Understanding the Burden of Childhood Stunting
Stunting, a developmental condition in children under five years caused by prolonged malnutrition, indicates a nutritional state other than wasting and underweight. Stunting has long-term effects on human resources, including a decline in earnings in the working world and a slowdown in cognitive development of about 7% compared with children who do not experience stunting. Stunted children have a more challenging time competing in the job market, which means they earn less money overall.
In 2022, the WHO predicted that stunting will affect roughly 22.3% of children under five years. The Southeast Asia region has the highest proportion of stunting episodes among the six WHO intervention zones, at approximately 30.1%. This region nearly surpasses the African region, which has an estimated ratio of 31.0%. When we examine the stunting condition in the Southeast Asia region over the last 3 years, from 2020 to 2022, we may observe a decline of about 0.9% from 2020 (31.8%) to 2021 (30.9%) and then another drop of 0.9%.8% from 2021 (30.9%) to 2022 (30.1%). The WHO has set a target of reducing the incidence of stunting in children by 40% by 2030; therefore, this rate is still far more significant than that.
Considering these goals, the stunting incidence in the Southeast Asia region is still significantly lower than anticipated, highlighting the necessity for joint efforts and collaboration across sectors to reach the established objectives. The Indonesian government previously released the National Strategy for Accelerating Stunting Prevention 2018–2024, which aims to ensure that all resources are directed and allocated to support and finance priority activities, significantly increasing the coverage and quality of nutrition services for households in the first 1000 days of life (pregnant women and children aged 0–2 years).
Examining Stunting in Indonesia’s Urban Poor Communities
With a prevalence of 24.4% in 2021 and 21.6% in 2022, Indonesia is one of the SEA Region member nations with a relatively high stunting rate. A closer inspection of these numbers reveals that stunting has dropped by about 3.3% in Indonesia in just 1 year. Nevertheless, the performance falls short of the national target established by the Indonesian government to reduce stunting to 14% by 2024.
The situation is much more dire when children are raised alone by their mothers without any support from other family members. In fact, in countries like Cameroon, the Republic of the Congo, and Nigeria, children cared for by a single mother have a higher risk of child mortality compared with children in complete families. Poverty is a problem for around 7% of Indonesia’s urban population, and even the most essential urban life, such as living near open gutters and water puddles, is constantly exposed to harmful trash. Poor sanitation can lead to the spread of intestinal parasites, such as worms. People living in poverty in metropolitan areas often struggle to afford nutrient-dense meals because of their limited budgets and the high cost of food.
Based on this background, the study aimed to determine the appropriate policy targets to reduce the prevalence of stunted children under five in urban-poor communities in Indonesia. The study used secondary data from the 2022 Indonesian Nutrition Status Survey, which the Indonesian Ministry of Health analyzed nationwide.
Methodology and Key Findings
The study’s population consisted of all Indonesian children under five who lived in urban-poor communities in Indonesia. Mothers were the survey respondents, while children under five (those younger than 59 months) were the analysis unit. The study selected 43,284 under-five children from urban poor societies through a multi-stage cluster random sampling survey to create a weighted sample for the experiment.
The dependent variable in this study was stunting, which measures a child’s nutritional condition based on age or height at a certain period. The study selected eight independent variables: mother’s age, educational level, work position, antenatal care (ANC), wealth, marital status, age and sex of the children.
The study found that 23.4% of children under five in urban-poor communities in Indonesia are stunted. This number exceeds the 21.6% national average for the same year. The key findings include:
Maternal Factors
- Age: Mothers aged 45 and above had the highest proportion of stunted under-five children.
- Education: The lower the maternal education, the higher the stunted toddler proportion.
- Employment: Unemployed mothers were more likely than employed mothers to have stunted under-five children.
Household Factors
- Wealth: The poorest households had a higher stunted kids’ ratio than the poorer households.
- Antenatal Care: Mothers without ANC during pregnancy had a higher stunted under-five prevalence.
Child Factors
- Age: Children aged 24-35 months had the highest ratio of stunted kids.
- Gender: Boys were more likely to be stunted than girls.
Policy Recommendations
Based on the research findings, the study proposes the following policy recommendations to reduce the prevalence of stunted under-five children in urban-poor communities in Indonesia:
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Targeted interventions for young mothers and those with low education: Intervention policies should prioritize young mothers and those with poor education, as they are at higher risk of having stunted under-five children. This could include reproductive health, nutrition, and parenting education programs.
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Economic support and skills training for unemployed mothers: Policies should provide economic support and skills training to increase employment opportunities for unemployed mothers, as their economic conditions can affect access to resources necessary for child growth and development.
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Improved access to antenatal care services: Policies should promote and improve access to antenatal care services for pregnant women, especially in poor urban communities, as ANC during pregnancy is influential in reducing the risk of stunting in children.
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Tailored interventions for older infants and boys: Interventions should pay particular attention to children aged 24-35 months and male children, as they were found to have a higher risk of stunting.
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Multisectoral collaboration and community engagement: Addressing stunting in urban-poor communities requires a coordinated effort across different government sectors, including health, nutrition, social protection, and urban planning, as well as active engagement with local communities.
By implementing these targeted policy interventions, Indonesia can make significant progress in reducing the prevalence of stunted children in its urban-poor communities, ultimately improving the long-term health and well-being of its population.
Conclusion
The study’s findings highlight the complex and multifaceted nature of childhood stunting in urban-poor communities in Indonesia. Addressing this challenge requires a comprehensive, evidence-based approach that considers the unique socioeconomic, cultural, and environmental factors influencing child nutrition and growth. By prioritizing interventions that target the key risk factors identified in this research, policymakers and practitioners can work towards achieving the national and global goals for reducing stunting and improving the overall health and development of children in vulnerable urban populations.
