlers aged 6 months was 42 babies.From the data at integrated healthcare center Nusa Indah Tirtoudanpesantren district, Kediri City, it can be seen that there are still many babies who are given early weaning food.
The provision of weaning food before the age of 6 months is still high due to several factors.Biological factors include maternal factors, parity, use of contraception, and the health of the baby and mother.Socio-cultural factors are the direct influence of western culture, urbanization, attitudes towards breasts, the influence of advertising, and the influence of health workers, the mother's education level, the mother's occupation, and the mother's knowledge, economic factors namely income (Dahlia,2018).
The main factor that influences giving weaning food to babies is the mother, these factors include knowledge, health, mother's occupation, health workers, culture and socio-economics.Maternal knowledge is still lacking regarding the benefits of exclusive breastfeeding and mothers who work outside the home are closely related to giving additional food/weaning food to babies aged 0-6 months (Heryanto, 2017).Exclusive breastfeeding that is not optimal is caused by giving weaning food early.The level of maternal knowledge that is still lacking regarding exclusive breastfeeding results in mothers giving their babies bottle milk/formula milk more often than being breastfed by their mothers, and often babies who are only 1 month old are given bananas or soft porridge as additional breast milk (Baharudin 2014).
Early complementary foods or complementary foods for breast milk (weaning food) given to babies before 6 months of age result in long-term and short-term negative impacts.Short-term negative impacts if babies are given complementary foods before the age of six months include the baby losing nutrition from breast milk, reducing the baby's sucking ability, triggering diarrhea and triggering anemia.Meanwhile, long-term negative impacts if babies are given additional food to accompany breast milk before they are 6 months old include obesity, hypertension, and allergies.The inappropriate timing of complementary food (weaning food) is due to several reasons, one of which is that the mother is working (Savitri, 2016).
Breast milk is the main and first baby food for babies.The content is rich in various kinds of needs that babies need, all of which are in breast milk.Any type of food will be difficult to match the quality of breast milk.The period of exclusive breastfeeding that is good for babies is 0-6 months, at this age babies do not need other food, because all the needs that babies need are found in breast milk.Once the baby is > 6 months old, the baby needs additional food known as weaning food.Data from the Indonesian Ministry of Health (2015) revealed that the use of breast milk was deemed less than optimal.This is due to early provision of complementary foods for breast milk (weaning food).
There are many factors behind giving early weaning food.According to Roesli (2016), the phenomenon of lack of breastfeeding is caused by several factors, including mothers' inadequate knowledge about exclusive breastfeeding, the circulation of myths that are not good enough, as well as busy working mothers and short maternity leave.Apart from that, education level, employment status, socioeconomic, socio-cultural, mother's attitude, mother's condition, baby's condition, also influence breastfeeding so that exclusive breastfeeding is difficult to implement and early complementary feeding becomes an option.
Realizing the importance of giving exclusive breastfeeding and giving additional food for babies at the right age, it is necessary to make concrete efforts that must be made, namely first, advocacy to decision makers so that they can provide support/policies, direction, concrete assistance so that the breastfeeding program can be realized/ Exclusive breastfeeding.
Second, is the empowerment of breastfeeding mothers, families and communities about the importance of breastfeeding, through faceto-face meetings, breastfeeding demonstrations, in places where mothers gather such as recitations, social gatherings, fostering family welfare meetings, as well as breastfeeding education using various types of print and media channels, electronics to achieve broad targets.(Rohmah, M. 2023) Third is social support, namely with an approach so that various non-governmental organizations, various kinds/types of community social organizations participate directly in increasing the knowledge, awareness, willingness and ability of mothers to behave in feeding by breastfeeding their babies with breast milk only until 6 months (Exclusive breastfeeding), then you can give complementary foods to breast milk while continuing to breastfeed the baby until 2 years (Anwar, 2017) Based on the above background, researchers are interested in knowing "The relationship between maternal knowledge and work and early provision of complementary foods for breast milk at Integrated healthcare center Nusa Indah Tirto Udan, Pesantren District, Kediri City.

METHODS
This research was conducted to analyze the relationship between giving weaning food too early which is caused by the mother's knowledge and work at integrated healthcare center Nusa Indah, Pesantren District, Kediri City.
The design of this research is quantitative, the research design used is Cross Sectional, and the sampling technique in this research is Simple Random Sampling.The population in this study were all mothers who had babies aged 6-12 months, a total of 33 respondents at the integrated healthcare center Nusa Indah Tirtoudan, Kediri City.Data collection techniques using questionnaires.

