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Indonesia's Battle Against Stunting

Aisha S. F., Jocelyn A. S., Alayya M. H.
Nov 18, 20206 min read

STUNTING IN INDONESIA - AN OVERVIEW

Did you know that, according to the FAO (2018), almost 1 out of 3 Indonesian children suffer from stunting? To be stunted is much more than just to be over 2 standard deviations shorter than the WHO Child Growth Standards median. A World Bank article (2018) revealed that stunting, or one’s failure to reach their growth potential, may result in permanently diminished physical and cognitive capacities, in addition to further lifelong damages. The World Health Assembly’s 2014 policy brief also mentioned several lasting effects of stunting, which includes weakened health, inclined risk of non-communicable diseases, and decreased productive competence. Being a principally irreversible outcome of undernourishment and frequent infections, childhood stunting negatively impacts not just individual toddlers, but rather societies in general, and is “one of the most significant impediments to human development” (WHA, 2014).


Unlike countries nearby, Indonesia has progressed tremendously in the fight against hunger. Positive trends have been shown by malnutrition and food security figures in its fourth year of implementing the UN’s Sustainable Development Goals (FAO, 2019). As revealed by Indonesia’s Ministry of Health (2019), the national stunting rate for children below 5 demonstrated similar yet slower patterns, experiencing only a 9.5 per cent decline throughout a period of 6 years. Despite this slight growth in nourishment quality, the country’s stunting prevalence of 27.7% (Indonesian Health Ministry, 2019) still falls into WHO’s ‘medium’ threshold. In fact, Indonesia was ranked fifth globally for having the most stunting cases (UNICEF, 2011). Disparities in the number of stunted kids under 5 were also reported due to factors like gender, geographical location, and economic status. UNICEF (2011) disclosed that childhood stunting, as of 2010, was slightly higher in boys than in girls by 3%. Contrastingly, the ratio of urban to rural cases was 0.8 in that same year, while the gap between stunting rates in the richest and poorest wealth quintiles reached 19% (UNICEF, 2011).


THE DOUBLE BURDEN OF MALNUTRITION

According to the World Health Organization (n.d.), millions of Indonesian youth remain “double burdened” by malnourishment — a condition in which under- and overnutrition coexist. Even though malnutrition comes in other forms such as wasting, stunting, and nutrient deficiency, the country tends to pay more attention to severe underweight and use it as a way to determine their nutrition state (World Bank, 2015). However, in the opinion of the World Bank (2015), stunting should actually be of greater concern because of its long-term consequences. Not only does it have the capability to reduce productivity in the coming years, stunting increases the chance of contracting degenerative diseases as well (Indonesia Investments, 2015).


Prof. Dr. Endang Achadi (2015), a nutritionist from the University of Indonesia, stressed the fact that shortness is not the real problem of stunting. Instead, the issue lies when other processes in the body like brain development, which affects intelligence, get stunted, too. Based on a 2015 World Bank statistic, children whose growth is impeded might experience a 5-11 point reduction in IQ score, leading them to perform worse and get lower grades at school. The projected gain from Indonesia’s highly-anticipated demographic transition may also be downsized by the double burden of undernourishment. This is on the grounds that adults who suffered from stunting as kids potentially possess weaker psychological and intellectual skills compared to their normal peers. Due to the predicted surge in competition, children who are currently stunted have a smaller opportunity of securing a proper job with a high salary later on. The future generation should be a demographic bonus for Indonesia, not a demographic burden (Soekirman, 2015).


On top of encumbering its victims personally, stunting brings suffering to the nation’s economy, too — most often through the heightened risk of non-communicable diseases. Though not transmissible between people, NCDs give rise to 41 million deaths worldwide every year (WHO, 2018). The treatment and medication for such illnesses — among them being diabetes, cardiovascular disorders, and cancer — could be expensive, especially for those without a stable income. “More cases of non-communicable diseases in Indonesia have caused higher expenditure for the government, particularly for the national health insurance. The highest costs for national health insurance are for treatment of stroke, diabetes, and kidney failure,” reported the director of nutrition at the Ministry of Health, Doddy Izwardy. In consequence, it is estimated that stunting and malnourishment will cost 2 to 3% of Indonesia’s GDP (World Bank, 2015). Stunting, without doubt, poses a serious threat both to the health and to the economy of the country.


