Postpartum-Specific Anxiety and Inadequate Breast-Milk Flow Among Indonesian Mothers: A Cross-Sectional Study of Prevalence and Determinants

Abstract

Postpartum-specific anxiety is an increasingly recognized perinatal mental-health disorder that may impair lactation by inhibiting the oxytocin-mediated let-down reflex, yet evidence from Indonesian primary care using validated childbearing-specific instruments is scarce. This study estimated the prevalence of postpartum-specific anxiety, examined its association with breast-milk flow, and evaluated the screening performance of the Postpartum-Specific Anxiety Scale (PSAS). An analytical cross-sectional study enrolled 40 mothers on days 2-4 postpartum at a midwife-led primary-care practice in South Kalimantan, Indonesia (December 2025-January 2026) using purposive sampling. Anxiety was measured with the 51-item PSAS and lactation adequacy with a validated 8-item breast-milk-flow questionnaire. Prevalence with 95% confidence intervals (CI), chi-square tests, odds ratios (OR), multivariable logistic regression, correlation and receiver-operating-characteristic (ROC) analyses were performed (alpha=0.05). Any anxiety was present in 72.5% of mothers (95% CI 58.7-86.3; mild 40.0%, moderate 32.5%) and inadequate breast-milk flow in 47.5% (95% CI 32.0-63.0). Higher PSAS scores correlated strongly with poorer lactation (Spearman rho=-0.685, p<0.001; Cohen d=1.36). Moderate anxiety substantially increased the odds of inadequate lactation (crude OR 10.55, 95% CI 2.16-51.61, p=0.001; adjusted OR 40.80, p=0.006), and the overall anxiety-lactation association was significant (chi-square=11.61, df=2, p=0.003). The PSAS predicted inadequate lactation with an AUC of 0.83 (95% CI 0.70-0.96; optimal cut-off >=80, sensitivity 84.2%, specificity 71.4%). Postpartum-specific anxiety was common and independently associated with inadequate lactation; routine PSAS-based screening in maternal care may identify at-risk mothers and protect breastfeeding in low-resource Indonesian settings.