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Aisha S. F., Jocelyn A. S., Alayya M. H.
Feb 15, 20215 min read

Behind Indonesia’s High Stunting Prevalence

Stunting is a health problem related to nutrition that is still a major issue in various developing countries, including Indonesia. In 2018, the Ministry of Village, Development of Disadvantaged Regions and Transmigration of Republic of Indonesia (MENDES) mentioned that there are 3 significant reasons why stunting rates remain high in Indonesia. This includes lack of education, poor sanitation, and a high level of poverty.


EDUCATION

A new report from BKKBN in January 2021 revealed that out of 5 million babies, about 1.2 million of them experience stunting. The shortage of knowledge regarding nourishment among Indonesians contributes to this high prevalence of stunting. Some parents are not aware that their children are stunted due to the lack of information related to it. For example, shortness is one of the characteristics of stunting, but it is often considered normal in Indonesia due to hereditary reasons (Achadi, 2015). Research has also shown that mothers with a lower level of education are more likely to have stunted children. This is most probably due to the difficulty in obtaining resources on child stunting and affording adequate food that will provide a nutritious and diverse diet for the children (WHO, 2018).


In 2008, a cross-sectional study was done in Indonesia and Bangladesh by Richard Semba and his colleagues to investigate how the education of parents affects stunting proportions. To prove their hypothesis, they gathered data for indicators of child growth and of parental education and socioeconomic status from 590,570 families in Indonesia and 395,122 families in Bangladesh. The results show that greater maternal formal education led to a decrease of between 4.4% and 5% in the odds of child stunting and greater paternal formal education led to a decrease by 3%. The research also explains that high levels of maternal and paternal education were both associated with protective caregiving behaviors, including vitamin A capsule receipt, complete childhood immunizations, better sanitation, and use of iodized salt.


Education on the importance of nutrition and breast milk particularly needs to be improved in Indonesia. Exclusive breast milk for babies aged 6 months and below is crucial to prevent different forms of childhood malnourishment such as stunting. Pediatrician Dr. Juwalita mentioned that premature babies and babies who do not receive exclusive breast milk during the first 6 months of their lives are more prone to stunting (Saputra, 2020). Breastfeeding ensures that the baby gets proper nutrients and protection against infectious diseases through the colostrum. Furthermore, exclusive breastfeeding will keep children away from contaminated water sources for at least the first 6 months of their lives.


WASTE MANAGEMENT, SANITATION & HYGIENE

In an analysis of Indonesia’s 2013 Basic Health Research (Riset Kesehatan Dasar 2013), Badriyah and Syafiq (2017) concluded that hygiene, sanitation, and waste management had “a direct relation” with the country’s stunting rates. Based on their study, children who come from families with poor waste management are 1.17 times more likely to be stunted than those who come from families that practice safe waste management. Unfortunately, results of the National Economic Survey (Survei Ekonomi Nasional), which was conducted 4 years later, still showed similarities with data from the 2013 Basic Health Research. Badan Pusat Statistik (BPS)’s evaluation of the 2017 Susenas revealed that the stunting prevalence in Indonesia remains significantly influenced by sanitation access. Moreover, Badriyah and Syafiq’s deductions were also aligned with the findings in a journal by Torlesse et al. (2016). Lack of sanitation and poor hygiene contribute to the risk of environmental enteropathy, where the small intestine becomes more permeable to pathogens and its nutritional intake becomes reduced (Badriyah & Syafiq, 2017).


Though these results are concerning, they are not very surprising since poor waste management, sanitation, and hygiene remain prevalent issues to be tackled. According to the Demographic and Health Survey (2017), one out of five households does not have improved toilet facilities. In fact, over 51 million Indonesians still defecate in the open (Torlesse et al., 2016). The DHS also reported that, as of 2017, around 19% of urban households and 38% of rural households do not have private latrines. Furthermore, 20% of Indonesian households in urban areas still do not have access to improved drinking water (DHS, 2017).


POVERTY

In Indonesia, poverty plays an important part in stunting. Families cannot fulfill their child’s nutrition and this will delay child growth and development. As a result, good quality human resources cannot be obtained. People experiencing this condition will have difficulty in fulfilling their needs when they grow up. This goes like a cycle and the main problem is poverty or poor economic condition. A country’s economic growth also depends on its human resources, thus according to the Centre for Data and Information of the Ministry of Health, investing through improved nutrition can help break the poverty chain and increase GDP up to 3% in a year.


A research that involved 1366 people was done by Torlesse et al. (2016) to observe the socioeconomic impacts of stunting in Indonesia. The lowest wealth quintile in this research is 21.5% and the highest is 19.5%. The research shows that there are 59.7% of households that have more than 4 family members. The number of family members in a household affects the family’s priority in fulfilling their needs. Apparently, children who did not receive age-appropriate feeding were more likely to be stunted. It is also shown from the research that the prevalence of stunting is 19.2 % among the highest wealth quintile and 40.1 % among the lowest wealth quintile. This proves that the lack of nutrition from foods and poor economic conditions are more likely to be the main factor of stunting in Indonesia.


 

REFERENCES


Anonymous. (2017, May 16). Stunting; Dalam Kacamata Kesehatan Lingkungan.


Arradea, D. (2020, September 15). Gizi Buruk di Indonesia: Statistik, Penyebab, dan Dampaknya. _______https://www.gooddoctor.co.id/tips-kesehatan/parenting/gizi-anak/gizi-buruk-pada-anak-_______di-indonesia/


Badriyah, L., Syafiq, A. (2017, January 8). The Association Between Sanitation, Hygiene, and Stunting in Children Under Two-Years (An Analysis of Indonesia’s Basic Health Research, 2013).


BKKBN, BPS, Kemenkes, ICF. (2018, September). Indonesia Demographic and Health Survey 2017. _______https://dhsprogram.com/pubs/pdf/FR342/FR342.pdf


Indonesian Ministry of Health. (2019). Laporan Nasional RISKESDAS 2018. _______http://labdata.litbang.kemkes.go.id/images/download/laporan/RKD/2018/Laporan_Nasional________RKD2018_FINAL.pdf


Mahmudah. (2020, August 26). Menilik Tingginya Prevalensi Stunting di Indonesia. _______http://news.unair.ac.id/2020/08/26/menilik-tingginya-prevalensi-stunting-di-indonesia/


Mustika, D. A. (2020, January 02). Stunting dan Pusaran Kemiskinan.


Prasasti, G. (2021, January 27). BKKBN Ungkap Penyebab Angka Stunting di Indonesia Masih Tinggi.


Putra, D. (2018, March 28). Mendes Beberkan Tiga Penyebab Tingginya Stunting Di Indonesia.


Saputra, A. (2020, February 14). GridHEALTH TALK; Faktor Utama Angka Stunting Masih Tinggi di Indonesia


Semba et al. (2008, January 28). Effect of Parental Formal Education on Risk of Child Stunting in Indonesia and Bangladesh: A Cross-sectional Study.


World Health Organization. (2018). Reducing stunting in children: equity considerations for achieving the Global Nutrition Targets 2025.


Torlesse, H., Cronin, A., Sebayang, S., & Nandy, R. (2016, July 29). Determinants of Stunting in INDONESIAN children: Evidence from a cross-sectional Survey indicate a prominent role for the water, sanitation and Hygiene sector in stunting reduction. _______https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966764/#CR5

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