 Finally, we've got the final slide here which tells us that we're going to be listening to Geeta who's going to be talking about strengthening elements of breastfeeding experience during the pandemic in Indonesia. All right. So Geeta, I'll put you back as the, oh, let's go straight onto your slides, I'll put you down as the, make you hostess now. All right. So I'd just like to introduce Geeta. Geeta works as a midwifery lecturer and researcher at the Department of Midwifery Education Programme Facility of Health at the University Rispati Yogurata, Indonesia. She has a background in midwifery science and she gained her master's in midwifery at the Universitas Padjan Dharan, exploring the importance of nutrition for children using a mobile application that she developed. Since then, her research has continued to examine maternal and child health, infant feeding, breastfeeding, mental health and gender equality that relates to nutrition. Her ability to critically think about field-related practices and competencies has positioned her to effectively advocate and advance the field to a diverse population of maternal and child health. Geeta is an award-winning researcher. In 2019, she was awarded the Yogyakarta City Innovation and Research Award as the initiator of the Portable Lactation Room in the tourist area of Yogyakarta City. She is founder of Durang Sehati and Rimanjabukarak 8000 HPK, a member of the Indonesian Association of Midwives, the Gender Equity Hub of Women in Global Health, a member of the Global Vaccine Trust Leadership Forum, which is an international pediatric association trust, a member of Quality Maternal and Newborn Care in Yale School of Nursing and Director of the Research Field at Yaksiasen, Big Ben, Burbanki, Indonesia. Geeta, I will hand over to you, and I hope I didn't go too badly with all the pronunciations. Thank you so much, Dr. Theri. First of all, I would like to say thank you so much to Dr. Theri for your willingness to be my facilitator here. You are so incredible. Thank you so much, Dr. Theri. And then good morning, everyone. Thank you for coming here to my presentation and taking time of such a busy schedule. I'm Gea Wati-Lilani Aguinarum, and everyone can call me Geeta, and I'm originally from Jukjikarta, Indonesia. I'm with a lecturer and researcher from Universitas Resparti, Jukjikarta, Indonesia, and I hope you will find this topic informative and interesting. So the topic of my talk is strengthening elements of breastfeeding experience during the pandemic in Indonesia. Yeah, this is new. You can reach me here. This is my contact number and then email. At this moment, I'm going to say thank you for Mother Hope Indonesia, Universitas Resparti in Jukjikarta, and our lovely breastfeeding mothers, and Jukjikarta City Government. I'm just speaking to say thanks for the assistance on the research here. We really appreciate you stepping into support us. I know you have to put in extra hours to catch up on your own work, so thank you so much. And your expertise was vital for this research, and I couldn't have finished it successfully without you. And you really helped us, and I hope to work with you again on future research. So I'm going to the next slide. This is the next slide. Indonesia and the COVID-19, you know that Indonesia is one of the countries affected by the COVID-19 pandemic. People are often deprived of resources to survive due to natural disasters. These natural disasters can lead to sporadic increases in employment and lack of food, making situations worse. Breastfeeding will continue to provide the cleanliness and service nutrition for babies and serve as the normative standard for infant nutrition in disaster situations. Most studies document the no respiratory or other illness in neonates born to mothers with confirmed or suspected infection with SARS-CoV-2. In addition, a recent report found that 12 out of 15 mothers, around 80%, previously infected with COVID-19 had a strong IgA SARS-CoV-2. This is breastfeeding here, a human right that needs to be respected, protected, and followed. You know that UN experts have highlighted practical steps to promote support and protect breastfeeding, such as paid maternity leave, workplace, and ensuring women have accurate information so they can make informed choices about optimal feeding practices. They also call for access to quality breastplate substitutes to be better regulated and affordable. I remember that children have the right to live, and then survival, development, and to the highest attainable standard of health of which breastfeeding must be considered. This is a comment used in provision in order to make informed choice about breastfeeding. They like to appropriate conditions and public spaces for breastfeeding, which are crucial to education. Lack of corporate accountability at first consequences of breast milk marketing practices compete the breastfeeding and continue to undermine e-boards to improve early and exclusive breastfeeding rates and act as a barrier for women to exercise their rights. And that should work towards introducing and scaling up simple seven cost-effective interventions, including the creation of an enabling environment to protect, promote, and protect their practices. Actually, English is not my mother language, so I apologize if my English is not clear. I continue to present my presentation. Breastfeeding is a critical first step to a healthy future, but as a foundation for a child's future health and well-being, breastfeeding also is a critical element of work-wide development e-boards to create a more healthy, prosperous, and sustainable planet. As a practical step towards protecting the survival and health of babies and