Advances in Social Science, Education and Humanities Research, volume 547

Proceedings of the 1st Annual International Conference on Natural

and Social Science Education (ICNSSE 2020)

Development of Weaning Index on Islamic Community Based

on Religion, Nutritional, and Psychological Aspect: A
Qualitative Exploration
Ony Linda1, Imas Arumsari2, Izza Rohman3
1
Public Health Study Program, Faculty of Health Sciences, Universitas Muhammadiyah Prof. DR. HAMKA, Jakarta
2
Nutrition Study Program, Faculty of Health Sciences, Universitas Muhammadiyah Prof. DR. HAMKA, Jakarta
3
Mathematics Study Program, Faculty of Education, Universitas Muhammadiyah Prof. DR. HAMKA, Jakarta

*Corresponding author: [email protected]

Abstract. This study aims to develop index of weaning based on religion, nutritional, and psychological aspect as the tool to
assess the weaning behavior in the Islamic community. In-depth interview was conducted with experts of Qur’an, Hadits,
nutrition, and psychology. This study was conducted on November 2019 – April 2020. Islam views exclusive breastfeeding and
gradual weaning as a command from Allah swt and its implementation should consider support from both parents of the child.
The command in Islam for 2 years of breastfeeding and gradually wean the baby is in line with the nutritional and psychological
aspect. The recommendation to do the exclusive breastfeeding for 6 month and gradual weaning to solid food is related to the
immunity, gastrointestinal and dental health, emotional bonding between mother and child, and training the child’s independency.
In the nutrition perspective, six-months period of breastfeeding and gradual weaning is beneficial for the baby, mother, father,
and whole families in the household. Since Indonesia is the biggest Muslim population in the world, the weaning index developed
from this study could be used as a tool to assess and design suitable health promotion program using religion-based approach.

Keywords: Health Promotion, Religion-based approach, Weaning.

1. INTRODUCTION or drink, not even water, except breast milk (including

milk expressed of from a wet nurse), for six months of
Infant mortality rate (IMR) still become a public life, but allows the infant to receive oral nutritional
health concern in the world, especially in Africa and support, drops, and syrups of vitamins, minerals, and
Asia, including Indonesia [1]. One of the risk factors of medicines [4]. Exclusive breastfeeding coverage in
infant mortality is weaken immune system which also Indonesia is decreased along with the increasing age of
leads to the infection. Improper weaning behavior, the baby as published data showed that the coverage of
including early weaning or prolonged weaning affects exclusive breastfeeding according to age was 66.% (0-1
poor immune system of infant [2]. Children aged 6-11 month), 54.6% (2-3 month), and 38.2% (4-5 month) [5].
and 12-23 who were not breastfed had 1.8 and 2.0-times Recommendation for exclusive breastfeeding comes
higher risk of mortality, respectively, compared to thos along with the gradual weaning. According to WHO,
who were breastfed [3]. The term successful there is four principal aspects regarding to weaning
breastfeeding is closely related with the concept of practice. First, giving breast milk to the baby right after
exclusive breastfeeding which defined as no other food birth, second, give the breast milk up to 6 months of age,

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 Advances in Social Science, Education and Humanities Research, volume 547

