The Relationship of Formula Milk Promotion with The Intention of Exclusive Breast Milk in Babies Aged 0-6 Months in The Work Area of The Tering Health

Introduction : Breast milk is an ideal nutrition for babies which contains the most suitable nutrients for the baby's needs and contains a set of protective substances to fight disease. The success of exclusive breastfeeding is influenced by a mother's intention to give exclusive breastfeeding, but currently the influence of formula milk promotion is very large and affects the coverage of exclusive breastfeeding. Objective : to determine the relationship between promotion of formula milk and the intention of exclusive breastfeeding in infants aged 0-6 months. Methods : This type of research is descriptive analytic with a cross sectional design. Result and Discussion : There is a relationship between the promotion of formula milk and the mother's intention to provide exclusive breastfeeding to infants aged 0-6 months in the Working Area of the Tering Public Health Center in West Kutai Regency in 2022 with a p value of 0.000 and OR = 28.500. Promotion of formula milk that is carried out on a large scale can affect the mother's intention to give exclusive breastfeeding because the promotion of formula milk gives a wrong understanding that formula milk is as good as exclusive breastfeeding. Conclusion : promotion of formula milk can affect the intention of exclusive breastfeeding in infants aged 0-6 months.


Introduction
Breast milk is an ideal nutrient for babies that contains nutrients that best suit the baby's needs and contains a set of protective substances to combat disease.The first two years of a child's life are very important, as optimal nutrition during this period decreases morbidity and mortality, reduces the risk of chronic diseases, and encourages better development throughout N (WHO, 2018).
The low coverage of exclusive breastfeeding has an impact, especially on the health of the baby.Research published in the European Respiratory Journal states that children who have never been breastfed have a risk of respiratory and digestive disorders in the first four years of life.Compared to infants who received breast milk for 6 months or more, and non-exclusive breastfeeding contributed 11.6% in mortality of children under the age of 5 years (Maryunani, 2018).
The lack of maximum exclusive breastfeeding is supported by the results that the percentage of mothers who breastfeed babies continues to decline as the baby ages.Results from the Turkey Demographic and Health Survey (TDHS) showed that although 58% of babies in the study were exclusively breastfed in the first and second months of life, the percentage decreased to 10% only in the next fourth and fifth month (Hacettepe University Institute of Population Studies, 2019).
The success of exclusive breastfeeding is influenced by a mother's intention to give exclusive breastfeeding.Factors that influence the intention of pregnant women in providing exclusive breastfeeding are gestational age, social norms,mmother's work, maternal motivation, promotion of formula milk and experience breastfeeding mothers (Jatmika et al., 2019).
The theory of resoned action states that behavior is an action that arises due to the intention that a person has.Intention (intention to perform behavior) is the transition from a person's beliefs or beliefs to a desired action.Intention will appear after the existence of a positive attitude and normative support from the surrounding environment to carry out a behavior.A person's intentions in the theory of reasoned action are influenced by the subjective attitudes and norms he has and believes in.Attitude towards behavior is influenced by behavioral beliefs and evaluation of behavioral outcomes.Subjective norms are influenced by normative beliefs and motivation to comply (Glanz and Viswanath, 2018).The high low intention of pregnant women to give exclusive breastfeeding will have an impact on the high and low coverage of exclusive breastfeeding.
A factor affecting exclusive breastfeeding is the promotion of infant formula.Rahmawati & Arti (2018) stated that currently it is difficult to avoid the promotion of formula milk, the ease of social media is a means of promotion of various products including advertisements for formula milk both directly nor indirectly.The results of a study by Ney et al. (2019) that respondents who were interested in formula milk advertising were 75% had no intention of exclusive breastfeeding.This proves that the magnitude of the impact of advertising on a person's interest in a product by using Sukensi, Hilda, Rosalin Ariefah Putri/KESANS The Relationship of Formula Milk Promotion with The Intention of Exclusive Breast Milk in Babies Aged 0-6 Months in The Work Area of The Tering Health Center West Kutai District in 2022 advertising to attract conTotalers to buy a product.This can increase the negative impact of optimizing exclusive breastfeeding coverage by changing the mother's perspective, intention to breastfeed exclusively and mother's confidence in exclusive breastfeeding (Hansen et al., 2018).
The preliminary study conducted by researchers through interviews of 10 breastfeeding mothers aged 0-6 months as many as 7 people did not give exclusive breastfeeding because they said their babies had been given formula milk and because feeling unsure that the milk is enough for the baby.According to researchers, mothers have less intention to give exclusive breastfeeding because mothers can breastfeed their babies exclusively but mothers prefer to give formula milk.

