Child health in Indonesia remains a major challenge largely because of malnutrition, although maternal health is improving, a key international report says.
The State of the World’s Mothers Report 2012, released this week by the nongovernmental organisation Save the Children, had Indonesia 70th out of 83 countries in its Child Index Rank.
The country was also 46th out of 81 in the Women’s Index Rank. The rankings combine to make Indonesia the 59th best country to be a mother out of a total of 80 developing countries.
Indonesia’s low ranking on child health was blamed on widespread malnutrition, which has resulted in moderate to severe stunting in 40 percent of children under the age of five.
The report noted that Indonesia was among the countries “that are underperforming [on child nutrition] relative to their national wealth [GDP].”
“There has been good economic growth across Southeast Asia in the last decade, but the results show that strong policies and investments targeted at improving maternal and child health, education and women’s rights are necessary,” said Michel Anglade, Save the Children’s campaigns and advocacy director in Asia.
The report highlights “a vicious cycle of how mothers, who may themselves have been stunted in childhood, go on to give birth to underweight babies who have not been adequately nourished in the womb.”
“If a mother is impoverished, overworked, poorly educated and in poor health, she may not be able to feed the baby adequately. The damage caused by malnutrition before the age of two is largely irreversible,” the group said in a news release, adding that while leaps had been made in reducing child mortality, stunting remained a problem in Southeast Asia as a whole.
The health ministry acknowledged the high prevalence of child stunting, citing the lack of attention given to mothers during pregnancy.
“Stunting is a problem that was not too widely known in Indonesia until a few years ago. We admit that,” Minarto, the ministry’s director for nutrition education, told the Jakarta Globe.
“In the past few years, we were still grappling with severe malnutrition cases in some parts of the country, so we were focused more on the children instead of the pregnant women. But we have since expanded the scope of our campaign.”
He said stunting could happen if the mother did not receive proper nutrition during pregnancy or if she did not visit the doctor regularly. The ministry says it has allocated Rp 700 billion ($76.3 million) annually to tackle the issue.
The ministry’s 2010 Basic Health Research survey found that 35.6 percent of Indonesian children under the age of five were stunted. It has set a target of cutting that figure to 32 percent by 2014.
“We’re on our way and there’s a possibility that we might exceed the target with our current programme,” Minarto said, referring to the ministry’s campaign to raise awareness about the importance of proper nutrition throughout the mother’s pregnancy and until the child turns two years old.
Save the Children also noted that “the best method for protecting the pregnant mother and her baby from the vicious cycle of malnutrition is to focus on the child’s first 1,000 days starting from pregnancy.”
With proper nutrition after birth, Minarto said, stunting could be corrected or at least minimised.
“Children who don’t get proper nutrition during pregnancy and are born stunted can still catch up during their golden age, which is until they turn two. Given the proper nutrition, they can improve. It might not be perfect, but it’s good enough,” he said.
Minarto also said that stunting was a complicated problem.
“It’s mostly related to poverty and lack of education, but sometimes it’s pure ignorance because the parents don’t have any knowledge of proper nutrition,” he said.
Subagyo Partodiharjo, a medical doctor who leads the health caucus at the House of Representatives, said that dangerous child-rearing myths were also responsible for the severity of the malnutrition problem in Indonesia.
Pregnant women are typically told not to eat certain types of food during pregnancy or when breast-feeding. That misconception, he said, often prevents them from getting the proper nutrition they need during those key periods.