third, give complementary feeding after 6 months, fourth, point from different perspective of expertise. Four
continue breastfeed until 2 years age. However, the interviews were conducted face to face in Bahasa
practice of giving proper weaning according to WHO Indonesia. Interviews were digitally recorded and lasted
guidance has not fully implemented as the data showed average for 1 h.
that breastfeeding coverage in Indonesia is decreased by Data were transcribed verbatim from the audio
the baby age [5]. The concept of weaning itself defined recordings of the interviews. Data was an iterative
as the process when the baby is not breastfed anymore. process between researchers. Any disagreements in the
This process can be related to several reasons, such as the finding were adjudicated between researchers. The goal
mother stop to give breast milk, the baby did not want to of data analysis was to elaborate the concept of each
be breastfed, or both of those factors. critical point from different perspective of expertise,
There are several factors affecting early weaning, therefore weaning index as the tool of assessment could
such as lack of support during breastfeeding period, be obtained from those critical point.
difficulty in breastfeeding, breastfeeding duration shorter
than 12 months in a previous pregnancy, and infant birth Ethical consideration
less than 2,300 gram [6]. There are reasons affecting
difficulty in breastfeeding including insufficient milk Ethical approval was obtained from Ethical
supply, infants’ behavior, and returning to work. Committee for Health Research, Universitas
Since weaning and breastfeeding practice still Muhammadiyah Prof DR. Hamka. Verbal consent were
become public health issue, especially in the developing explained to the informant prior to the interview process.
countries, several approach of intervention have been
applied to cope with this problem. However, study 3. RESULTS AND DISCUSSION
reported that a successful breastfeeding practice are not
The results of this study will be discussed according
only affected by knowledge and attitude, but also culture,
to five critical aspects of weaning: (1) optimum age of
tradition, and support from the family [7]. Therefore, this
weaning; (2) benefits of weaning in optimum age for
study use religion based approach using qualitative
infants, mother, and families; (3) negative impact of
exploration to develop tools for assessment of weaning
weaning earlier than optimum age for infants, mother,
behavior. This intervention model is in line with health
and families; (4) negative impact of weaning longer than
promotion based on social ecological model which has
optimum age for infants, mother, and families; (5) the
been proved potential to change behavior [8]. This study
criteria of family support during breastfeeding and
aims to develop index of weaning based on religion,
weaning.
nutritional, and psychological aspect as the tool to assess
the weaning behavior in the Islamic community. The
weaning index developed from this study could be 3.1. Optimum age of weaning
beneficial to assess the practice of weaning in the Islamic
According to the expert of Qur’an, the optimum age
community for further intervention.
of weaning is not usually at 2 years of age, can be less
than 2 years of the age, which is 21 months, as it is
2. RESEARCH METHOD considered deducting 2 years by the pregnant period (9
months).
This is a descriptive, qualitative, cross-sectional In the point of view from expert of hadist and
study applied purposive sampling to recruit informants nutrition, the optimum age of weaning is exactly at 2
through collaboration with experts from universities. The years of age. From the psychological perspective, the
four experts were recruited from Universitas optimum weaning age is not earlier than 6 months, but no
Muhammadiyah Prof. DR. Hamka (UHAMKA) and later than 2, 3, or even 4 years of age.
Universitas Indonesia (UI), Jakarta, Indonesia. Experts of
Qur’an, Hadist, and Psychology were obtained from 3.2. Benefits of weaning in optimum age for
UHAMKA, while expert of maternal and child nutrition
was obtained from UI. This study was conducted on infants, mother, and families
November 2019 - April 2020. Qur’an views the optimum age for weaning as the
Semi-structured and individual in-depth interviews ideal condition for infants. In the perspective of hadist,
were conducted with informants. Interview questions weaning in the optimum age can strengthening bone and
were designed according to critical point of weaning muscle, building the foundation of physical growth and
practice including optimum age of weaning, advantage of psychological development, bonding mother and baby,
weaning in the optimum age for infant, mother, and perfect timing for the child before adapting/copying to
families, negative impacts of weaning earlier or longer the environment, walk independently, and holding
than the optimum age, and family support. The questions his/her own plate or glass.
were designed to investigate the concept of each critical

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This concept is in line with the nutritional perspective this condition, child cannot control food intake, which
as in the health perspective, 2 years of weaning is further leads to obesity. Another oral phase problem is
optimum for growth and development. In the the stagnation/fixed which showed by picky eating.
psychological perspective, the optimum age is enough to For the mother, earlier age of weaning will cause
wait until the child can be independent or ready, can built potential distance of emotional bonding between mother
close relationship to parents, can support the baby to feel and child. Mother also need to give more effort to prepare
secure, to build cooperation with the surrounding food. In the psychological aspect, if the mother not ready
environment, to build self-confidence and control. enough to wean the baby, it can leads to depression and
In the Qur’an perspective, weaning in the optimum feeling useless. It also mentioned by Quran that wean the
age represents the obedient towards Allah swt and it is an baby is a mutual agreement between both of parents,
ideal condition for mom. Hadist also views weaning at because when the family decide to wean the child, father
optimum age can facilitate the mom to build emotional should give proper financial support for both child and
bonding with the child. It also facilitates mom to give mom.
first strength for the child.
Nutrition and health views weaning at optimum age 3.4. Negative impact of weaning longer than
is beneficial for mom as it is physiologically act as a optimum age for infants, mother, and families
natural contraception, therefore it can control birth. If the
breastfeed practice applied correctly, it also can reduce Prolonged breastfeeding or longer age of weaning
body weight back to ideal weight. Meanwhile, in the also has negative impact. Nutrient intakes will not
psychological perspective, weaning at optimum age can sufficient which resulting to under nutrition. In the
be beneficial for mom to be mentally prepared for child psychological aspect, the child will miss important
fussiness during weaning period. developmental step, such as the ability of self-regulation,
Weaning at optimum age not only beneficial for mom confidence, and creativity.
and child, but also for the whole family. Qur’an views Prolonged breastfeeding not only affect the child, but
weaning at optimum age as ideal condition for the whole also the mother. The mom need higher nutritional
family. It is supported by Hadist views, in the optimum requirement, higher than pregnant mom. It also affects
age, the whole family can prepare child development self-dependency of the child, resulting to the more effort
easier and more measurable. for mom to give her attention to the child.
In the health perspective, weaning at optimum age
gives chance for the whole family of the child to train
3.5. The criteria of family support during
his/her chewing ability. It is also good in the breastfeeding and weaning
psychological perspective as weaning at optimum age
will build close relationship in the whole family when the According to Quran, it is a mandatory for the child’s
child get used to have meal together with family. It also father to give enough financial support for child and mom
reduces economic stress because family can save money during breastfeeding and weaning period, even if they are
from buying formula. divorce. The father also needs to make sure that the
financial support is enough to fulfill the food intake of
3.3. Negative impact of weaning earlier than breastfeed mom more than usual condition (when she is
optimum age for infants, mother, and families not breastfeed). This is also supported by nutrition aspect
that the nutritional need of breastfeed mom is higher than
Quran views earlier weaning does not always have woman in usual condition. Psychological aspect sees the
negative impact because weaning related to the child support from the family in including financial support
ability and condition. In the hadist, it is explained that and condition.
earlier weaning will cause insufficient nutrient and
impairment of child emotional development. In the 3.6. Development of weaning index
nutrition perspective, earlier weaning cause weaken
immune system and the digestive system is not ready This study developed an index to assess weaning
enough. behavior according to results from the expert explained
There are several impacts in the psychological aspect above. This index could be used as the tool for
if the child was earlier weaned. There will be problem in assessment and further intervention by using religion-
the oral phase, which called as oral aggressiveness. In based approach in Islamic community.