women, breastfeeding is a central part of the 2030 agenda for sustainable development and is linked to many examples. This is the goals 1, 8, and 10, first on ending poverty, promoting breastfeeding associated with adding around US$302 billion annually in additional income to the world economy, nearly 0.5% of world gross national industry. And then goals 2 and 3 are concerned with hunger, health, and well-being. Breastfeeding is a vital source of nutrition that can save children and the goal 4 is about education, the association between breastfeeding and higher IQs and educational to achieving global learning targets. And then the goals, goal 5, centers on gender equality, breastfeeding is linked to critical equality issues including broad spacing and workplace rights. And then the last one is goals 12, take a sustainable consumption. Breast milk doesn't require industry for production and is created and consumed with a minimal ecological footprint. As national governments through budget and action plans to achieve the SDGs, breastfeeding should be a priority. What is it? Breastfeeding contributes not only to achieving many of the SDGs, sustainable development goals. It's also a critical component of the global strategy for women, children, and adolescents. And then I'm going to the next slide, yeah, recent research estimates that the increase in exclusive breastfeeding in the world can prevent 823,000 child mortality and 20,000 maternal mortality from breast cancer annually. And the benefits of breastfeeding have been expanded due to the epidemiological and biological discoveries over the past few decades. Despite this, low rates of breastfeeding are still reported in Indonesia. And the prevalence of exclusive breastfeeding in children under 6 months was 54.3% less than 80%, which is the national target of exclusive breastfeeding coverage. In Indonesia, the proportion of mothers who didn't breastfeed their babies because of lack of milk supply was 65.7% and 68.3%. Babies in the zero until six months age group were not breastfed for the same reason. And I'm going to the next slide. Policies and strategies developed in Indonesia to promote, protect, and support breastfeeding are considered limited and fragmented. So it's necessary to increase the legal status of existing breastfeeding policies to improve the commitment towards increased use to breast milk. Breastfeeding is the best source of nourishment for infants and young children and a proven life-saving strategy that helps protect children against many common childhood illnesses such as diarrhea, pneumonia, and its well-established breastfeed children perform better on intelligence tests are less likely to be obese or overweight and are less prone to non-communicable disease later in life. And you know that UNICEF, Indonesia representative, say that breastfeeding provides countless health, social, and economic benefits for both children and their mothers. And now more than ever, we need to support breastfeeding mothers so they give their children as possible start in life. For this, we need to ensure that all breastfeeding mothers are vaccinated against COVID-19 in order to be protected against the virus and able to care for their child. Even before the pandemic, only one in advance under exclusively breastfed in Indonesia with the median duration of exclusive breastfeeding only lasting three months and 12 months and 23 months of age, three quarters and slightly more than half of the infants continue to breastfeed respectively. And the pandemic has brought new challenges for mothers who are not only concerned about the safety of breastfeeding, but social restrictions also mean that breastfeeding support is harder to find. And moreover, with the health system in Indonesia stretched by the COVID-19 crisis, counseling and scale lactation support for mothers has been strained. A national survey conducted by the Ministry of Health with support from UNICEF reported that less than 50% of mothers and caregivers of children aged under the age of two received breastfeeding counseling during the pandemic. And the situation has been worsened by frequent violations of the international code of marketing of breast milk substitutes. As the benefits of breastfeeding are significant, mother will confirm or suspected COVID-19 infection and who are isolating at home should continue breastfeeding with necessary and appropriate protocols during feeding. And mother should also be advised to continue breastfeeding if their child is suspect or confirmed to have COVID-19. So and during the COVID-19 pandemic, the government has superficially explored the roles of families, health professionals, communities and the state in the country. The success of breastfeeding is a social responsibility collectively beside being the decisions of the women. It's the responsibility of all to protect and support mother to breastfeed the children. And then optimal breastfeeding is so critical and important that it's one of the most effective ways to ensure optimal child health and survival. And then a study reported that maternal intentions, maternal and child health conditions, maternal occupation, family support, health professionals and cultural issues influence the incidence and duration of breastfeeding. And the study reported the importance of more studies that seek to develop maternal and professional skills for sustaining breastfeeding and strengthening strategic actions to support breastfeeding mothers. So this is the prevalence of exclusive breastfeeding during the COVID-19 pandemic in Indonesia. Based on a study conducted in Indonesia, it turns out that breastfeeding mothers who work from home are 97.8% successful in exclusive