Relationship between Family Support and Attitude of Postpartum Mothers in Exclusive Breastfeeding at Clinic Hj. Tarpianie A.Md. Keb. Prambon Sidoarjo

Mother's Milk (ASI) is the best and most suitable food for babies to ensure the growth of babies into human quality. The substances contained in breast milk contain almost all the nutrients needed by babies with concentrations that suit the needs of the baby. (MOH RI, 2014). Based on preliminary studies conducted by researchers at Clinic Hj. Tapianie Prambon Sidoarjo in January 2020 from 15 respondents showed that the attitude of the mother in giving exclusive breast milk is very good. This is because of the large amount of family support in motivating mothers to want to breastfeed exclusively. The purpose of this study was to determine the relationship between family support and attitude of postpartum mother in giving exclusive ASI at clinic Hj. Tarpianie Prambon Sidoarjo year 2020. The design of this study included a cross sectional analytic study with a survey approach.


BACKGROUND
Mother's Milk (ASI) is the best and most suitable food for babies to ensure the growth of babies to become quality human beings. The substances contained in breast milk contain almost all the nutrients needed by babies with concentrations that are according to the needs of babies. Breast milk also contains immune factors that give the baby protection against infection when the baby's body is not yet able to protect it self. Experts have agreed that breast milk can provide all that is needed now from birth to 6 months which is called exclusive breastfeeding (Depkes RI, 2004).
Data on exclusive breastfeeding conducted by the 2017 Indonesia Demographic and Health Survey (IDHS) states that 32% of babies under six months are exclusively breastfed. Comparison with the 2017 IDHS, the number of babies under six months who are exclusively breastfed has increased by 6.4% to 38.4%. The target for exclusive breastfeeding for babies 0-6 months is set at 80%, but the achievement rate is still very far from this target, while the provision of formula milk as complementary food to breast milk reaches 85.8%. Exclusive breastfeeding coverage in East Java was 30.72% in 2017, far from the target set at 80% (East Java Provincial Health Office, 2017).
Based on initial studies conducted by researchers at the Hj Clinic. Tapianie Prambon Sidoarjo in January 2020, out of 15 respondents, 9 respondents were found to be very supportive of percentage (60%) with a very good attitude as many as 6 people (66.7%), and a good attitude 3 people (33.3%). 3 respondents supported (20%) with a very good attitude 2 people (33.3%), with a good attitude 1 person (66.7%). 2 respondents did not support a good attitude 1 person (50%), attitude was not good 1 person (50%) and attitude was not very good. And 1 respondent really did not support and behaved very badly 1 person (100%). Based on the survey above, it can be concluded that the attitude of mothers in exclusive breastfeeding is very good, this is due to the large amount of family support in motivating mothers to want to breastfeed exclusively. Roesli (2004) states that family support is a factor external to the greatest influence on the success of exclusive breastfeeding. The existence of family support, especially the husband, will have an impact on increasing the self-confidence or motivation of the mother in breastfeeding. It was stated that encouragement and support from the government, health workers and family support were the determinants of the emergence of mothers' motivation in breastfeeding. Friedman (2010) suggests that family support can be provided in several forms, namely: informational support, esteem support, instrumental support and emotional support. Breastfeeding mothers need support and help, both when starting and continuing to breastfeed. As a first step they need help from pregnancy and after delivery. They need support for breastfeeding for up to 2 years, health care and support from their family and environment (Proverawati, 2010). The family, especially the husband, is an important part in the success or failure of breastfeeding, because the husband determines the fluency of breastfeeding knowledge which is greatly influenced by the emotional state and feelings of the mother (Roesli, 2007).
The general objective of this study was to determine the relationship between family support and the attitude of postpartum mothers in exclusive breastfeeding At the Clinic Hj. Tarpianie Prambon Sidoarjo 2020. The specific objective of this study is to identify family support in exclusive breastfeeding At the Clinic Hj. Tarpianie

