Father's involvement in the success of exclusive breastfeeding

Breastfeeding is to be the best food that babies should eat because it contains all the nutritional elements needed for growth and development. The role of the father is a factor, one of which can affect the practice of breastfeeding where the role of the father can make the mother feel cared for, calm and this can facilitate milk production. This study aims to see the relationship between the factors of breastfeeding fathers on the practice of breastfeeding. Cross-sectional is a design used in this study which has a sample of 78 fathers who have toddlers taken by random sampling in the Mandonga District, the data obtained were analyzed using the chi-square test. The results of the study showed that there was a relationship between father's knowledge and breastfeeding practice (p= 0,014), attitude variable and breastfeeding practice (p= 0,000) and there was no relationship between father's role and breastfeeding practice p= 0,485). In conclusion, the knowledge and attitudes of breastfeeding fathers are related to the practice of exclusive breastfeeding. There needs to be an increase in father's knowledge of breastfeeding practice support.


Introduction
Exclusively, breastfeeding is a very effective method that is beneficial for the health of the baby and mother.Breast milk is a complete source of nutrition.So, it is useful for increasing children's immunity, increasing intelligence, improving motor skills, reducing the risk of cancer and diabetes in children, improving vision and speech, preventing allergies, and preventing stunting (Wulandari et al., 2019).Breast milk can also reduce the risk of children developing diarrhea and infectious diseases.This is because breast milk is hygienic and has a composition and temperature suitable for the growth and development of children (Otik & Amanda, 2019).
Low exclusive breastfeeding coverage greatly affects the quality of life of the next generation and impacts the national economy (Citra & Dewi, 2016).Exclusive breastfeeding contributes 302 billion USD in economic income to the world every year.This is in line with the goals of the Sustainable Development Goals (SDGs) in points 1, 8, and 10, namely economic growth, reducing inequality, and eliminating poverty.Breastfeeding is the best source of nutrition with a bioactive composition so that it can improve the health status of children and mothers, which is contained in the goals of SDGs points 2 or 3 related to hunger reduction, welfare, and health problems (Prasetya et al., 2019).
But on the contrary, children who do not get nutrition from breast milk and have an impact on hunger so that it can cause malnutrition do so because of multiple factors that can cause failure in breastfeeding activities (Lundquist et al., 2022).This is one of them because of the lack of role from the closest person to the mother, so it becomes a cause of the unsuccess of the exclusive breastfeeding program because the process of giving breast milk does not only involve the baby and the mother but also involves the closest people, such as the husband, who is said to be the breastfeeding father (Sinaga & Siregar, 2020).A breastfeeding father is the full support of a husband to his wife in breastfeeding activities (Domili et al., 2021).
In fact, conditions on the ground regarding the role of fathers in the breastfeeding process are not fully implemented.The father leaves the decision entirely to the mother to breastfeed because the mother undergoes (Ningsih, 2018).Fathers are only focused on the task of earning a living and usually do not participate in helping mothers (wives) in home management, and fathers prefer to use formula milk if the milk does not come out smoothly without trying to improve milk production (Kartini et al., 2018).
The role of the father will be more effective if the father has knowledge and understands his role in the exclusive breastfeeding process.Fathers must better recognize that breastfeeding is not only the duty of the mother but also the duty of a father (Rosyada & Putri, 2018).Fathers must recognize what should be done so that actions or mindsets can be affected by the success of breastfeeding (Citra & Dewi, 2016).Fathers who take part in breastfeeding activities will have an impact on the achievement of exclusive breastfeeding.The role of the father will succeed based on the knowledge that the father has; the more knowledge the father has, the more he will know about the importance of the involvement or role of the father (Utami et al., 2020).
Knowledge is something that fathers must have in order to have a positive impact on the practice of breastfeeding (Prasetya et al., 2019).One step that can improve the behavior and knowledge of fathers is to conduct education or health education (Ratnaningsih, 2020).Provision of health education in the form of the importance of breastfeeding for infants Then he breastfed his father in order to carry out his role.Providing health education to breastfeeding fathers in Perth, Western Australia, can increase breastfeeding 1.46 times compared to formula feeding (Lundquist et al., 2022).The level of health education among fathers can have an impact on the role of breastfeeding fathers (Ardia & Purnamasari, 2020).
In addition to knowledge, there are still many factors that can affect the success of exclusive breastfeeding practices in infants, such as attitudes and the role of the father himself.For this reason, this study aims to analyze the influential factors in the development of exclusive breastfeeding practices.