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Table 1. Weaning index developed from this study

No Question Yes No
1 Did you practice breastfeeding because of Quran guidance?
2 Did you practice breastfeeding because of Hadist guidance?
3 Did you practice breastfeeding because of mother’s health concern?
4 Did you ever feel hurts because of breastfed?
5 Did you practice breastfeeding because of mother’s psychological condition concern?
6 Did you ever feel mentally hurts because of breastfed?
7 Did you practice breastfeeding because of child’s health concern?
8 Did you practice breastfeeding because of child’s psychological condition concern?
9 Did you wean when child aged < 21 months old?
10 Did you wean when child aged 21-24 months old?
11 Did you wean when child aged 25-36 months old?
12 Did you wean when child aged > 36 months old?
13 Did you breastfed the child by yourself?
14 Did you ever give your child to be breastfed by another mom?
Did your husband and/or father of child give enough financial support to fulfill nutritional needs of
15
child and mother during breastfeeding process?
Did your husband and/or father of child give enough financial support to fulfill psychological needs
16
of child and mother during breastfeeding process?
Did your husband and/or father of child give enough financial support to fulfill needs for clothes of
17
child and mother during breastfeeding process?
Did your husband and/or father of child give enough financial support to fulfill needs for access for
18
information and health service of child and mother during breastfeeding process?

The results from this study showed that optimum both parents of the child and whole family [13-15]. It
weaning age is at 2 years of age according to informants considers ability from the mother to breastfed and whole
from Quran, hadist, nutrition, and psychology experts, family to support. Early weaning could be considered to
even though it was found some notes regarding to that have a positive impact if it was done fulfilled consents
optimum age according to Quran and psychology expert. and agreement to do so by both of the parents and whole
Those noted are informed and also being consideration at families, even though other experts explained it might not
defining the optimum age of weaning because different beneficial for the growth and development. Child who
aspect has different rationale at deciding that optimum was early weaned might not be ready for complementary
age. foods [16, 17], and if it was done without the mother’s
The results from this study is in line with the previous consent, it might leads to mother’s unpreparedness to
study reported that weaning at 2 years of age is beneficial give complementary foods [18].
for the child, mom, and whole families [9-12]. Negative Negative impact to the child, mother, and whole
impact caused by early weaning, according to Quran families might be occurred at not only early age of
expert, is not always considered as negative since weaning, but also at prolonged breastfeeding or late age
breastfeeding practice needs consents and supports from of weaning. Children who were late weaned are prone to

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have problem on growth and development as shown by [3] M. J. Sankar, B. Sinha, R. Chowdhury, N.
studies from several developing countries [19-21]. Bhandari, S. Taneja, J. Martines, et al.,
Children with prolonged breastfeeding will not receive "Optimal breastfeeding practices and infant and
sufficient nutrient content from the breastmilk [21]. child mortality: a systematic review and meta‐
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breastfeeding also inhibits the mother to do other 2015.
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