Method
This research was carried out with a quantitative approach with a cross-sectional research design.The population in this study was all mothers who had babies aged 0-6 months in the Tering Puskesmas Work Area West Kutai Regency, as many as 66 people.The sampling technique used a total sampling technique of 66 respondents.The research instrument used is a questionnaire.Data analysis in this study used univariate analysis with frequency distribution and bivariate analysis using the Chi Square formula.

Results and Discussion
Result 1.Based on the table above, out of 66 respondents, most of the respondents aged between 20-35 years were 36 people (54.5%), most of the respondents had a junior high Sukensi, Hilda, Rosalin Ariefah Putri/KESANS The Relationship of Formula Milk Promotion with The Intention of Exclusive Breast Milk in Babies Aged 0-6 Months in The Work Area of The Tering Health Center West Kutai District in 2022 school education of 34 people (51.5%), most of the respondents were Housewives peers of 51 people (77.3%), most of the multiparity of 36 people (54.5%).Based on the table above, it can be seen that of the 66 respondents, most of the respondents were affected by the promotion of formula milk, namely 42 people (63.6%) and those who were not affected by the promotion of formula milk as many as 24 people (36.4%).Based on the table above, out of 66 respondents, most of the respondents have a weak intention to provide exclusive breastfeeding, namely 44 people (66.7%) and those who have strong intentions gave exclusive breastfeeding as many as 22 people (33.3%).Analysis of the relationship between the promotion of formula milk and the intention of exclusive breastfeeding was carried out using the Chi Square formula with a significant level of alpha 5% and df= (2-1) (2-1) =1, when viewed at χ 2

Bivariate Analysis
The table found the number 3,841, while the value of χ 2 count= 26,592>χ 2 table=3,841.The result of the probability value (p value) =0.000 <α 0.05, by itself Ho was rejected, which means that there is a relationship between the promotion of formula milk and the intention of exclusive breastfeeding in infants aged 0-6 month in the Working Area of the Tering Health Center, West Kutai Regency in 2022.
OR (Odds Ratio) analysis shows a value of 28,500, which means that mothers who are affected by formula milk promotion are at 28,500 times greater risk of having a weak intention to give exclusive breastfeeding compared to with mothers who are not affected by the promotion of formula milk.

Discussion a. Age
The results showed that most of the respondents were aged between 20-35 years, namely 54.5%, this shows that most mothers who have babies aged 0-6 months are at the age of healthy reproduction is the age of 20-35 years.Age is behind a person's mindset or perspective, the more mature a person's age should be, the more logical or mature the person's mindset should be (Wulan & Hasibuan, 2020).
Age can affect a person's way of thinking, acting, and emotions.A more mature age generally has more stable emotions than a younger age.The age of the mother will affect the emotional readiness of the mother.A mother's age that is too young when pregnant can cause her physiological and psychological condition to not be ready to be a mother.This can affect pregnancy and parenting (Hurlock, 2018).Age affects how breastfeeding mothers make decisions in exclusive breastfeeding, the older they get, the more experience and knowledge they gain (Notoatmodjo, 2018).

b. Education
The results showed that most respondents had a junior high school education level of 51.5%, this shows that most mothers who have babies aged 0-6 months have a level of low education.
The level of education and the mother's access to mass media also influence decision making, where the higher the education the greater the opportunity to provide exclusive breastfeeding.Conversely access to media affects negative to breastfeeding, where the higher the mother's access to the media, the higher the chance of not giving exclusive breastfeeding (Abdullah et al., 2020).

