ISSN: 2347-467X, Vol. 10, No. (2) 2022, Pg.

607-619

Current Research in Nutrition and Food Science

www.foodandnutritionjournal.org

Women’s Empowerment and Sociodemographic

Characteristics as Determinant of Infant and Young Child
Feeding Practice in Indonesia
EKA MISHBAHATUL MARAH HAS*, FERRY EFENDI, SYLVIA DWI WAHYUNI,
IKA ZULKAFIKA MAHMUDAH and KUSNUL CHOTIMAH

Faculty of Nursing, Universitas Airlangga, Surabaya City, East Java, Indonesia.

Abstract
Proper infant and young child feeding (IYCF) practices are essential
to promote child's optimum health and improve their survival. Women's
empowerment is believed can mediate intra-household resources towards Article History
optimal IYCF practice. However, the evidence is limited in South-East Asia. Received: 08 October
This study was aimed to determine the association of women's empowerment 2021
and sociodemographic characteristics with IYCF practice in Indonesia. Accepted: 06 June 2022
This cross-sectional study used the 2017 Indonesia Demographic
Keywords
and Health Survey (IDHS) data. Samples were 4,923 women of reproductive Demographic and Health
age (aged 15-49 years) whose last child was aged 6-23 months old. Multiple Survey; Indonesia;
logistic regression was performed to determine the association of women's Infant and Young Child
Feeding Practice;
empowerment and sociodemographic characteristics with IYCF practice. Sociodemographic
Child's age 18-23 months old (AOR=6.58; 95% CI=5.121-8.456), husband's Characteristics;
occupation in non-agricultural sector (AOR = 2.18; 95% CI: 1.17-4.07), Women Empowerment
the richest household (AOR=2.83; 95% CI=2.007-4.002), and high level
of women's empowerment (AOR=1.311; 95% CI=1.085-1.584), significantly
associated with Minimum Dietary Diversity (MDD). Living in urban
residence is significantly associated with Minimum Meal Frequency (MMF)
(AOR = 1.23; 95% CI=1.026-1.481). Child's age 18-23 months old
(AOR=2.31; 95% CI=1.916-2.785), living in the richest household
(AOR=1.46; 95% CI=1.121-1.905), in urban residence (AOR=1.224; 95%
CI=1.033-1.451), and high level of women's empowerment (AOR=1.27;
95% CI=1.093-1.488), significantly associated with Minimum Acceptable
Diet (MAD). While women aged 45-49 years had significant negative
association with MAD (AOR=0.342; 95% CI=0.141-0.833; coef. =-1.072).

CONTACT Eka Mishbahatul Marah Has [email protected] Faculty of Nursing, Universitas Airlangga, Surabaya City,
East Java, Indonesia.

© 2022 The Author(s). Published by Enviro Research Publishers.

This is an Open Access article licensed under a Creative Commons license: Attribution 4.0 International (CC-BY).
Doi: http://dx.doi.org/10.12944/CRNFSJ.10.2.17
 HAS et al., Curr. Res. Nutr Food Sci Jour., Vol. 10(2) 607-619 (2022) 608

It can be concluded that women empowerment and sociodemographic

characteristics are associated with IYCF practice. Therefore, enhancing
women's Empowerment through health promotion is inevitable,
considering their sociodemographic background.