Methods
The quantitative research using a crosssectional design was conducted in Mandonga District, Southeast Sulawesi Province, in June 2022.A sample of 78 fathers with toddlers was taken from a population of 350 using the Slovin formula and a random sampling technique based on criteria determined by researchers.Fathers who are sampled must have children who are over 6 months to 1 year old.

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The variables studied were the knowledge, attitudes, and roles of fathers towards exclusive breastfeeding, collected using questionnaires and interview techniques.The questionnaires used were those developed by researchers and tested for validity (r table 0,196) and reliability (0,840 > 0,60).Knowledge variables are categorized into good and bad; attitudes are categorized into 2 categories, namely positive (supportive) and negative (not supportive); the role of fathers is also categorized into 2 categories, namely good and bad; and exclusive breastfeeding is categorized into exclusive breastfeeding and not exclusive breastfeeding.The determination of these criteria is based on previous research that has been used: knowledge variables with cut-off points with good knowledge categories >17,36, bad knowledge ≤17,36, negative attitudes ≤21,75, and positive attitudes >21,75, bad roles ≤22,41 and good roles >22,41.
The results obtained were analyzed bivariately using the Chi-square test to test the relationship of independent variation with dependent variation and presented in the form of tables and narratives to explain the results obtained from this study.
This research has gone through the ethical review stage with the Health Research Ethics Commission of the Indonesian Institute of Health Sciences (No. 2935/KEPK/IV/2022).

Result and Discussion
The following the result of research that has been conducted on breastfeeding fathers regarding exclusive breastfeeding.The results obtained on the knowledge variable described that fathers who had poor knowledge, such as fathers who did not know the benefits of breastfeeding for infants and toddlers, did not exclusively breastfeed as much as 50,6%, while fathers who had a good level of knowledge and toddlers exclusively breastfed were 66,6%, and the results of the analysis obtained showed that there was a significant relationship between fathers' knowledge and the practice of providing exclusive breastfeeding with a value of 0,014.An OR value of 4,350, which means that the father's poor knowledge has a 4,350-fold risk of the baby not getting exclusive breastfeeding.
Negative paternal attitude variables such as not providing support and motivation to mothers to breastfeed with their toddlers not getting exclusive breastfeeding were 70,3%, while positive attitudes with toddlers getting exclusive breastfeeding were 42,8%, and the analysis described a relationship between fathers' attitudes and exclusive breastfeeding with a value of 0,000.An OR value of 3,004, which means that the negative attitude possessed by the father has a risk of 3,004 times the baby not getting exclusive breastfeeding.
Poor fatherhood variables such as often ignoring or not helping mothers in breastfeeding with toddlers not exclusively breastfeeding as much as 55,5%, good fathers with toddlers getting exclusive breastfeeding as much as 39,3%, and analysis illustrates no relationship between the role of fathers and the practice of exclusive breastfeeding, which is worth 0,485.

Father's Knowledge of Exclusive Breastfeeding Practices
Knowledge is said to be a necessary domain in the formation of one's behavior.Knowledge is the result of knowing or sensing objects through the senses that a person has (Nilakesuma, 2018).In this study, the variable knowledge of toddler fathers was almost entirely poor, which means that toddler fathers did not receive much education or information about the role of fathers in exclusive breastfeeding involvement.This study illustrates that there is a relationship between paternal knowledge and exclusive breastfeeding practices (p = 0,014).
Fathers' knowledge about exclusive breastfeeding can influence mothers to give toddlers exclusive breastfeeding.Good knowledge that fathers have about the benefits of exclusive breastfeeding, so that fathers will be able to educate and motivate mothers to be able to give their toddlers exclusive breastfeeding (Pratiwi et al., 2022).But on the contrary, the father's low knowledge about the benefits of exclusive breastfeeding means it cannot educate or motivate mothers of toddlers to implement exclusive breastfeeding (Mariani & Suratmi, 2021).Therefore, fathers' knowledge related to breastfeeding is one of the factors that can be related to the practice of breastfeeding.Knowledge is not one of those absolute factors that can influence the practice of exclusive breastfeeding (Budianto & Handayani, 2020).
Some research results illustrate that knowledge has a relationship with exclusive breastfeeding practices.Other factors, namely formula milk advertising, lifestyle changes, and mindset, are among the factors that can affect the practice of exclusive breastfeeding (Yanti, 2021).

