Correlation Of Using Contraception With Breast Milk Production In Breastfeeding Mothers In The Andalas Public Health Center In Padang

Indonesia is still categorized as low in 2017, only 35.73% with a target of 50%. West Sumatra Province occupies the fifth position with exclusive breastfeeding coverage of 73.6%. The percentage of babies with exclusive breastfeeding in the city of Padang in 2017 was 74.77% of the target of 80%. Andalas Puskesmas has the lowest exclusive breastfeeding coverage of 59.84%. The purpose of this study was to determine the relationship between hormonal contraceptive use and breast milk production in breastfeeding mothers in the Kubu Village in the Parak Karakah Work Area of the Andalas Padang Health Center in 2019. This type of research was analytic with a cross sectional design. The population of mothers who have babies aged 1-6 months is 268 people with a sample of 73 people. Purposive sampling technique. Analyzed univariately using a frequency distribution table and bivariate using the Chi-Square statistical test. Univariate analysis results showed there were more than half (57.5%) with insufficient milk production. More than half (67.1%) use hormonal birth control. The results of bivariate analysis have a relationship between the use of hormonal contraception with the production of breast milk (X2h> X2t). The conclusion is that there is a relationship between hormonal contraceptive use factors, and milk production. It is expected that health workers can provide counseling to nursing mothers by providing health education about efforts to increase milk production.


INTRODUCTION
Mother's Milk is food that has been prepared for the prospective baby when the mother has a pregnancy. During pregnancy, the mother's breast changes to prepare for the production of breast milk if the time comes for breast milk can be used as a nutritional fulfillment of infants (Mulyani, 2013). Exclusive breast milk is only breastfeeding without other liquids such as formula milk, oranges, honey, tea water, water, and without the addition of solid foods such as bananas, papaya, porridge, milk, biscuits, rice porridge for a period of 6 months (Roesli, 2012). Non-current milk production is one of the factors that causes failure in exclusive breastfeeding. One effort to increase milk is by regularly breastfeeding children. The more often the child sucks the mother's nipples, there will be an increase in milk production and vice versa if the child stops breastfeeding there will be a decrease in breast milk (Anggriani, 2018).
Growth and development of infants and toddlers is largely determined by the amount of breast milk (ASI) obtained, including energy and other nutrients contained in breast milk.
Breastfeeding can prevent 1/3 the incidence of upper respiratory tract infections (ARI), the incidence of diarrhea can decrease by 50%, and severe intestinal disease in premature babies can be reduced by as much as 58%. In mothers, the risk of breast cancer can also decrease by 6-10% (Fadhila, 2016).
According to Walyani (2015) factors related to milk production are food, peace of mind and mind, use of contraceptives, breast care, breast anatomy, physiological factors, resting patterns, child suction factors or frequency of breastfeeding, baby's birth weight, gestational age during childbirth, consumption of cigarettes and alcohol.
One factor that often influences the production of breast milk is the use of contraceptives in nursing mothers need to be considered so as not to reduce milk production. For mothers who are breastfeeding is not recommended to use contraceptive pills that contain estrogen, because this can reduce the amount of milk production and can even stop the production of breast milk as a whole (Walyani, 2015). Sufriani's research (2016) about the factors that influence the production of breast milk with the adequacy of breast milk found that the use of contraception is not right 80%, rest is not enough 45% and milk production is not enough (56.2%). There is a relationship between the use of contraception (pvalue = 0.003), there is a relationship between resting factors and the adequacy of breast milk (pvalue = 0.003). Maria's research (2017)

Bivariate Analysis
Correlation of using contraception with breast milk production in breastfeeding mothers Based on the test, it was obtained the value of X2h> X2t ( (52%). There is a relationship between breast care and production (p value = 0.001).
One factor that often influences the production of breast milk is the use of contraceptives in nursing mothers need to be considered so as not to reduce milk production. For mothers who are breastfeeding is not recommended to use contraceptive pills that contain estrogen, because this can reduce the amount of milk production and can even stop the production of breast milk as a whole (Walyani, 2015).
The use of contraception in nursing mothers needs to be considered so as not to reduce milk production. Examples of contraceptives that can be used are condoms, IUDs, breastfeeding pills or 3-month hormonal injections. A woman's need for contraception during breastfeeding is that contraception is safe to use during breastfeeding, but hormonal contraceptive methods mainly contain estrogen and progesterone can interfere with lactation by inhibiting proclatin thereby reducing milk production. Concerns have also risen regarding the passage of exogenous hormones in breast milk. The amount of ethinyl estradiol present in breast milk, a combination of oral contraceptives is not recommended for use during early breastfeeding.
The use of contraception in nursing mothers needs to be considered so as not to reduce milk production. Examples of contraceptives that can be used are condoms, IUDs, breastfeeding pills or 3-month hormonal injections. A woman's need for contraception during breastfeeding is safe contraception used during breastfeeding, but hormonal contraceptive methods mainly contain estrogen and progesterone can interfere with lactation by inhibiting proclatin so that it reduces milk production. Concern has also been raised about the travel of exogenous hormones in breast milk.
The amount of ethinyl estradiol present in breast milk, a combination of oral contraceptives is not recommended for use during early breastfeeding.
Progestin contraception is a method of contraception that only contains the hormone progesterone. The BKKBN recommends mini-contraceptive pills for mothers in breastfeeding.
The production of breast milk is influenced by the hormone prolactin, but its function has not been able to stimulate the expenditure of milk if it is blocked by estrogen and progesterone (Hartanto, 2011).
Currently there are contraceptives that contain estrogen and do not contain estrogen. This type of progestin, this drug works by suppressing the formation of hormones from the brain thereby preventing ovulation. This injection drug is very suitable to be given to mothers who are breastfeeding because the way it works does not interfere with lactation. For this type of pill there are only mengandong progesterone but there are also those containing progesterone and estrogen.
The type of pills that do not interfere with lactation are those that contain progesterone only.
The results of this study can be seen that mothers who have not enough milk production on the use of hormonal birth control (70.5%). This is because hormonal birth control contraception contains progesterone which can inhibit milk production. In addition, it was also found that mothers who did not produce enough milk but used non hormonal birth control (37.9%). This is due to the physical condition of the mother with minimal ASI, irregular eating patterns, lack of breast care, use of hormonal contraception and so forth and in this study found mothers who use hormonal birth control but adequate milk production (29.5%), meaning that the use of hormonal birth control does not affect the production of breast milk for mothers because mothers have sufficient milk and mothers consume milk for nursing mothers.

CONCLUSION
Based on the test, it was obtained the value of X2h> X2t (7.6), there was a resting relationship using contraception with the production of breast milk in breastfeeding mother.