Introduction related to a child's mental health, socioemotional

Appropriate nutrition is essential to support a child’s behaviour, low intelligence, reduced productivity,
health and survival. Well-nourished children were reduced endurance, and increased morbidity
able to grow and develop optimally according to their and mortality.16,17
age.1 However, the world is still facing three faces
of malnutrition which robs a child's potential growth In most families, women are responsible for
and development. By 2020, 149.2 million children managing meals and caring for other family members,
under five years old are stunted, 45.4 million especially toddlers. Women's Empowerment is a
are wasted, and 38.9 million are overweight. 2 crucial determinant so that resources owned by the
The coronavirus disease 2019 (COVID-19) global family can be optimised for appropriate IYCF.18
pandemic and its economic fallout during 2020-2021 Kabeer divides women's Empowerment into three
also significantly worsen the prevalence of childhood components: resources, agency, and achievement.19
malnutrition. Most countries were loose track to meet Women who are empowered have these three things
nutrition targets.3 to claim the resources available in the household,
have control, participate in decision making,
Indonesia is one of the developing countries currently and act following their wishes to change their lives
experiencing a double burden of malnutrition.4–6 for the better.20
The 2018 Indonesia Basic Health Research revealed
that the proportion of wasted and stunted children Women's Empowerment, recently known, positively
is 17.7% and 30.8%. It is decreasing from 19.6% correlates with children's nutritional status. 20–24
dan 37.2% by 2013. However, the decrease was One study in Sub-Saharan Africa mentioned the
too slight and needed to be accelerated. On the positive correlation between women's empowerment
other hand, the proportion of overweight and the and IYCF practice.24 However, the role of women's
obese child continues to increase from 14.8% Empowerment as the determinant of IYCF practice
by 2013 to 21.8% by 2018.7,8This condition among Indonesian children is still limited. Therefore,
is insufficient to promote the World Health Organization this study was aimed to determine the association
(WHO) target's achievement by 2025 (20% for of women's Empowerment and sociodemographic
wasting and 40% for stunting) and Sustainable characteristics with IYCF practicefor 6-23 months
Development Goals, which targeted zero hunger old children in Indonesia using the 2017 IDHS data.
by 2030.9 The evidence was essential to develop a health
promotion program to improve IYCF practice for 6-23
Malnutrition is directly caused by inadequate months old children and accelerate the decrease
nutritional intake and infectious diseases. Indirectly, of childhood malnutrition.
it is influenced by improper parenting styles, food
insecurity, family sociodemographic characteristics Materials and Methods
(such as poverty and low education), poor sanitation This study was used across-sectional design
and health services access, and political and cultural derived from the 2017 IDHS data. In brief, the
conditions.10–12 Malnutrition reflects an unbalanced 2017 IDHS was a nationwide survey placed in 34
nutritional intake between intakes and needs.13 different provinces across Indonesia. Indonesian
Inappropriate infant and child feeding practices occur investigators started data collection on July 24th
most frequently during the transition period (6-23 to September 30th, 2017, helped by the Inner-City
months), from breast milk to solid food.14,15 If not Fund (ICF) International. Data are available for the
treated immediately, malnutrition can delay children public by registering on The Demographic and Health
growth and development. Malnutrition is also Survey (DHS) Program website. This study used an
 HAS et al., Curr. Res. Nutr Food Sci Jour., Vol. 10(2) 607-619 (2022) 609

individual data set. The individual recode contains should get solid/semi-solid food at least twice a day,
information about the eligible women who completed 2) a breastfed 9-23 months old child should get
the interview, including their characteristics, child solid/semi-solid food at least three times a day, and
health and nutrition, and background of husband/ 3) a non-breastfed 6-23 months old child should
spouse and respondent's work. The children's get solid/semi-solid food at least four times a day.
recode also included information about under The MAD combines MDD and MMF with different
five-year-old children. criteria between breastfed and non-breastfed 6-23
months old child.27 Each indicator used dichotomous
The 2017 IDHS successfully interviewed 49,627 coded: (1) if the respondent's IYCF practice comply
women of reproductive age (aged 15-49 years). with the WHO guidelines and (0) if the respondents
This study only uses data from women of reproductive did not comply with the guidelines.24 The instrument
age (aged 15-49 years), whose last child was used was a questionnaire for women of reproductive
6-23 months old, and complete data records. There age section 6 on child's health and nutrition.25
were 4,923 samples included.
The independent variable in this study was
The 2017 IDHS useda stratified two-stage sampling women's Empowerment. Kabeer's define women
method. In stage one, several census clusters were empowerment from the three dimensions.
selected using a systematic sampling proportional 1) resources (education level, asset ownership,
to size it was then stratified by urban and rural bank account ownership, and cell phone ownership),
areas, sorted by wealth index category. Stage two, 2) agency (control of personal income, control of
25 common households in each selected census husband's income, and participation in decision
cluster, were selected using systematic sampling making: significant household expenses) and
after updating the household list. There were 1,970 3) achievement (work status, type of work,
census clusters in urban and rural areas across income, and attitude towards wife-beating).19,22,28
Indonesia, with 49,250 eligible households and Each subdimension item is given a score of
59,100 women (15-49 years old) were expected to 1 if the respondent indicates the highest level of
respond.25 Empowerment and 0 if the respondent indicates
a lower level of Empowerment.24 Each dimension
This study's dependent variable is an IYCF practice score is obtained from the subdimensions' total—the
performed by the reproductive age of women maximum scores for the resources dimension 4,
(15-49 years old) to their youngest child (6-23 agency 3, and achievement 4. Next, the dimension
months old). There was three indicators for scores are added to determine the women's
assessing IYCF practice as recommended by WHO, empowerment score (range of values 0-11).
which were mentioned as follows: minimum dietary Determination of respondents having a high or low
diversity (MDD), minimum meal frequency (MMF), level of Empowerment is assessed by comparing
and minimum acceptable diet (MAD). The standard the total score of women's Empowerment with
recodes manual for DHS 7 was used to determine the mean of the entire sample. Respondents with
each indicator.26 The MDD was defined as food a total score ≥mean are classified as having high
received by 6-23 months old children in the last 24 women’s Empowerment, while those with a total
hours before the interview. Children should receive score <mean have low women’s Empowerment.
at least four from seven food groups, including The instrument used was the 2017 IDHS
grains, roots and tubers; legumes and nuts, dairy questionnaire, namely: households, women
products, flesh foods, eggs, vitamin-A rich fruits of reproductive age, and currently married men.25
and vegetables and other fruits and vegetables.
The MMF was defined as a 6-23 months old As an independent variable in the present study,
child who received solid, semi-solid, or soft sociodemographic characteristics are divided
foods(including milk feeds for non-breastfed intochild, women, husband/spouse, and household
children) in minimum frequency in the last 24 hours characteristics. The sex and age group of the child
before the interview, which differed by child’s age represented child characteristics. The sex of the
and their breastfeeding status. The guide for MMF child has differed as male or female.29–31 The child's
was as follows 1) a breastfed 6-9 months old child age group was ranged6-11, 12-17, 18-23 months
 HAS et al., Curr. Res. Nutr Food Sci Jour., Vol. 10(2) 607-619 (2022) 610