breastfeeding. Meanwhile, breastfeeding mothers who work from the office have succeeded in providing 82.9% exclusive breastfeeding during the COVID-19, during the COVID-19. You know that there has been an increase in the achievement of exclusive breastfeeding in Indonesia during the pandemic because of their homes or their spending. There are many breastfeeding mothers who cannot get out of the house. So mothers continue to breastfeed their children and do not buy formula milk. And then maybe the mothers over the COVID-19 coronavirus, they continue to breastfeed their babies. And this research question is, what are the elements that strengthen breastfeeding in lactating women who are affected by the pandemic? So this is the method. We use an exploratory collaborative design with progressive sampling techniques to recruit breastfeeding mothers who have mild and moderate stress based on the PSS-10. PSS-10 is a progressive stress-scaled instrument. A collaborative design approach provides a comprehensive understanding of a particular situation, a description that confuses participants' experience or questions from their perspective. Collerative approaches are the basic for collaborative research and include meaningful methodological approaches with theoretical framework. And in addition, the collaborative findings of exploration can provide information about new intervention in the socio-cultural context of the exploratory qualitative study is considered appropriate because the comprehensive study aims to gain an in-depth understanding of the paradigm seen from breastfeeding mothers who have experienced breastfeeding during the COVID-19 pandemic. And then the study setting and participants, the study was conducted in Indonesia and breastfeeding mothers who were impacted by the COVID-19 pandemic either psychologically or physically and didn't breastfeed their baby at the time of data collection in different districts in the province participated in this study. And then the participants' recruitment for postpartum and lactating mothers less than three months were purposefully recruited from four districts in the urban setting of Ducati, Indonesia, lactating mothers who didn't breastfeed their baby during data collection were not included in the study. And then the eligible participants were invited to participate in the study by the outdoor researcher. And they were informed about the aims of the data collection for victims of sexual violence, i.e. rape, before they had a baby and one of them didn't marry. Data collection and then the data analysis. We collected and analyzed the data and in total nine interviews were completed and generated. The required number of participants was not determined before the study was carried out and researchers collected data until it reached a saturation level. The purpose of sampling method was used because of the difficulty in identifying participants and face-to-face using topic guidelines and covering the COVID-19 pandemic. And then the interviews explored the it like to fill about the impact of COVID-19 pandemic. The changes that had since the initial period of the pandemic, their plans for breastfeeding during the pandemic from home and where they would find any help as well as strengthening and weakening factors during breastfeeding in a pandemic situation. And then the data were collected between November and December 2020 and each interview lasted approximately 45 until 60 minutes and all interviews were audio recorded and transcribed word by word or verbatim in Japanese and translated into Indonesian by the me. And then another person confirmed accuracy between the audio recording and the transcription as independent as I saw. And then the data analysis that data were analyzed using six stages of thematic analysis including data introduction, initial code generation, time source, time study and time definition and naming and reporting. And then we also used and people 12 to facilitate us to perform iterative data management and emerging terms were arranged according to the semantic code, semantic content of the code. And then this is the result. So this is the table. This is the table one baseline characteristic of participants. And this is the mother's education level and then mother's employment status, breastfeeding period, parity, household income and myriad status. So this is the table two, the terms identified through interviews with breastfeeding mothers. At the time of data collection, all participants in this study were still breastfeeding. And the majority of participants had a higher education but didn't work and earned from their husbands slightly more than the provincial minimum wage. And there were only two unmarried participants at the table one, the previous slide. One participant was a rape victim and while the other was the result of interest with her brother and then according to the windings of the interviews, there are very strong and strong participants breastfeeding during the COVID-19 pandemic. This is the strengthening elements, maternal abaction to her baby and then support system from family and community and having adaptive coping strategy. I'm going to the next slide. Yeah. The maternal abaction to her baby, to keep breastfeeding and preventing COVID-19 transmission by these mothers having a baby are as follows that the participant five say that I have a baby so I didn't do the things that can put my baby and my family in a dangerous situation. Yeah. And then the participant eight say that if breastfeeding mothers can be vaccinated, I'm the first one who would like to reach the stuff because I have a baby and I must protect her. Yeah. Then, you know, that maternal abaction to her baby, yeah, that breast milk