ACTIONS TAKEN BY NGOS & THE GOVERNMENT

One of the organizations fighting childhood stunting in Indonesia is the Tanoto Foundation. It was founded in 1981 by Sukanto Tanoto and her wife Tinah Bingei Tanoto when they established a kindergarten and primary school in Besitang, North Sumatra. The organization focuses on significantly reducing Indonesia’s stunting rate to below 20% by 2030 as well as elevating Indonesia’s global ranking in education. In November 2018, Tanoto Foundation coordinated a training session regarding the reduction and prevention of stunting in Indonesia, with the improvement of early childhood development and education being one of the key target areas. The event, executed in collaboration with the Office of the Presidential Staff (KSP) and the National Team for the Acceleration of Poverty Reduction (TNP2K), was held in Cianjur, West Java from November 8 to 9. More than 500 health care volunteers from Maternal and Child Health Centres (Posyandu) around the town attended the session.


Another non-profit group promoting the decrease of the national stunting prevalence is Save The Children Indonesia. It is part of Save The Children Fund that was established in the United Kingdom in 1919. “Berpihak Pada Anak” is a campaign by Save The Children Indonesia that aims to reduce the national burden of stunting by 2030. Out of several projects the campaign has launched is one called the “Youth Employment Program”. This initiative helps 15 to 24-year-olds acquire skills that will open the doors to employment and economic opportunity. Nearly 5,000 youths have completed employability skills training, while nearly 3,600 have been enrolled in vocational training.


Not just foundations and charitable organizations, the Indonesian government also showed efforts in the battle against stunting through their “National Strategy for Stunting Prevention Acceleration 2018-2024”. It consists of 5 pillars: leadership, vision, and commitment; national campaign and behaviour changes communication; convergence and coordination in all levels; nutrition and food resilience; as well as monitoring and evaluation. As of 2019, the government prioritised 160 cities or regencies in which the scheme will be implemented. Among the 160 listed regions, 17 are located in the Lampung and West Java provincial municipalities.

Experiencing similar problems, the two provinces came up with plans to tackle the growth of stunting prevalence. Lampung’s provincial health agency formed the Lampung Stunting Agency to address the issue better. According to UCLG (2019), the initiative is on its way to becoming a governor regulation. Moreover, South Lampung — the district with the highest stunting prevalence in the province — has been actively involved in a social conditional aid program named Program Keluarga Harapan (PKH). PKH enables selected poor families to access health and basic education services, a key factor in reducing the number of stunted kids across the nation. The West Javan government, on the other hand, introduced a provincial program called Ojek Makanan Balita (OMABA). It is “a motor-bike based delivery service for children nutrition focusing on stunting-extreme areas in West Java” (UCLG, 2019). In 2016, this activity was supported by PT. Pertamina Persero for Bandung area and replicated at the city level, and was then further replicated at the provincial level in 2018.



 

REFERENCES


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Izwardy, D. (2020, February 20). Studi Status Gizi Balita Terintegrasi SUSENAS 2019


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UNICEF. (n.d.). Nutrition: Tackling the ‘double burden’ of malnutrition in Indonesia.


WHO. (2014). WHA Global Nutrition Targets 2025: Stunting Policy Brief.

WHO. (2015, November 19). Stunting in a nutshell. _______https://www.who.int/nutrition/healthygrowthproj_stunted_videos/en/

WHO. (2018, June 1). Noncommunicable diseases.

World Bank. (2015, April 23). The Double Burden of Malnutrition in Indonesia. _______https://www.worldbank.org/en/news/feature/2015/04/23/the-double-burden-of-malnutrition-in-

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World Bank. (2018, June 26). Indonesia Accelerates Fight Against Childhood Stunting.

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