old.24 Women characteristics were represented by Variable with p-value 0.05 and 95% CI were
age group of women, categorised as 15-19, 20- significantly associated with IYCF practice.
24, 25-29, 30-34. 35-39. 40-44. 45-49 years old.32
Husband/spouse characteristics include education The DHS survey and its procedures were reviewed
level and occupation. The education level of the and granted by The ICF Institutional Review
husband/spouse was classified as less than the Board (IRB). Additionally, the 2017 IDHS protocols
primary, secondary or higher level of education.33 are also ethically reviewed by the Ministry
Husband/spouse's occupation was divided into did of Health of Indonesia. Consent was collected
not work, agriculture worker, or others.29 Household from all respondents before the interview. When
characteristics were represented by the number downloading the dataset, personal identity was
of under five-year-old children in the household, excluded to maintain the confidentiality of the
wealth index, and residence place. The number respondent's data.
of children under five years old was classified
as ≤1 or≥2 children. 34 The household's wealth Results
index is scored from the number of assets owned, A total of 4,923 respondents were included
housing characteristics, source of drinking water, in the statistical analysis. Table 1 shows the
toilet facilities, and other wealth status indicators distribution of respondents' characteristics.
(BKKBN, 2018). Based on DHS 7, the wealth index The child's characteristics showed that 51.94%
was classified as poorest, poorer, middle, richer, of children were male, and 35.48% were 12-17
richest.35,36 Place of residence was categorised into months old. Women's characteristics showed that
an urban or rural area.24,29,35 26.28% of respondents were aged 25-29 years,
had a husband/spouse who attained secondary
There were several independent datasets in or higher educational level (73.25%) and worked
the 2017 IDHS survey, including household's, in the non-agricultural sector (77.71%). Household
individual's, and children's recode. These different characteristics showed that 70.61% of respondents
files were merged to build the data set for analysis. had less than one child under five years, 21.28%
Then, data cleaning is performed. Incomplete data lived in richer wealth index quintile households,
were deleted. So, a valid result can be obtained. and 50.73% lived in an urban residence.
Bivariate analysis using chi-square (level of Half of the respondents have a low level of women's
significance 95%) will be performed to determine Empowerment (50.02%). The distribution of three
the association of women empowerment and indicators of IYCF practice showed that the majority
sociodemographic characteristics with IYCF practice of children met MDD (77.45%), MMF (66.67%),
and the Odds Ratio (OR). A Multiple Logistic and MAD (53.93%).
Regression was used to perform multivariate analysis.

