Tuesday, 10 February 2015

Prosperity rests on stronger efforts to reduce malnutrition

Gunilla Olsson, Representative of UNICEF Indonesia
Children from a traditional village in Sumba Island, East Nusa Tenggara.

There is a widespread belief in Indonesia that its people are short by nature. Because generation after generation of family members is small in size, many people assume that physical stature is a genetic trait over which people have no control. 

But science shows that this is not usually the case. Short and thin mothers give birth to small and malnourished children, who grow poorly because they are unable to eat sufficient nutritious food, or they suffer frequent episodes of diarrhea and other infectious diseases. The girls become short and thin mothers, and so the intergenerational cycle of malnutrition continues.

Today in Indonesia, almost 9 million children under the age of five are too short for their age, a condition known as stunting. Many of these children will not do well at school because the same nutrients that are needed for growth are also needed for healthy brain development.

The first 1,000 days of life between conception and a child’s second birthday is when the development of the brain is greatest and potentially irreversible damage is caused. As adults, they will earn up to 20 percent less than their well-nourished peers and will find it difficult to help their families exit from poverty. And unless action is taken, their children and grandchildren will suffer the same fate.

The 2014 Global Nutrition Report places Indonesia among 31 countries in the world that are unlikely to meet global targets for reducing malnutrition by 2025. Government data indicates that 37 percent of children under five were stunted in 2013, 12 percent were wasted (too thin for their height) and 12 percent were overweight.

Poor Indonesians are 50 percent more likely to be stunted than those in the upper wealth quintile. Nevertheless, up to 30 percent of Indonesian children in the top wealth quintile are stunted. There are also wide disparities between provinces and districts in the prevalence of malnutrition.

These figures are unusually high for a country in the middle-income bracket. There has been almost no progress in reducing malnutrition since 2007, which means the absolute number of malnourished children continues to rise because of population growth.

Failure to act carries a heavy cost. With reduced productivity and earnings, adults who were stunted in early life are less able to contribute to Indonesia’s economic growth. In fact, a study determined that undernutrition costs African and Asian nations 11 percent of their gross national income.

But the problems do not end there. When stunting in early life is combined with excessive weight gain in later life, the risks of obesity, diabetes and cardiovascular diseases escalate. The so-called “double burden” of malnutrition, when undernutrition and overnutrition coexist side-by-side, is an emerging reality in Indonesia, which the health system can ill-afford to address. The percentage of overweight adult women in Indonesia doubled to 33 percent between 2007 and 2013, while diabetes and cardiovascular diseases are increasing at alarming rates.

Stunting and other forms of malnutrition are not inevitable. They can be prevented. The potential returns on investment are considerable.

A recent study calculated that efforts to reduce stunting alone in Indonesia would yield Rp 48 million (US$3,840) for every Rp 1 million invested (Hoddinott, J, Alderman, H, Behrman, J R, Haddad, L and Horton, S, 2013).

Good nutrition is everyone’s business and we need more champions at all levels.

The government is serious about reducing malnutrition in Indonesia. In fact, child stunting is one of the overall development indicators in the government’s National Medium Term Development Plan for 2015-19. It recognizes that it cannot achieve results alone. A collective effort of all stakeholders, as well as families and communities themselves, is needed.

The Scaling Up Nutrition (SUN) Movement provides a golden opportunity to more effectively harness the investments of government, UN agencies, donors, civil society and the private sector.

It has greatly enhanced the political prominence of nutrition at the national level. Now, Indonesia’s districts and communities are being asked to improve the access of children, women and communities to essential services to reduce malnutrition. Progress must be measured and district authorities held to account.

UNICEF, the World Food Program, World Health Organization and Food and Agriculture Organization of the UN proudly support the SUN Movement.

We work with the government to ensure that families have access to information and counseling on how to breastfeed and feed their young children, to provide women and children with essential vitamins and minerals, and to treat malnutrition when prevention efforts fail. In addition, we are supporting efforts to prevent and treat diseases that cause undernutrition, particularly diarrhea, malaria, measles and HIV.

We are also deeply concerned about the high number of adolescent pregnancies — 500,000 per year in Indonesia — as pregnancy in adolescence is harmful for the growth and health of the mother and her baby.

But reducing malnutrition requires actions from many sectors.

Since the poorest families are most likely to be malnourished, we seek to improve the nutritional impact of social protection programs. We are working with the agricultural, marine and commercial sectors to improve the supply of safe and nutritious foods, and to provide clean water and sanitation.

The private sector is being encouraged to contribute to improved nutrition and to market food and beverages responsibly, especially when they are aimed at infants and young children.

Good nutrition is everyone’s business and we need more champions at all levels — village heads, health workers, religious leaders, industry leaders, celebrities, politicians and beyond — to challenge the assertion that Indonesians are destined to be stunted. With a nationwide effort, all Indonesian children can grow up as healthy and strong and smart as they deserve to be.