c. Work
The results showed that most respondents did not work or as Housewives at 77.3%.This explains that most mothers have more time at home to breastfeed exclusively because they are not tied to formal work.
One of the most common reasons for mothers not breastfeeding is because they must work.Women are always working, especially at childbearing age, so it is always a problem to figure out how to care for a baby.Work not only means work that is paid for and done in the office, but it can also mean working in the fields, for people in rural areas (King, 2016in Liliana et al., 2017).
World Breastfeeding Week in 1993 was commemorated with the theme Mother Friendly Workplace, showing that there is worldwide attention to the dual role of breastfeeding and working mothers.One of the policies and strategies of the Ministry of Health of the Republic of Indonesia concerning the Improvement of Breastfeeding (PP-ASI) for female workers is to strive for facilities that support complementary food for mothers who breastfeed at work by providing milking room facilities, providing equipment for milking and storing breast milk, providing breast milk counseling materials, and providing counseling (Pertiwi & Suyatno, 2017).

d. Parity
The results showed that most respondents with multiparity had children between 2-4, which was 54.5%.This explains that pregnant women have good parity because the pregnancy at risk is the first pregnancy or > 4 pregnancy.Suradi (2007) in Handayani & Rustiana (2020) that one of the factors that influence breastfeeding includes the characteristics of 24 mothers, namely the experience of breastfeeding mothers.The difference in the number of children will affect the mother's experience in terms of breastfeeding.A mother who has successfully breastfeeding at a previous birth will be easier and more confident that she will be able to breastfeed at the next birth.A young mother with her first child will find it difficult to be able to breastfeed (Solihah, 2010in Handayani & Rustiana, 2020).

Formula Milk Promotion
Based on the results of the study, most mothers who had babies aged 0-6 months were affected by the promotion of formula milk, namely 42 people (63.4%), this explains that there are still many mothers who are more believe in formula milk compared to breast milk.
Promotion of formula milk is a variety of activities carried out by producers to communicate the benefits of formula milk products as breast milk substitutes with the aim of persuading and reminding target conTotalers in order to buy such formula milk products (Kotler, 2017).
Improved communication and transportation facilities that facilitate advertising of the distribution of artificial milk (formula milk) have led to a shift in behavior from breastfeeding to formula feeding in both rural and urban areas.Ads that promote that a factory's milk is as good as breast milk, can shake the mother's confidence so that she is interested in trying to use formula milk.The faster the addition of formula to the baby causes the suction power to decrease.Since the baby easily feels full, the baby will be lazy to suck the nipples, as a result of which the production of prolactin and oxytocin will decrease.Currently, there is an increasing number of formula milk advertisements with the distribution of brochures about formula milk advertisements.Compared to even the most expensive or claimed best formula milk, the quality of breast milk will never be matched.In breast milk, it contains many useful substances as well as what babies need for the growth and development process and support their intelligence that formula milk does not have, so the Department Health and WHO (World Health Organization) emphasized the importance of exclusive breastfeeding in babies at least the first 6 months (Ministry of Health of the Republic of Indonesia, 2017), This research supports research conducted by Dewi (2021) where in her research explained that as many as 80% of mothers who have babies aged 0-6 months are interested in the promotion of formula milk, they consider formula milk as good as breast milk.
According to researchers, there are still many mothers who are affected by the promotion of formula milk because there are still many as Totalptions that obese children are healthy children, so many mothers give formula milk With the hope that the baby will get big and fat quickly, even though the child who is fat because of formula milk can cause problems in the future.