Table 1: The distribution of respondent's characteristics

Variables n=4,923 %

Sex of child
Male 2557 51.94
Female 2366 48.06
The age group of children

6-11 months old 1637 33.26

12-17 months old 1747 35.48
18-23 months old 1539 31.26
The age group of women
15-19 years old 160 3.25
 HAS et al., Curr. Res. Nutr Food Sci Jour., Vol. 10(2) 607-619 (2022) 611

20-24 years old 941 19.11

25-29 years old 1294 26.28
30-34 years old 1287 26.15
35-39 years old 900 18.29
40-44 years old 294 5.98
45-49 years old 47 0.93
The education level of husband/spouse
Less than primary or primary 1317 26.75
Secondary or higher 3606 73.25
Occupation of husband/spouse
Did not working 45 0.91
Agricultural worker 1053 21.38
Others 3825 77.71
Number of children under five years old in
the household
≤1 3476 70.61
≥2 1447 29.39
Wealth index
Poorest 957 19.44
Poorer 978 19.86
Middle 959 19.47
Richer 1047 21.28
Richest 982 19.95
Place of residence
Urban 2426 49.27
Rural 2497 50.73
Women's empowerment level
Low 2462 50.02
High 2461 49.98
MDD
No 1110 22.55
Yes 3813 77.45
MMF
No 1587 32.23
Yes 3336 66.67
MAD
No 2269 46.08
Yes 2654 53.93

The distribution of family socio demographic from the richest wealth index (86.95%), living in the
characteristics and women empowerment based on urban residence (81.38%), and had a high level
IYCF practice are presented in Table 2. It is shown of women empowerment (81.98%). Table 2 also
that the percentage of children who met MDD was shows that the percentage of children who met
high in the following group female children (78.92%), MMF was high in the following group male children
aged 18-23 months old (88.87%), children of women (68.49%), aged 6-11 months old (68.52%), children
aged 25-29 years old (78.82%) whose husband/ of women aged 20-24 years old (70.50%) whose
spouse had a secondary or higher level of education husband/spouse had a secondary or higher level
(79.85%) and worked in the non-agricultural sector of education (68.57%) and worked in the agricultural
(79.83%), with the number of children under sector (68.73%), with the number of children under
five years old in the household were ≤1 (78.76%), five years old in the household were ≥2 (69.11%),
 HAS et al., Curr. Res. Nutr Food Sci Jour., Vol. 10(2) 607-619 (2022) 612

from the richest wealth index (70.89%), living in the husband/spouse had a secondary or higher level
urban residence (69.67%), and had a high level of education (56.18%) and did not working (57.06%),
of women empowerment (69.18%). It is shown with the number of children under five years old
that the percentage of children who met MAD in the household were ≤1 (54.28%), from the
was high in the following group female children richest wealth index (62.82%), living in the urban
(54.04%), aged 18-23 months old (61.26%), children residence (57.93%), and had a high level of women
of women aged 25-29 years old (56.04%) whose empowerment (58.29%).

Table 2: Distributions of family sociodemographic characteristics and women empowerment