Father's Attitude to Exclusive Breastfeeding
Fathers have an important role in influencing mothers decisions to breastfeed children.This is because mothers believe that the positive attitude that fathers have when the process begins to continue breastfeeding children will take place very well because of support from the father or the closest person (Winingsih et al., 2021).The results of the study of fathers' attitude variables almost entirely show a negative attitude towards breast milk, which means that fathers receive little information about exclusive breastfeeding, which has an impact on the attitude shown by fathers.This study illustrates that there is a relationship between fathers' attitudes and the practice of exclusive breastfeeding (p = 0,000).
Fathers who already have experience in decision-making matters for breastfeeding mothers can reduce or modify negative views of men so that breastfeeding achievement can increase and fathers develop more positive views (Ardia & Purnamasari, 2020).But on the contrary, fathers who are not experienced in breastfeeding practices and do not have good knowledge will be able to influence the attitude that will be taken by the father, and this will also be affected by the decision that will be taken by the mother in terms of breastfeeding (Maryani & Zuriyyatina, 2018).This is in accordance with the results of previous research, which illustrates that there is a relationship between the attitudes shown by fathers and the practice of exclusive breastfeeding.Fathers who have a positive attitude can affect the level of achievement of exclusive breastfeeding in society (Otik & Amanda, 2019).

Father's Role in Exclusive Breastfeeding
The involvement or role of a father in making a decision, starting from Early Breastfeeding Initiation (EBI/Inisiasi Menyusu Dini/IMD) to introducing an alternative feeding method for infants, is a key form of support for a father in promoting the benefits of breastfeeding to infants (Sihota et al., 2019).In addition, many fathers argue that they feel unable to influence the mother in making a decision regarding feeding, but a mother will feel that the father's support in playing a role in making a decision is very important, especially in the early decisionmaking process (Bich et al., 2019).
The results of the study show that fathers have a bad role, which means that fathers are not much involved in breastfeeding practices because this is entirely left to the mother and because fathers think that mothers will do it in the future.This study illustrates that there is no relationship between the role of fathers and the practice of exclusive breastfeeding (p = 0,485).This is in accordance with the results of research that has been conducted by previous studies, which show that there is no relationship between the role that fathers play Umrana et al.
in the practice of breastfeeding.But in reality, a mother needs the support or role of a father's involvement because it can provide and anticipate the emotional breastfeeding mother's needs as well as affection, physical needs, support, and encouragement for a mother to constantly breastfeed her baby (Kartini et al., 2018).There needs to be an effort made by the government to increase the role or support from fathers to mothers in providing breast milk to their babies, by means of which the government can work with a breastfeeding community to increase fathers' knowledge related to breastfeeding.The role of the father is very important because it can make the mother more relaxed so as to increase the hormone prolactin, which plays a role in promoting breast milk (Ningsih, 2018).

Conclusion
Fathers' attitudes and knowledge have a relationship with the practice of exclusive breastfeeding, while the role of fathers is not related to the practice of exclusive breastfeeding.
Suggestions, specific efforts, and comprehensive efforts need to be made by stakeholders such as central and local governments, especially health offices that interact directly with the community.Empowering the community, especially fathers, in the involvement of parenting patterns, providing support to wives to provide exclusive breastfeeding, increasing knowledge, and encouraging fathers' motivation to be involved in household affairs.

Table 1 .
The Relationship of Breastfeeding Father Factors with Exclusive Breastfeeding