is an excellent source of nutrition for newborns and infants. It protects these respiratory infections, obesity, type one and type two diabetes, asthma and other illnesses. According to a recent study, yeah, 12 of 15 mothers, around 80%, who had previously been infected by COVID-19 had a strong IGA, SARS-CoV-2 immune response in their breast milk. Since they were aware of the benefits of breastfeeding the mothers in this study believe that should breastfeed their children. This decision is based on the mother's love for the child that she has given birth to after a long and challenging labor. These findings were consistent with a study in Portugal that found more abaction in women who received support from breastfeeding counseling group. Breastfeeding is also important from an emotional standpoint in the mother-baby interaction because of the cooperation, closeness and physical contact. Allowing, let's see, a connection of individual bones, i.e. a rich and complex bone between a mother and her child. And then the majority of participants have a high level of education, which makes it easier for them to understand the benefits of breastfeeding in protecting their children during the COVID-19 pandemic, resulting in a stronger attachment to babies, yeah. And then maternal affection was not influenced by age, marital status, employment status, residence, number of pregnancies, pregnancy monitoring, length of breastfeeding, time interval before breastfeeding, pregnancy plan, or desire to become pregnant or type of daily free, yeah. And we also discovered that they continued to breastfeed their child despite having a low income because their husband received less pay as an impact of the pandemic situation. They felt that formula milk was not affordable for them, yeah. So this is the support system from family and community. You know that when we collected the data, since the pandemic began, most activities have been carried out online, right? It also affects breastfeeding mothers' behavior in seeking information to increase knowledge by taking online classes and utilizing live features on social media, such as Instagram Live and Facebook Live. So like participant three say that I can join on IG Live and free online class. It can reduce my stress because of this pandemic, yeah. And then the other participants say that even though my husband and I live separately, but he absolutely supports me for exclusive breastfeeding, yeah. So support from husband and parents also could reduce stress and support breastfeeding in a pandemic situation, right? And then participant seven also, participant nine say that I almost committed suicide, yeah. I almost committed suicide. But my parents strengthened me. Then my mother told me to clean my breast and nipple every time I took a bath. And thank God my mother always supports me, yeah. They say they said like that. So another support system from, what is it? From parents, from husband, and then from online community could build the stress relief in breastfeeding mothers. Because the participant one also said to me that I got support to keep breastfeeding my baby from my community on Facebook, yeah, on community, community on IG, Instagram, yeah, community on Twitter, yeah. Just like that. Then this is the adaptive coping. This study found one of the coping strategies carried out by breastfeeding mothers to reduce stress in lactating during COVID-19. And then this strategy is emotion-focused coping as a strategy for reducing the stress-causing situation while breastfeeding during the pandemic through positive reappraisal, distancing and escape. Participant 4 said to me that at the end of the day, I thought that God would be with us and provide sustenance for us even this pandemic situation. Yeah, and then the participant 7, another participant also said to me that I'm grateful for this pandemic situation with the government policy to stay at home and keep the distance. I did not interact with my neighbors who mean to me. They said, she said like that, yeah. And then she also told me that I'm trying to forget the bad things that happened in my past. I do not follow my bad people on social media and I try to focus on selling, keep myself busy, then salad, yeah, pray, pray to God. And several times I participate in online recitation. Emotion-focused coping as a strategy for reducing the stress-causing situation while breastfeeding during the pandemic. And then the problem-focused coping by seeking social support is also a coping strategy for reducing and healing stress. Like another participant told me that my friend in breastfeeding community or perinatal mental health community on Facebook always helped me mention about healthy life so that it can make me better and I'm not confused anymore, yeah. She said, she told me like that, yeah. You know that support system from family and community like show that unconditional support from husband, families, and communities immensely help these women, these breastfeeding women maintain their commitment to breastfeeding during the pandemic. Participation in breastfeeding activities makes us capable and confident about breastfeeding, yeah. Right, so husband are highly influential in influencing mothers. This is seen about breastfeeding their children and whether or not to continue breastfeeding. This is critical for successful breastfeeding practice and exclusive breastfeeding for up to six months. And then having adaptive coping, yeah, you know that all of the participants face some problems related to multiple problems in the pandemic situation. They realized that becoming a breastfeeding mother during the pandemic was very challenging and prone to stress. To overcome that, our participants