based on IYCF practices

MDD MMF MAD

Variables No Yes No Yes No Yes

n % n % n % n % n % n %

Sex of child
Male 611 23.91 1946 76.09 806 31.51 1751 68.49 1181 46.18 1376 53.82
Female 499 21.08 1867 78.92 781 33.00 1585 67.00 1087 45.96 1279 54.04
Age groups of child
6-11 697 42.57 940 57.43 515 31.48 1122 68.52 953 58.20 684 41.80
12-17 242 13.84 1505 86.16 579 33.15 1168 66.85 719 41.18 1028 58.82
18-23 171 11.13 1368 88.87 492 31.99 1047 68.01 596 38.74 943 61.26
Age groups of women
15-19 47 29.68 113 70.32 53 32.89 107 67.11 84 52.54 76 47.46
20-24 220 23.35 721 76.65 278 29.50 663 70.50 420 44.60 521 55.40
25-29 274 21.18 1020 78.82 410 31.70 884 68.30 569 43.96 725 56.04
30-34 276 21.47 1011 78.53 408 31.72 879 68.28 585 45.46 702 54.54
35-39 207 22.99 693 77.01 322 35.81 578 64.19 436 48.41 464 51.59
40-44 71 24.27 223 75.73 94 31.95 200 68.05 142 48.44 152 51.56
45-49 14 30.79 33 69.21 22 46.16 25 53.84 33 70.11 14 29.89
The education level of husband/spouse
Less than 384 29.14 933 70.86 453 34.40 864 65.60 688 52.26 629 47.74
primary
Secondary or 727 20.15 2879 79.85 1133 31.43 2473 68.57 1580 43.82 2026 56.18
higher
Occupation of husband/spouse
Did not 15 34.37 30 65.63 15 33.22 30 66.78 19 42.94 26 57.06
working
Agriculture 323 30.69 730 69.31 329 31.27 724 68.73 523 49.69 530 50.31
worker
Others 772 20.17 3053 79.83 1242 32.48 2583 67.52 1726 45.12 2099 54.88
Number of children under five years old in the household
≤1 738 21.24 2738 78.76 1140 32.79 2336 67.21 1589 45.72 1887 54.28
≥2 372 25.71 1075 74.29 447 30.89 1000 69.11 679 46.93 768 53.07
Wealth index
Poorest 311 32.54 646 67.46 311 32.51 646 67.49 497 51.98 460 48.02
Poorer 265 27.11 713 72.89 316 32.31 662 67.69 484 49.53 494 50.47
Middle 222 23.10 737 76.90 316 32.96 643 67.04 449 46.81 510 53.19
Richer 184 17.58 863 82.42 357 34.14 690 65.86 473 45.14 574 54.86
Richest 128 13.05 854 86.95 286 29.11 696 70.89 365 37.18 617 62.82
Type of place of residence
Urban 452 18.62 1974 81.38 736 30.33 1690 69.67 1021 42.07 1405 57.93
 HAS et al., Curr. Res. Nutr Food Sci Jour., Vol. 10(2) 607-619 (2022) 613

Rural 658 26.37 1839 73.63 851 34.07 1646 65.93 1248 49.97 1249 50.03
Women's empowerment level
Low 667 27.08 1795 72.92 828 33.63 1634 66.37 1242 50.44 1220 49.56
High 443 18.02 2018 81.98 758 30.82 1703 69.18 1026 41.71 1435 58.29

Table 3 shows the age group of children, occupation MDD than those whose unemployed husbands
of husband/spouse, household wealth index, (AOR = 2.18; 95% CI: 1.17-4.07). Children of women
and the level of women's Empowerment significantly from the wealthiest quintile increase the odds
associated with MDD. This study revealed that of meeting MDD 2.83 times compared to those
18-23 months old children had 6.58 times higher odds from the lowest quintile (AOR=2.83; 95% CI=2.007-
of meeting MDD than 6-11 months old (AOR=6.58; 4.002). Children of women with a high level of women
95% CI=5.121-8.456). Children of women whose empowerment are more likely to achieve MDD
husband/spouse worked in the non-agricultural 1.31 times higher than women with low empowerment
sector had 2.18 times the odds of delivering levels (AOR=1.311; 95% CI=1.085-1.584).

Table 3: The association of women's Empowerment and sociodemographic

characteristics with IYCF practices

Variables MDD MMF MAD

OR p-value OR p-value OR p-value

(95% CI) (95% CI) (95% CI)

Sex of child
Male
Female
The age group of children
6-11 Ref Ref
12-17 5.205 0.000 2.067 0.000
(4.188-6.467) (1.743-2.450)
18-23 6.581 0.000 2.310 0.000
(5.121-8.456) (1.916-2.785
The age group of women
15-19 Ref
20-24 1.172 0.478
(0.756-1.819)
25-29 1.111 0.627
(0.726-1.699)
30-34 1.015 0.944
(0.661-1.559)
35-39 0.875 0.552
(0.563-1.359)
40-44 0.870 0.573
(1.536-1.412)
45-49 0.342 0.018
(0.141-0.833)
The education level of husband/spouse
Less than primary or primary
Secondary or higher
 HAS et al., Curr. Res. Nutr Food Sci Jour., Vol. 10(2) 607-619 (2022) 614

Occupation of husband/spouse
Did not working Ref
Agricultural worker 1.726 0.096
(0.907-3.283)
Others 2.176 0.015
(1.165-4.067)
Number of children under five years old in the household
≤1
≥ 2
Wealth index
Poorest Ref Ref
Poorer 1.213 0.147 1.021 0.854
(0.934-1.576) (0.819-1.273)
Middle 1.482 0.009 1.087 0.495
(1.104-1.989) (0.855-1.383)
Richer 1.979 0.000 1.092 0.494
(1.459-2.683) (0.848-1.407)
Richest 2.834 0.000 1.461 0.005
(2.007-4.002) (1.121-1.905)
Place of residence
Urban 1.233 0.025 1.224 0.020
(1.026-1.481) (1.033-1.451)
Rural Ref Ref
Women's empowerment level
Low Ref Ref
High 1.311 0.005 1.275 0.002
(1.085-1.584) (1.093-1.488)

