Disertasi

The Role of Women’s Empowerment on Complementary Feeding Practices among Children Aged 6-23 Months in Indonesia: A Mixed-methods Study = Peran Pemberdayaan Perempuan dalam Praktik Pemberian Makanan Pendamping ASI pada Anak Usia 6-23 Bulan di Indonesia: Studi Mixed-Methods.

Background Suboptimal complementary feeding practices (CFP) contribute to poor child nutrition in Indonesia, and the specific ways in which different domains of women’s empowerment influence CFP remain unclear. This study aimed to assess how three empowerment domains—attitude towards violence (ATV), social independence (SI), and decision-making (DM)—affect CFP among children aged 6–23 months in Indonesia. Methods We conducted a mixed-methods analysis combining quantitative data from the 2012 and 2017 Indonesia Demographic and Health Surveys with qualitative interviews of mothers and health-care workers. Empowerment domains were defined as (i) ATV: extent to which mothers reject domestic violence; (ii) SI: autonomy and life-course resources proxied by media access, educational attainment, age at first cohabitation and birth, and age/education differences with spouse; and (iii) DM: mothers’ involvement in major household decisions. Outcomes were minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). Results Mothers with medium ATV had 33% higher odds of achieving MAD compared to those with low ATV (adjusted odds ratio [AOR] 1.33; 95% CI 1.08– 1.64), and high ATV was also significantly associated with MAD (AOR 1.25; 95% CI 1.02–1.54). Greater SI consistently increased the likelihood of meeting MDD, MMF, and MAD. DM showed a mixed pattern: positively associated with MDD (AOR 1.15; 95% CI 1.03–1.28) but inversely with MAD (AOR 0.89; 95% CI 0.78– 1.01). Qualitative findings indicate that empowered mothers strive for dietary diversity but face structural barriers—limited rural food markets, reliance on family caregiving support, and time constraints from combining childcare and paid work— while formal education and digital nutrition information facilitate better CFP. Conclusions Women’s empowerment domains influence complementary feeding differently. Interventions should (i) strengthen rejection of domestic violence, (ii) enhance social independence through education and information access, and (iii) reduce mothers’ time and resource constraints—particularly in rural areas—to translate empowerment into improved child nutrition.
Keywords Complementary feeding, dietary diversity, feeding frequency, nutritionsensitive, mixed-methods, women’s empowerment


Latar Belakang Praktik pemberian makanan pendamping ASI (MP-ASI) di Indonesia masih belum optimal, berkontribusi pada rendahnya status gizi anak, dan mekanisme pemberdayaan perempuan mempengaruhi praktik ini masih belum jelas. Studi ini menilai pengaruh tiga domain pemberdayaan—sikap terhadap kekerasan dalam rumah tangga/ KDRT (ATV), kemandirian sosial (SI), dan pengambilan keputusan (DM)—terhadap praktik MP-ASI pada anak usia 6–23 bulan. Metode Studi mixed-methods mengombinasikan data kuantitatif Survei Demografi dan Kesehatan Indonesia 2012 dan 2017 dengan wawancara kualitatif bersama ibu dan tenaga kesehatan. Domain pemberdayaan didefinisikan sebagai: (i)ATV: sejauh mana ibu menolak KDRT; (ii) SI: kemandirian, diproksikan melalui akses media, tingkat pendidikan, usia pertama kali tinggal bersama pasangan dan usia pertama melahirkan, serta perbedaan usia dan pendidikan dengan suami; dan (iii) DM: keterlibatan ibu dalam pengambilan keputusan penting di keluarga. Outcome meliputi: keberagaman makanan minimum (MDD), frekuensi makan minimum (MMF), dan diet minimum yang dapat diterima (MAD) Hasil Ibu dengan ATV sedang memiliki 33% peluang lebih tinggi mencapai MAD dibanding ATV rendah (aOR 1,33; CI 1,08–1,64), sedangkan ATV tinggi juga signifikan (AOR 1,25; CI 1,02–1,54). Kemandirian sosial lebih besar konsisten meningkatkan MDD, MMF, dan MAD. DM menunjukkan pola terbalik: positif pada MDD (AOR 1,15; CI 1,03–1,28) tetapi negatif pada MAD (AOR 0,89; CI 0,78–1,01). Wawancara mengungkap ibu berdaya berupaya diversifikasi pangan tetapi terhambat pasar pedesaan yang terbatas, ketergantungan dukungan keluarga, dan waktu yang terpecah antara mengasuh dan bekerja; pendidikan formal dan informasi digital membantu praktik MP-ASI lebih baik. Kesimpulan Domain pemberdayaan memengaruhi MP-ASI secara berbeda. Intervensi sebaiknya (i) memperkuat penolakan perempuan terhadap KDRT, (ii) meningkatkan kemandirian sosial melalui akses pendidikan dan informasi, serta (iii) meringankan keterbatasan waktu dan sumber daya ibu—terutama di pedesaan—agar pemberdayaan dapat berdampak pada peningkatan gizi anak.
Kata kunci Pemberian makanan pendamping ASI, keragaman diet, frekuensi pemberian makan, sensitif gizi, metode campuran, pemberdayaan perempuan