Socio-cultural Determinants of Stunning in Coastal Areas in Indonesia: A Report of an Ethnoghraphic Study

DEAR EDITOR

Stunting is a chronic malnutrition problem to which developing countries are faced. Stunting increases the risk of child death, affects cognitive and motor development, and reduces performance and productivity in adulthood. Globally, 1 out of 4 children under the age of 5 suffers from stunting, which causes developmental and growth delays. ¹

The prevalence rate of stunting in Indonesia was 24.4 percent in 2021. This figure is still far above the standard set by the world health organization (WHO) which is below 20 percent. ² However, the prevalence rate in 2021 has decreased about 30.8 percent in 2018, 27.7 percent in 2019, and 26.9 percent in 2020, based on the Indonesian Nutrition Status survey results. ³ Indonesia is targeting a 14% reduction in growth and development disorders in children in 2024. ⁴ Since stunting cases are relatively high in Indonesia and are evenly distributed across all provinces, one of the areas of concern is the high stunting cases in Indonesia’s coastal areas. The report revealed the findings of an ethnoghraphic study for explanation of socio-cultural determinants related to the high prevalence of stunting in the fishing areas of Sulawesi Island of Indonesia.

Participants were two health workers who handled community nutrition, four population and family planning officers, one person from traditional midwives, and ten families of fishermen with 1-5-year-old children suffering from stunting. Data were collected through participant observation, in-depth interviews, and document searches.

Two categories, parenting patterns and characteristics of families, emerged from data analysis. Parenting patterns consisted of belief system, parental involvement, and parenting experience. Belief system had a very significant effect on stunting of children. The pattern of childcare for fishermen’s families is rooted in the beliefs passed down from generation to generation, starting from prenatal care to childbirth. Then, caring for children until they become teenagers is all influenced by the habits carried out by their parents for generations.

The characteristics of families included early marriage age, parents’ education, parent’s psychosocial status, eating habits or food choices, very close pregnancies, environmental conditions, limited access to public facilities, limited sources of family income, and many families in one house. These various conditions independently or simultaneously contributed to the high incidence of stunting.

Models for handling stunting carried out in general by the government sometimes ignore indigenous models, namely ignoring the unique characteristics of an area that has a different cultural background from community groups in general. Stunting management programs adopt a uniform approach to deal with very different societies. Social design is made in general and is also applied in general. This causes underdifferentiation or ‘less differentiation’ where there are stunting treatments that are declared successful and some are deemed unsuccessful. Gaps in the policy, program, and intervention levels have hampered the stunting prevalence rate reduction. All parties have an important role in accelerating stunting reduction by providing evidence and policy recommendations to stakeholders at the country level.5 This shows that there are differences in the handling of stunting.

In this study, the people who lived in coastal areas had their own way of dealing with the problem of stunting according to the culture they adhered to. Parenting techniques that do not consider the first 1000 days of life as a golden or sensitive phase have a negative impact on the life histories of children who experience stunting. The WHO refers to it as the “window of opportunity,” which is a vulnerable period in human development when malnutrition can have short- and long-term consequences on children’s health. ⁶ Therefore, policymakers in nutritional fields for handling stunting programs need to have sociocultural lens.

ACKNOWLEDGEMENT

We would like to thank the institution National Research and Innovation Agency for financial support of the present research.

Conflict of Interest:

None declared.

References

1. Huriah T, Nurjannah N. Risk factors of stunting in developing countries: A scoping review. Open Access Macedonian Journal of Medical Sciences. 2020; 8:155-60.
2. World Health Organization. Reducing stunning in children. Equity considerations for achieving the global nutrition targets 2025. World Health Organization: Geneva; 2018.
3. Niga J. Collaborative Governance in an Effort to Reduce stunning Rate in TTS District, NTT Province. International Journal of Social Service and Research. 2023; 3:1060-7.
4. Siswati T, Iskandar S, Pramestuti N, et al. Effect of a Short Course on Improving the Cadres’ Knowledge in the Context of Reducing Stunting through Home Visits in Yogyakarta, Indonesia. International Journal of Environmental Research and Public Health. 2022; 19:9843.
5. Lopez de Romaña D, Greig A, Thompson A, Arabi M. Successful delivery of nutrition programs and the sustainable development goals. Current Opinion in Biotechnology. 2021; 70:97-107.
6. Martorell R. Improved nutrition in the first 1000 days and adult human capital and health. American Journal of Human Biology. 2017; 29:10.