Exclusive Breastfeeding Intentions
The results showed that most respondents had a weak intention in exclusive breastfeeding.This explains that it seems that the mother has no strong desire to give breast milk for 6 months without additional food.
Intention is an indication of a person's readiness to perform a certain behavior and is considered a direct determinant or cause of the appearance of a behavior.The intention is formed based on attitudes towards behavior, subjective norms, and perceived behavioral control, where each of these predictors has an important interrelationship weight to behavior and attraction (Ajzen, 2005in Azwar, 2019).
According to researchers, the behavior of a mother to continue breastfeeding only until the baby is 6 months old is still weak because of the lack of family support such as parents or husbands who supporting mothers to continue to give breast milk only without the addition of formula milk or other foods, this is because sometimes parents actually advise mothers to add formula milk so that Meet the needs of babies, which is a problem that is often faced by mothers who have babies aged 0-6 months.The Relationship between Formula Milk Promotion and Exclusive Breastfeeding Intentions The results showed that there was a significant relationship between the promotion of formula milk and the intention of exclusive breastfeeding in terms of the p-value of 0.000 <α 0.05.This explains that mothers who are affected by the promotion of formula milk are at greater risk of 28,500 times having a weak intention to exclusively breastfeed compared to mothers who are not affected by the promotion of formula milk.
Mothers who have confidence in breastfeeding, will be better prepared to face breastfeeding problems.But maternal self-confidence is also related to several dimensions, including maternal health status, occupation, knowledge about breastfeeding, culture, education, and career.Maternal appreciation of breastfeeding and maternal perception of the benefits of breastfeeding will increase the mother's intention in exclusive breastfeeding (Hamilton et al., 2018).
A factor affecting exclusive breastfeeding is the promotion of infant formula.Rahmawati & Arti (2018) stated that currently it is difficult to avoid the promotion of formula milk, the ease of social media is a means of promotion of various products including advertisements for formula milk both directly nor indirectly.The results of a study by Ney et al. ( 2019) that respondents who were interested in formula milk advertising were 75% had no intention of exclusive breastfeeding.This proves that the magnitude of the impact of advertising on a person's interest in a product by using advertising to attract conTotalers to buy a product.This can increase thennegative impact of optimizing exclusive breastfeeding coverage by changing the mother's perspective, intention to breastfeed exclusively and mother's confidence in exclusive breastfeeding (Hansen et al., 2018).
Currently, the promotion of formula milk is carried out on a large scale and through various media including health service places.The promotion of formula milk is informed through advertising and other print media, and manufacturers are pursuing more worrying marketing methods, namely direct marketing to mothers, health facilities, or through health workers, such as midwives and doctors (Kotler, 2017).
The promotion violates the Decree of the Minister of Health of the Republic of Indonesia Number: 237 / Menkes / SK / IV / 1997 concerning Marketing of Breast Milk Substitutes which states that all health services are prohibited from being used for formula milk promotion activities, providing and receiving samples of infant formula and advanced infant formula for routine or research purposes.
According to researchers, the vigorous promotion of formula milk in the community has caused a decrease in the coverage rate of exclusive breastfeeding success because mothers have more confidence in the content of formula milk compared to breast milk, some things This can happen because of the low level of public education so that it is easily influenced by the information provided without seeking the truth first through the mass media or energy health.

Conclusion
The results of maternal intentions in giving exclusive breastfeeding to babies aged 0-6 months in the Tering Puskesmas Working Area, West Kutai Regency, in 2022, most of them had weak intentions, namely 42 people (63.6%).The promotion of formula milk to mothers who have babies aged 0-6 months in the Working Area of the Tering Health Center, West Kutai Regency in 2022, was mostly affected, namely 42 people (63.6%).There is a relationship between the promotion of formula milk and the mother's intention in giving exclusive breastfeeding to babies aged 0-6 months in the Working Area of the Tering Health Center, West Kutai Regency in 2022 with a p value of 0.000 and an OR value = 28,500.

Sukensi
Sukensi, Hilda, Rosalin Ariefah Putri/KESANS The Relationship of Formula Milk Promotion with The Intention of Exclusive Breast Milk in Babies Aged 0-6 Months in The Work Area of The Tering Health Center West Kutai District in 2022

Table 1
Distribution of Age Frequency of Mothers who have babies aged 0-6 months

Table 2
Distribution of Frequency of Promotion of Formula Milk for Mothers who have Infants Aged 0-6 months

Table 3
Distribution of Frequency of Intention to Exclusive Breastfeeding in Mothers who have babies aged 0-6 months

Table 4
Crosssub Relationship of Promotion of formula milk with the intention of exclusive breastfeeding in mothers who have babies aged 0-6 months in 2022