METHODS
The research design is a quantitative analytic research cross sectional with a survey approach (survey research). The population in this study were all postpartum mothers At the Clinic Hj. Tarpianie Amd. Keb. Prambon Sidoarjo in 2020, the samples in this study were taken using the non probability sampling accidental sampling which amounted to 31 respondents. The independent variable in this study is family support, namely the mother's assessment of the provision of support from the family to mothers regarding exclusive breastfeeding which is categorized as very unsupportive (0-25%), not supportive (26-50%), supportive (51-75%) ), Very supportive (76-100%) with an ordinal scale and the dependent variable is Attitude in exclusive breastfeeding, namely the reaction that arises after receiving support from the family regarding exclusive breastfeeding which is categorized in Very bad (0-25%), Not good (26-50%), Good (51-75%), Very good (76-100%) with ordinal data scale. This research was conducted from January to July 2020 in the Pregnant Women Class at the Hj Clinic. Tarpianie, Amd. Keb. Prambon Sidoarjo using a questionnaire measuring instrument tested by validity and reliability tests with results for the questionnaire support all valid questions marked with results pearson's correlation all positive and the value of sign 2 tailed <0.05, while in the questionnaire on the attitude of mothers in exclusive breastfeeding there is one question, namely in question no 11 the Pearson correlation results are positive with a sign 2-tailed value of 0.237> 0.05 so that in question no 11 it is stated invalid. In this study, prior to data collection, submit a letter of introduction from the Faculty of Nursing Study Program DIV Midwifery IIK Strada then submit it to the Hj Clinic. Tarpianie Amd. Keb. Prambon Sidoarjo to request permission for research. After obtaining permission, the researcher then asked the respondent's permission to be used as a subject in conducting research to find out the relationship between family support and the attitude of postpartum mothers in exclusive breastfeeding. At the Clinic Hj. Tarpianie Amd. Keb. Prambon Sidoarjo Method of data collection by giving questionnaires to respondents. by doing the process editing, coding, scoring, tabulating, entry data and cleaning. This study was analyzed by statistical test testSpearman rank which is interpreted When p value > level of significant (0.05) then the conclusion is that Ho is accepted and H1 is rejected, meaning that there is no relationship between family support and the attitude of postpartum mothers in giving exclusive breastfeeding. At the Clinic Hj. Tarpianie Amd. Keb Prambon Sidoarjo and When p value < level of significance (0.05) then the conclusion is that Ho is rejected and H1 is accepted, meaning that there is a relationship between family support and the attitude of postpartum mothers in giving exclusive breastfeeding. At the Clinic Hj. Tarpianie Amd. Keb. Prambon Sidoarjo. From the test results Spearman rank following the normal distribution with a significant level (α = 0.05) it is found that the p value <α or 0.001 <0.05, which means that H0 rejected and H1 accepted. The conclusion is that there is a relationship between family support and the mother's attitude in exclusive breastfeeding.

Family Support in Exclusive Breastfeeding
Based on the results of data processing in table 2, it was found that out of 31 respondents, the majority (70.9%) of families strongly supported exclusive breastfeeding at the Hj Clinic. Tarpiani Prambon Sidoarjo in 2020, namely 22 respondents. The psychological condition of the mother greatly influences the production of breast milk, so that it also indirectly influences the fulfillment of milk intake for her baby. Therefore, mothers should avoid feeling uncomfortable, anxious and depressed. Comfortable conditions cannot be created if the mother does not get support from the parties, including: close family, husband,group support, health workers, agencies where mothers work and the government. According to Chomaria (2011) Support is helping, and supporting something. The family is one of the most important social institutions. The family represents the primary social group that influences and is influenced by other institutions. Individuals recognize the family as the basic social unit because most individuals have more contact with this social group than with other social groups. The family bears the main responsibility in introducing and socializing individuals. The family passes on the basic cultural background of a family to its members.