RESULTS
Table 1    Primary Data Sources 2022 Based on table 9, after being tested together, it was concluded that there was a relationship between mother's knowledge and occupation and giving weaning food before the age of 6 months with the result obtained Sig = 0.005.So the significant result is 0.005 < 0.05, which means H1 is accepted.

DISCUSSION Mother's knowledge at integrated health care center Nusa Indah Tirtoudan
Based on table 4.1, it is known that almost half of the respondents have little knowledge about weaning food which can be seen in Table that there were 20 respondents (60%) out of 33 respondents.In this era, getting information to increase your knowledge about many things is easier, you don't need to go to high formal school to gain a lot of knowledge about various things, such as giving weaning food with increasingly advanced technological developments.However, there are still many people who use technology incorrectly, where most people only want to find out on the internet things that are less useful, such as watching viral TikToks, watching meaningless programs on TV or YouTube.
Therefore, mothers who have good knowledge are expected to easily get information The importance of giving exclusive breast milk to babies aged 0-6 months and can be reflected in their attitudes and behavior by trying to only give breast milk until the baby is 6 months old and not giving weaning food early / before the age of 6 months without any reasons that support it in terms of quality.a big role in someone's action of giving additional food to accompany breast milk (Syerlia et al, 2019).According to Lestari (2020), the mother's employment status variable is a protective factor, meaning that mothers who do not work will be more supportive of exclusive breastfeeding than mothers who work.This is because mothers who do not work outside the home (IRT) will have more time and opportunity to breastfeed their babies compared to mothers who work outside the home.(Lestari, 2020).

Mother's job in Tirtoudan Village
Working mothers tend to give weaning food to their babies before the age of 6 months due to work reasons which cause exclusive breastfeeding coverage to not be optimal, not according to the expected targets.The reasons usually given by working mothers are heavy work load, working hours that are not compatible with exclusive breastfeeding, the distance between the workplace and the place of residence, mothers are lazy to express breast milk, do not know how to express and store expressed breast milk properly and correctly.and there is no time to give breast milk directly so they choose to give food to their children.
Working mothers who work outside the home need ≥ 7 hours in accordance with the working hours policy at work, making them unable to provide exclusive breast milk to their babies.It is possible that mothers who work outside the home ≥ 7 hours do not have much opportunity to pay attention to and care for their babies, so the proportion of weaning food given before the age of 6 months is high.Apart from that, working mothers prefer to give weaning food to their babies because they can be given readily if the mother doesn't have time or when the mother is not with her baby.

Giving early weaning food at integrated healthcare center Nusa Indah Tirtoudan
Based on table 4.3, it is known that almost all respondents gave weaning food to their babies before the age of 6 months, namely 28 respondents (84%) out of 33 respondents.And almost all of them give weaning food from when the baby is 2 months old.The form of weaning food most often given by mothers is formula milk.
Almost all mothers give weaning food to their babies before the age of 6 months because it prevents the baby from fussing and being calm.the mother assumes that the baby is still fussy even though she has been breastfed with 2 breasts, so giving weaning food before the age of 6 months is an alternative to calm the baby.Apart from that, cultural traditions believe that they believe in giving weaning food in the form of bananas for the reason that the baby will be fuller, can sleep soundly and not be fussy.Giving banana to babies before the age of 6 months is because it has become a habit among the community.This shows that the respondent's attitude is still traditional or upholds the habits (customs) that exist in society.This is also in accordance with the theory put forward by syafrudin, 2018, that other factors that influence culture are traditional community attitudes and fear of cultural instability.
Under normal conditions for both mother and baby, breast milk alone can meet the nutritional needs of babies aged 0-6 months.Because breast milk is considered the most suitable for the baby's digestion at that time.Giving complementary foods before the age of 6 months can trigger digestive disorders and various other diseases, as stated by akre in anhari (2019).The conclusion is that giving complementary foods early in the short term will cause digestive disorders such as diarrhea and in the long term obesity, arteriosclerosis, hypertension and even children will be allergic to certain foods.
There are many benefits offered by exclusive breastfeeding for both babies and mothers.Weaning food itself can only be given when the baby is 6 months old because the nutritional content of breast milk has decreased while the baby's nutritional needs are increasing, as stated by Krisnatuti & Yenrina (2017) that additional food must be given when the baby no longer gets enough energy and nutrition from the baby.Breast milk only and most babies are given weaning food around the age of 6 months.
Many factors influence the provision of weaning food before the age of 6 months, apart from education and knowledge, employment, parity, socio-economic factors and the condition of the baby and mother.Conditions for mothers who can tolerate giving weaning food before the age of 6 months are mothers who have certain diseases such as TB, Hepatitis B, etc. (Yenrina & Krisnatuti 2018).Meanwhile, in babies it can be cleft lip, twins, etc. (Akre, 2018).However, we strive to provide complementary foods before the age of 6 months that have a consistency that is almost the same as breast milk.

