On average, stunted children surrender between six and 11 IQ points, and they miss half a year of schooling due to illness. (Photo courtesy of Valerie Esmeralda Krisni)

Vice-Presidential Debate Serves as Perfect Opportunity to Talk About Stunting

BY :VALERIE ESMERALDA KRISNI

MARCH 17, 2019

Few people are looking forward to the vice-presidential debate, scheduled for Sunday evening. Social media is already aflutter with jokes about how much coffee will have to be consumed to not fall asleep during the debate. But for people concerned about stunting, the tête-à-tête between Sandiaga Uno and Ma'ruf Amin will set the tone on how the world's largest archipelago plans to address stunting – Indonesia's silent emergency.

Stunting is associated with terrible disadvantages. On average, stunted children will surrender between six and 11 IQ points, and they will miss half a year of schooling due to illness. Stunting is also intergenerational – children whose mothers or even grandmothers were stunted have a higher risk of being stunted themselves. And stunted children will, as adults, likely earn up to 20 percent less than their non-stunted peers.

More importantly, it is an economic disaster for Indonesia. Stunting costs the country more than $20 billion in economic losses per year.

Meanwhile, stunting is not only confined to remote areas. The Ministry of Health's ‎national basic health survey‎ (Riskesdas) for last year indicates that stunting affects more than one in every three Indonesian children under the age of 5. That is more than 9 million children. Even in Jakarta, more than one in four are stunted.

So, what can be done to reverse stunting?

Almost nothing. Much of the damage incurred during the first 1,000 days of life is irreversible. Therefore, it is extremely important that measures to prevent stunting are taken during that time, which means from conception until the child's second birthday.

What few people know, is that stunting prevention is both relatively easy and extremely cheap. Exclusive breastfeeding, good hygiene practices and regular health checks, just to name a few, are key to preventing children from becoming stunted. Following best practices outlined by the Lancet medical journal series of 2008 and 2013, it costs a little over $100 per child to provide a comprehensive package of benefits, such as maternal education, enhancing water and sanitation quality, and nutritional supplements.

These proven interventions can have a massive social and economic return, for every $100 spent on stunting prevention in Indonesia will yield $4,800 in return. Children who are saved from stunting will be smarter, healthier and spend more time in school.

But whatever is done on a national level would not completely work if there are no significant behavioral changes at a local level. We need a widespread increase in knowledge on what stunting is, and the many ways it can easily be prevented.

At a recent workshop for pregnant women at a health center in Messah, an island on the fringes of the Komodo National Park in East Nusa Tenggara, a participant asked the facilitator: "Is it true that we can get worms if we eat fish?" The facilitator promptly debunked the myth, stating the many health benefits, in the hope of convincing more pregnant mothers to eat more fish.

On Messah, more than half of children below the age of 5 are stunted and fish is one of the most affordable and accessible sources of protein. Unfortunately, many old wives' tales like this persist in the villages of East Nusa Tenggara. For example, kelor, also known as moringa, a plant native to India, is rich in nutrients and abundant on remote islands like Messah, where most other forms of vegetables are not readily accessible. However, many people still refuse to make kelor a part of their diet, believing that a deceased relative's spirits would not return in peace if they consumed the plant.

The combination of limited access to a diverse, healthy diet and superstitious beliefs surrounding many nutritious food items result in a diet that consists of instant food and snacks full of preservatives and sugar. A diet based completely on snacks, coupled with a lack of access to water, handwashing and toilets, is one of biggest reasons children in Messah, and many other parts of East Nusa Tenggara, are stunted.

Everyone has a responsibility to raise awareness of stunting and its impact, and prevent more children from becoming stunted. We need to create changes and raise awareness from the grassroots to the national level, and everywhere else in between. Because what we ignore now, has detrimental effects in the future, both on the individual and the nation.

Let us change the myths going around in villages of East Nusa Tenggara from "eating too much fish will give you worms" to the fact that "eating too much snacks early in your life will cause you to be stunted." Let us change more minds for the better and save 2 million children from becoming stunted by 2021.

More importantly, let us remember President Joko "Jokowi" Widodo's recent pledge. At the 2019 National Health Work Meeting in South Tangerang, Banten, in February, the president stated that: "We have to make Indonesia a stunting-free country." He has publicly pledged to reduce stunting by 2 million children every year. March 17 is an opportunity to see those bold pledges in action.

Valerie Esmeralda Krisni is a graduating senior at Yonsei University's Underwood International College in South Korea. She is also an intern at the 1,000 Days Fund, a nongovernmental organization that focuses on household-level interventions to stunting in Indonesia.

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