used two types of coping strategy. The first one is the problem-focused coping seeking social support such as joining on Instagram Live or Facebook Live, webinars and talking with their friends in the breastfeeding community on Facebook. And the second one is an emotion-focused coping through positive free appraisal being grateful and cheering to God, following physical distancing during a pandemic and escaping from negative people who remind them to bad experience in the past such as in the case of a victim of sexual violence, yeah. You know that however all participants attempted to handle all the problems by using coping strategies, participants performed coping strategies not only after the problems appear but also before such problems appear as they did anticipatory and preventive coping so that coping can be seen as something that can be done before the stress or distress emerge, yeah. And anticipatory coping means that someone shows an effort to deal with an imminent threat or even a critical even shortly. Efforts are made to build differential distress through the preventive coping and then besides taking the anticipatory and preventive coping also perform reactive coping which means to deal with an ongoing stressful encounter or one that has already happened, yeah. And then after the problems appear, participants try to finish by using coping strategies such as problems and emotion focused coping and that can be completed as a reactive coping, yeah. Then this is the conclusion. Breast milk is full with complete and natural nutrition. In addition, it contains other elements that promote child growth and protection against infection including the transmission of SARS-CoV-2. Their breast milk also contains a strong IGA, yeah. IGA SARS-CoV-2 immune response apart from being caused by the mother's immune defenses to the child. The possibility of breast milk being contaminated will also allow it will provide alleged protection and adaptation and breastfeeding is also important from an emotional standpoint in the mother-baby interaction because of the cooperation, closeness and visual contact allowing reciprocity and the formation of gradual reach and complex child born, yeah. And it can be concluded from this collaborative inquiry that breastfeeding mothers had strengthening elements in lactating during the COVID-19 pandemic. These women cited valid reasons for their strength in lactating during the pandemic such as maternal infection to her baby, support system, objective coping strategy. These reasons point to the ability of these women to keep breastfeeding during the pandemic and other findings highlight the weekend, what is it? The uncertainty in monthly income because of salary deduction prompted them to continue breastfeeding and not by formula milk because the latter was not affordable for them, yeah. And as a result, these women adopted a more empowered position and retained control of their circumstances and even though it was difficult for them, yeah. And the weakening elements, the weakening elements. So the last one is this is my... This is our portable public lactation room in the tourist area of Yucyukarta city, yeah. We call this Ruang Sahati the portable public lactation room. We plan that the construction will be completed by the end of this month. So please pray for us and so that it can be immediately used by tourists who are breastfeeding mothers in the city of Yucyukarta or if you... What is it? If you are going to go to Yucyukarta city so please come here and then use our portable public lactation room in the tourist area of Yucyukarta city. Thank you so much. Thank you. That was absolutely fantastic. Can I invite you to put any questions in the public chat? That would be wonderful. And we've probably only got about time for one question. So we have to close up by 150. I might just ask you a quick question, Gita while we're writing for people to type. You mentioned early on that about 65.7% of mothers did not breastfeed due to a lack of milk supply. I found that in an incredibly high number of women who were saying that they didn't have a very good milk supply. However, when the COVID-19 pandemic hit suddenly that number was considerably decreased and I was wondering why you think that might be that suddenly they had a better milk supply during COVID. Lack of supply. Because lack of supply. I think... Sorry, Dr. Therry. Can you... As you mentioned that over 65% of women had no milk supply prior to COVID and then suddenly that number reduced when COVID hit. That back one. No? Oh. That side there. Yes. So 65% of women... Yeah. Before the COVID-19 pandemic putting in children under six months was 54.3%. Because I don't know maybe the mothers breastfeeding mothers what is it? They feel that lack of milk supply and then they feel that they cannot breastfeed their baby anymore. Yeah, and then so lack of milk supply was higher and then... I guess my question was why do you think the lack of... Why do you think they lacked the milk supply? That's a very high number of people that don't have milk. Oh, yeah. Because maybe it's from different source, different source. This is from RISCAS desk. RISCAS desk. Yeah. Last year we collected the data and this is the number. The number of lack of milk supply. So it's a different... What is it? Different source. This is from Indonesia. Data from research in Indonesia based on the research in Indonesia. Research data and then this is from data from us from our research last year. Okay. All right. Thank you. Well, we have to end it there. Thank you everyone for participating and thank you so much, Geeta. That was an absolutely amazing presentation. Thank you so much. Thank you. Thank you so much, Dr. Terry.