As present in Table 3, the only place of residence 1.451). Children of women aged 45-49 years
which significantly associated with MMF. Children had 0.34 times lower odds to meet MAD than those
of women living in an urban area have 1.23 times aged 15-19 years old (AOR=0.342; 95% CI=0.141-
the odds of achieving MMF than those living in 0.833; coef.=-1,072). See Table 3.
rural areas (AOR = 1.23; 95% CI=1.026-1.481).
Discussions
The age group of children, age group of women, Children aged 18-23 months old were more likely to
wealth index, place of residence, and women meet MDD. Similarly, previous studies revealed that
empowerment level were significantly associated older age groups had attained MDD compared with
with MAD. Children between 18 and 23 months the youngest age groups.29,35 Since children's age
of age have higher odds of meeting MAD than is increasing, mothers' misconceptions that infants
children between 6 and 11 months (AOR=2.31; and younger children find difficulties swallowing and
95% CI=1.916-2.785). Children of women with digesting a particular meal, such as animal orplant-
high empowerment levels were 1.27 times more source foods, were decreased.37,38 Mothers were
likely than women with low empowerment to then encouraged to provide complementary feeding
achieve MAD (AOR=1.27; 95% CI=1.093-1.488). as suggested by WHO to their children.
Children of women from the richest wealth index had
1.46 higher odds of delivering MAD than those from This study revealed that children of women
the lowest wealth index (AOR=1.46; 95% CI=1.121- who had husbands/spouses worked in the non-
1.905). Children of women living in an urban area agricultural field tended to receive a diversified diet.
had 1.22 higher odds of delivering MAD than those This result was in line with earlier research in Nepal
living in rural areas (AOR=1.224; 95% CI=1.033- that indicated that children whose father worked
 HAS et al., Curr. Res. Nutr Food Sci Jour., Vol. 10(2) 607-619 (2022) 615

as a sellerhave higher odds of meeting MDD.39 associated with the MAD.45 That study revealed
Non-agricultural occupation linked to fixed monthly that the prevalence of MAD in children aged 18-23
income, allowing them to afford diversified food months old was 55.2% higher than the younger
for their child. age.45 Study in the Santal community found that
58.1% fulfilment of MAD was delivered by children
This present study revealed that children of aged 12 to 23 months.46 Another study stated that
women from the richest wealth index households the factor associated with MAD was prior knowledge
were more likely to meet MDD. It was congruent and experience in feeding frequency according
with the previous study, which stated that mothers to child’s age. As the child grows older, the mother
in wealthier households tended to give variety can give more varied and frequent food.47 This
and healthy food to their children.35,40 A study also study indicates that the younger child receives
reported that most families in the highest wealth less than four food groups recommended by WHO
index of Ethiopia feed their children with at least four and less frequent in their daily meal. It can also be
food groups daily.41 Family’s ability to buy food is affected by the lack of knowledge about diet variety
compulsory to achieve children's MDD.42 Diversified and frequency based on children's age and culture
food is affordable for mothers who live in the higher in feeding practice.
wealth index household.
The present study informed that children of women
In this study, children whose mothers had a high aged 45-49 years old had a lower propensity
level of women empowerment were more likely to deliver a MAD than those aged 15-19 years.
to meet MDD. Similar to this finding, previous The previous study using 2007 Demographic
studies mentioned that women's empowerment and Health Survey data revealed that only 20.3%
was a significant positive determinant of children's of mothers by the age 35-49 deliver the MAD than
dietary diversity.35 A study from sub-Saharan Africa the younger age mother.45 Mother and father with
found that working women who were economically a high level of education, informally employed
empowered had more control over their family mother, and listen to the radio were correlated
finances.24 It will increase their financial ability with the achievement of MAD. 44 Older mothers
to access foods and distribute them to their children. with low formal education may face difficulties
Another Benin study stated that women with higher in using technology to access information and gain
self-confidence could make better health-enhancing knowledge about how tofulfil their children's MAD.
decisions.43 So, they can also decide to feed their
children a wider variety of food. This study also revealed that wealth status has
a positive association with the delivery of MAD.
This study found that the children of urban women The wealthiest family were reported as the
had greater odds of meeting MMF than rural women. determinant of providing MAD to the child.48,49
In line with this finding, earlier research mentions that The economic status that influences one's behaviour
children who lived in the edge region were unmet the in achieving a child is MAD, especially for low-income
MMF as their mother faced economic constraints and families. Poverty may hinder a mother's ability
disadvantages by the bad weather, which affected to provide good quality food and meet children's
their food availability.44 Another study conducted in dietary needs.31 Targeting poor households for the
Ethiopia found that urban mothers are better than national nutritional program should be considered
rural mothers in providingMMFfor their children when tailoring a proper diet for children.
as recommended by WHO (AOR = 3.02; 95%
CI: 1.41, 6.48).38 Urban mothers were more likely to This study found that urban residents had a
have a good awareness of IYCF practices to provide high propensity to deliver a minimum acceptable
the recommended MMF. diet than rural residents. Similarly, a previous
Ethiopia study found that urban mothers had 4.8
Children aged 18-23 months old had a higher times to deliver a MAD to their children.49 Another
propensityto deliver a MAD than children aged 6-11 study also highlighted that 6-23 months old children
months old. These findings related to other studies living in an urban area were more likely to meet
noted that increasing a child's age is positively the minimum acceptable diet than children living in
 HAS et al., Curr. Res. Nutr Food Sci Jour., Vol. 10(2) 607-619 (2022) 616