The Relationship between Mother's Education and work and giving early weaning food
Based on the results of research conducted at the integrated health care center Nusa Indah Tirtoudan sub-district, Pesantren sub-district, Kediri city, it shows that the analysis results obtained when tested together show that there is a relationship between mother's knowledge and work and giving weaning food before the age of 6 months with a Simultaneous Sig value of 0.005 < 0.05, so H1 accepted.
The research results show that knowledge will influence the provision of weaning food before the age of 6 months.In accordance with the theory (Notoatmodjo, 2019) that knowledge influences a person's actions.The lower the knowledge, the lower the person's actions and the higher the knowledge, the better the person's actions.What is meant is action in the accuracy of giving weaning food with high knowledge, mothers understand the benefits of exclusive breastfeeding so they do not give weaning food before the age of 6 months.Mothers who understand the benefits of weaning food are given to babies aged more than 6 months.Parental knowledge is an important factor in children's growth and development.Knowledgeable mothers have more access to health facilities, both health facilities and infrastructure, than mothers who are less knowledgeable (Maritalia, 2019).
In the research results, most of the respondents' knowledge was lacking.The higher the mother's knowledge, the low er the possibility of the mother giving weani ng food before the age of 6 months.According to the researchers, this is possible because respondents who have high knowledge will find it easier to receive information and implement it in their daily lives.Meanwhile, respondents who have low knowledge have less ability, so even though they have been given information by the midwife, mothers are still less likely to accept it and be able to implement it.
In accordance with the opinion of Wawan and Dewi (2019), in general the higher a person's education, the easier it is to receive information so that the more knowledge they have.The mother's education level plays a role in the quality of her baby's care.Education in this case is linked to knowledge which will influence the choice of food ingredients and meeting nutritional needs.One example, the principle held by someone with low knowledge is usually "the important thing is to fill up", so that the portion of food that is a source of carbohydrates is greater than that of other food groups.On the other hand, groups of people with high knowledge have a tendency to choose food sources of protein and will try to balance them with other nutritional needs.
The higher the mother's education level, the more mothers work.And working mothers are more likely to give weaning food to their babies.This is because mothers are too busy and cannot leave their work for long, so weaning food is an alternative to replace breast milk while mothers work.This is also supported by (Roesli, 2010) that many working mothers experience a dilemma in giving exclusive breast milk to their babies even though mothers actually know the benefits and advantages of breast milk, but find it difficult to practice it.
Kristanto stated that work factors are related to the mother's daily activities to fulfill her daily needs.Mother's work can be done at home, at work places both near and far from House.In this case, the length of time a mother leaves her baby to work daily is the reason for giving additional food to the baby before the age of 6 months.
Most mothers say that they spend a lot of time working outside the home and that many offices or institutions do not support breastfeeding programs, maternity and maternity leave policies and breastfeeding facilities in the workplace that are less supportive.Lack of support from the workplace makes mothers lazy and unmotivated in giving exclusive breastfeeding to their babies.The physical and mental condition of working mothers who are tired after coming home from work means that mothers do not have time to express breast milk, which can result in decreased milk production.So mothers prefer to give weaning food as an addition or substitute for breast milk when the mother is working.
Suparyanto stated that weaning food is food given to children aged 6-24 months.The role of additional food is not to replace breast milk at all but to complement breast milk.So, complementary foods must still be given to children, at least until the age of 24 months.Weaning food is food or drink containing nutrients given to babies/children to meet their nutritional needs.Suprayanto stated that the practice of feeding babies from working mothers at home is the same as for mothers who do not work.Mothers who work without leaving the house are twice as likely to introduce weaning food in the form of formula milk to their babies at an early age compared to those who work without leaving the house and 4 times more likely than mothers who do not work.Rigid working hours, unavailability of child care, long distances from work locations and unsupportive maternity leave policies mean that mothers have to leave their babies for several hours, making it difficult for them to breastfeed on demand.

CONCLUSION
There is a relationship between mother's knowledge and work and giving weaning food before the age of 6 months at integrated health care service the Nusa Indah Tirtoudan sub-district, Pesantren subdistrict, Kediri city in 2022.