Determinants of Midwife Performance in Lactation Management in Surakarta and Karanganyar, Central Java


  • Nurul Wahidah Masters Program in Public Health, Universitas Sebelas Maret
  • Endang Sutisna Sulaeman Masters Program in Public Health, Universitas Sebelas Maret
  • Uki Retno Setia Budihastuti Department of Obstetrics and Gynecology, Dr. Moewardi Hospital, Surakarta


Background: Exclusive breastfeeding has been recommended by World Health Organization for reduction of infant illness and death. Midwives have an important role in lactation management, which includes: (1) Teaching all lactating mothers on how to successfully breastfeed and sustain it up to 2 years or more; (2) Coming in contact with mothers and infants to promote, protect, and support breastfeeding. However, exclusive breastfeeding coverage was still low at 80% nationally, 76.7% in Surakarta, and 61.1% in Karanganyar in 2016, suggesting low midwife performance in lactation management. This study aimed to determine factors associated with midwife performance in lactating management in Surakarta and Karanganyar, Central Java.

Subjects and Method: This was an analytic observational study with a cross-sectional design. The study was conducted in community health center in Surakarta and Karanganyar, Central Java, from April to June 2018. A sample of 200 midwives was selected by simple random sampling. The dependent variable was performance in lactation management. The independent variables were skill, motivation, experience, health facility, and work load. The data were collected by questionnaire and analyzed by a multilevel logistic regression.

Results: Midwife performance in lactation management increased with better skill (b= 2.06; 95% CI= 0.48 to 3.65; p= 0.011), strong motivation (b= 1.15; 95% CI= -0.09 to 2.41; p= 0.070), work experience (b= 2.06, 95% CI= 0.69 to 3.44, p= 0.003), and available facility (b= 2.29, 95% CI= 0.89 to 3.68, p= 0.001). Performance decreased with higher workload (b= -1.47; 95% CI= -2.76 to -0.18, p=0.025). Community health center had a contextual effect on midwives performance with ICC= 34.8%.

Conclusion: Midwife performance in lactation management increases with better skill, strong motivation, work experience, and available facility. Performance decreases with higher workload. Community health center has a contextual effect on midwives performance.

Keywords: performance, lactation management, determinant, midwife

Corresp ondence:Nurul Wahidah. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, 57126, Surakarta, Central Java. Email:

Journal of Health Policy and Management (2018), 3(1): 26-33


Aninanya GA, Howard N, Williams JE, Apam B, Prytherch H, Loukanova S, Otupiri E (2016). Can performance based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi experimental study. Global HealthAction, 9(1).

Bacolinia (2013). Breastfeeding during the first hour of life and neonatal mortality. Jornal de Pediatria, 89(2), 131136.

Bhutta ZA, Das JK (2013). Global Burden of Childhood Diarrhea and Pneumonia: What Can and Should Be Done? Pediatrics, 131(4), 634

Birhanu Z, Assefa T, Woldie M, Morankar S (2010). Determinants of satisfaction with health care provider interactions at health centres in central Ethiopia: a cross sectional study. BMC Health Services Research, 10(1): 78.

Bogaert VP, Timmermans O, Weeks SM, van Heusden D, Wouters K, Franck E (2014). Nursing unit teams matter: Impact of unitlevel nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse eventsA crosssectional survey. International Journal of Nursing Studies, 51(8), 1123-1134.

Dinkes Kabupaten Karanganyar (2016). Profil Kabupaten karanganyar.

Dinkes Surakarta (2016). Profil Kota Surakarta tahun 2016.

Erkul et al. (2010). Evaluation of breastfeeding in a baby.Friendly city,

Gay et al. (2013). Kecamatan Ternate Selatan Kota Ternate Maluku Utara Tahun 2013 Social Determinant Factors Affecting Lactation Management In Pregnant Women In Work Area Health Center Kalumata Southern District Of Ternate In North Maluku City Of Ternate In 2013 2Bagian Bio, (42).

Hanieh et al. (2015). Exclusive breast feeding in early infancy reduces the risk of inpatient admission for diarrhea and suspected pneumonia in rural Vietnam: A prospective cohort study Global health. BMC Public Health, 15(1), 1

Haron (2016). The study of nurses

Isfahani HM, Aryankhesal A, Haghani H (2014). The Relationship Between the Managerial Skills and Results of

Kemenkes RI (2014). InfoDatin, Situasi dan analisis ASI EKSKLUSIF. Pusat Data Dan Informasi Kementerian KesehatanRI.

Lamberti et al. (2013). Breastfeeding for reducing the risk of pneumonia morbidity and mortality in children under two: a systematic literature review and metaanalysis. BMC Public Health, 13(3).

Larson E, Hermosilla S, Kimweri A, Mbaruku GM, Kruk ME (2014). Determinants of perceived quality of obstetric care in rural Tanzania: a crosssectional study. BMC Health Services Research, 14(1): 483.

Lok et al, 2017. (2017). Family members

Parker V, Giles M, Lantry G, McMillan M (2014). New graduate nurses

Putriningrum (2016). Exclusive Breast Feeding Management: Qualitative Study on Working Mothers in Kalibawang District, Kulon Progo, Yogyakarta, 13

Sahito (2013). Keberhasilan Pemberian Asi Eksklusif. Jurnal Health Quality, 4(2): 77

Sari UP (2016). Pengaruh Fasilitas, Lingkungan Kerja Dan Motivasi Terhadap Kinerja Pegawai Di Kantor Camat Sangatta Selatan Kabupaten Kutai Timur. eJournal Pemerintahan Integratif, 4(4), 505

Snowden A, Stenhouse R, Young J, Carver H, Carver F, Brown N (2015). The relationship between emotional intelligence, previous caring experience and mindfulness in student nurses and midwives: A cross sectional analysis. Nurse Education Today, 35(1), 152

Suryantini SH (2008). Analisa Determinan Pelaksanaan Manajemen Laktasi Pada Pelayanan Antenatal, 2006 USU Repository

Tecla SJ, Omenge OR, Priscah MJ (2017). Evaluating Provider

UNICEF (2017). Determined to breastfeed

Victoria (2017). A prospective study of breastfeeding intentions of healthy weight and overweight women as predictors of breastfeeding outcomes. Midwifery. 53: 2027.

WABA 2017 (2017). Awareness of the Benefits and Practice of Exclusive Breastfeeding (EBF) among nursing mothers in Anyigba , North Central Nigeria. World Journal of Nutrition andHealth,5(1),15.

Weldegebriel (2016). Motivation of health workers and associated factors in public hospitals of West Amhara, Northwest Ethiopia. Patient Preference and Adherence. 10: 159-169.




How to Cite

Wahidah, N., Sulaeman, E. S., & Budihastuti, U. R. S. (2018). Determinants of Midwife Performance in Lactation Management in Surakarta and Karanganyar, Central Java. Journal of Health Policy and Management, 3(1), 26–33. Retrieved from