Postpartum Mother's Attitude in Exclusive Breastfeeding
Based on the research results presented in table 3, it was found that the majority of respondents (58.1%) had a very good attitude towards exclusive breastfeeding. According to Allport (1954) quoted by Notoatmodjo (2010), that attitude is a tendency to act (tend to behave) which means that attitude is a component that precedes open action or behavior. Attitudes are not formed by themselves but take place in human interaction. The process of changing and forming new attitudes comes from internal factors and external factors (Gerungan, 2004). External factors come from outside the individual in the form of a stimulus to form and change attitudes, for example from friends, family (husband), environment and media (Sunaryo, 2004). Factors that influence attitudes include personal experience, the influence of people who are considered important, the influence of culture, the mass media, educational institutions and religious institutions and the influence of emotional factors.
This condition will contribute to the act of giving exclusive breastfeeding to breastfeeding mothers, meaning that seen from the attitude aspect it shows a positive attitude, so that it will have an impact on the desire of mothers to give exclusive breastfeeding.

Relationship between Family Support and Attitudes of Postpartum Mothers in Exclusive Breastfeeding At the Clinic Hj. Tarpianie Prambon Sidoarjo Year 2020.
Based on table 4. shows that most of the respondents (51.5%) are very supportive and have a very good attitude as many as 16 respondents. From the test resultsSpearman rank following the normal distribution with a significant level (α = 0.05) it is found that the p value <α or 0.001 <0.05, which means that H0 rejected and H1 accepted. The conclusion is that there is a relationship between family support and the mother's attitude in exclusive breastfeeding. The conclusion is that there is a relationship between family support and the attitude of postpartum mothers in exclusive breastfeeding At the Clinic Hj. Tarpianie Prambon Sidoarjo Year 2020. Based on the research above, it can strengthen the theory put forward by Sunaryo (2004) that factors forming and changing attitudes can come from friends, family (husband), environment, and the media. So that the husband's support obtained by a mother can be a factor of the mother's attitude in giving exclusive breastfeeding to her baby. Family social support (husband) consists of informational support, appraisal support, instrumental support, and emotional support (Asih et al., Eds., 1998:196). The husband's support can be shown by the husband through daily activities, for example providing information to the mother about the importance of exclusive breastfeeding for the baby or taking the mother to a health service to find information. If a mother benefits from all of her husband's support, then the mother has received a positive stimulus to change her attitude to be positive.
So that the greater the family support received by mothers in exclusive breastfeeding At the Clinic Hj. Tarpianie Prambon Sidoarjo Year 2020, the better the attitude of mothers in giving exclusive breastfeeding to their babies. Therefore, family (husband) support is still being sought to be given to the mother maximally while taking into account other factors that can influence the mother's attitude in exclusive breastfeeding. To improve the attitude of postpartum mothers in giving exclusive breastfeeding, the participation of health workers is needed because in general mothers are willing, obedient, and follow the advice of health workers, therefore health workers are expected to provide information about the right time to give exclusive breastfeeding. The benefits of exclusive breastfeeding can increase endurance and the risks of not giving exclusive breastfeeding to babies. The research was conducted using an instrument in the form of a questionnaire filled out by the respondents. In this study there were obstacles either from the researchers themselves or other matters related to the research. These obstacles include: researchers are conducting research for the first time and are still in the learning process because there are still many shortcomings and the results are still far from perfection. Limited data collection in the form of closed questions allows respondents to answer dishonestly or do not understand the intended question.

CONCLUSION
Most (70.9%) families really support postpartum mothers At the Clinic Hj. Tarpianie Prambon Sidoarjo in 2020 in exclusive breastfeeding, namely 22 respondents. Most (58.1%) of postpartum mothers At the Clinic Hj. Tarpianie Prambon Sidoarjo in 2020 has a very good attitude towards exclusive breastfeeding, namely as many as 18 respondents. From the test results Spearman rank following the normal distribution with a significant level (α = 0.05) it is found that the p value <α or 0.001 <0.05, which means that H0 rejected and H1 accepted. The conclusion is that there is a relationship between family support and the attitude of the mother in exclusive breastfeeding. The conclusion is that there is a relationship between family support and the attitude of postpartum mothers in giving exclusive breastfeeding At the Clinic Hj. Tarpianie Prambon Sidoarjo Year 2020.