a rural area.48 The urban resident might have various reproductive age) to recall the child's diet in the
choices and easy access to various diets, leading last 24-hours before the interview, which increases
to high consumption. the probability of information bias.

This study showed that children whose mothers had Conclusions

high empowerment levels tended to deliver a MAD In summary, the current IYCF practice among 6-23
than their counterparts. This finding was similar to months old children in Indonesia is not yet adequate.
previous studies, which stated that empowerment Family sociodemographic characteristics include
increase mothers' ability to provide a minimally child's age, women's age, occupation of husband/
diverse and acceptable diet to their children.24,50 spouse, wealth index, and residence, which remain
Empowerment is the maternal capabilities' domain significant factors in IYCF practice according to
that influences IYCF practice and child nutritional WHO recommendation for 6-23 months old children.
status. Empowerment provided a baseline This study also highlighted the significance of women
for adaptation and refinement, which increased empowerment for proper IYCF practice. Therefore,
maternal capabilities to fulfil child nutrition and it is necessary to develop health promotion that
promote positive health outcomes.50 It is also one empowers women as the key people responsible
of the critical features that facilitate intra-household for their household feeding. So, their ability
resources towards the best care to improve the to manage household resources optimally to
child’s nutritional status.51 Children whose mothers deliver IYCF as recommended by WHO for their
had a higher level of women empowerment might children can be increased. Future research should
have more control and freedom in the household also consider paternal factors, as they play
decision-making process regarding the child's a significant direct or indirect role in IYCF practice.
nutrition fulfilment, which has contributed to
the achievement of the child's MAD. Acknowledgement
The authors wish to thank the Faculty of Nursing,
This study has strengths includes 1) the data Universitas Airlangga, which gives financial support
used was nationally representative data, which for this study through "Penelitian Unggulan Fakultas"
makes the findings could be possibly generalised (Excellence Research Grant) grant number 1368/
to the national level, 2) the instrument used was UN3.1.13/PT/2020. The author also wishes to
internationally standardised based on DHS phase thank the ICF and BKKBN (Indonesian National
7 questionnaires with high validity and reliability, Family Planning Coordinating Board), which provide
4) study which examining women empowerment the 2017 IDHS data, and Sarni Berliana for
and IYCF practice in South East Asia setting are still supporting data cleaning and analysis.
lacking and 4) most published study only focusing on
women empowerment and its correlation with IYCF Funding
practice, but in this study, we also measure family Funding given by Faculty of Nursing, Universitas
sociodemographic characteristics. Airlangga, Surabaya, Indonesia through "Penelitian
Unggulan Fakultas" (Excellence Research Grant)
However, the present study had several limitations. grant number 1368/UN3.1.13/PT/2020.
First, data were collected using a cross-sectional
approach, making it difficult to determine a cause- Conflict of Interests
effect relationship. Second, IYCF practice was The authors declare no conflict of interest regarding
measured by asking the mother (women of this paper's research, authorship, and publication.

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