• What Is Stunting and Why It Matters

    What Is Stunting and Why It Matters

    More than one in four children in Indonesia under the age of five suffers from stunting. That’s more than the population of Jakarta, or equivalent to almost two Singapores.

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    Stunted growth is caused by a lack of adequate nutrition and results in life-long health problems, from reduced IQ to greater susceptibility to diabetes and cancer. There is also a huge economic cost, with Indonesia’s Ministry of Health estimating that the prevalence of stunting costs the country 2-3% of GDP, or as much as US$27 billion each year.

    The good news is that the condition is easily preventable, but a lot of work remains if Indonesia is to achieve its target of bringing stunting down from 27.7% in 2019 to 20% by 2024.

    That’s why Tanoto Foundation, an independent family philanthropy organisation founded by Sukanto Tanoto and Tinah Bingei Tanoto in 1981, is holding Stunting Awareness Month, to raise awareness of this condition, how to prevent it, and how to treat it in kids who are already stunted.

    What is stunting?

    Stunting is when a child fails to grow to the proper height for his or her age. The main cause is poor nutrition in pregnant women, babies and toddlers.

    Stunting is a form of malnutrition, but it’s more accurately described as under nutrition. Few people in Indonesia lack sufficient calories, but low awareness of balanced nutrition means that meals are often heavy on rice, with little protein or vegetables. Many parents also don’t understand the importance of breastfeeding, relying instead on formula which is not as nutritious for a baby.

    In some areas, lack of clean water for sanitation and personal hygiene as well as limited access to health services can exacerbate the problem.

    Stunting often begins in the womb due to a poor maternal diet, but symptoms typically don’t manifest themselves until the child is around two years old, when it becomes clear that the child is not growing as quickly as he or she should.

    Why does stunting matter?

    Stunting has huge costs for the child and for the economy. Stunted children have weakened immune systems, are more susceptible to diseases like diabetes and cancer, and are likely to die earlier than non-stunted individuals.

    Brain development is affected too, resulting in lower IQs and reduced income in adult life. According to research by the WHO children who were stunted at age two completed a year less of schooling than non-stunted individuals, and were likely to earn 20% less as adults.

    This impacts the country’s economy. The government has set a target of becoming the fifth largest economy in the world by 2045, buoyed in part by a demographic dividend from a ‘youth bulge’ entering the workforce in the coming decades. But if stunting remains at current levels, more than one quarter of those new workers will be less healthy and less productive than they should be, holding back the nation’s growth and condemning millions to poverty unnecessarily.

    What can parents do?

    Stunting is easily preventable with proper nutrition.

    Mothers need to follow a balanced diet before pregnancy starts to ensure that the proper nutrients are passed on to the fetus.

    Indonesia’s Ministry of Health recommends that a healthy meal should consist of around one third fruits and vegetables, one third carbohydrates like rice, and one third protein like meat, fish or vegetarian protein sources.

    You should also practice proper hygiene, including washing your hands with soap and water before preparing or eating food.

    Experts recommend exclusive breastfeeding for the first six months of a baby’s life, and husbands can play a role by supporting their wife’s decision to breastfeed.

    And once the baby starts weaning, introduce fruit and vegetables into his or her diet.

    How do you know if a child is stunted?

    Children suffering from stunting typically weigh less than 2.5kg at birth, and grow more slowly than they should. They also often start teething later than non-stunted children.

    The good news is that some of these effects can be reversed by following a balanced diet within the first 1,000 days of life, or up to the age of two.

    If you think that your child may be stunted then you should seek advice from a medical professional.

    What is the government doing?

    The government launched the First 1,000 Days of Life Movement in 2013 which focused on fulfilling nutrition for children from the pregnancy phase (270 days) to two years old (730 days).

    The government also launched the National Strategy to Accelerate Stunting Prevention in 2017, gathering 22 ministries and around US$14.6 billion commitments to implement various nutritional interventions. In 2018, this strategy targeted 100 districts with high stunting prevalence. The number of districts was increased to 160 in 2019, 360 districts in 2020, and finally all 514 districts and cities in 2021.

    In the National Medium-Term Development Plan (RPJMN) 2020-2024, efforts to accelerate stunting reduction are one of the priorities.

    The government is aiming to get stunting under 20% in 2024, and some progress has been made. In 2007 36.8% of children were stunted, compared to 27.7% in 2019.

    What is Tanoto Foundation doing?

    Through our Early Childhood Education and Development program, we’re actively supporting the government’s efforts to prevent stunting. We invest in research that enables data-based decision making, and are working to strengthen care-giving in Indonesia to support children’s development.

    We are also a founding donor of the World Bank’s Multi Donors Trust Fund for the Indonesian Human Capital Acceleration, which provides US$2 million to help the government’s stunting prevention strategy.


    Together with the Smeru Research Institute, Tanoto Foundation is conducting a pilot study in Rokan Hulu, Riau, to map the prevalence of stunting down to the village level. These data will help inform future prevention strategies.

  • Tanoto Foundation and SMERU Collaborate to Develop Nutritional Status Map

    Tanoto Foundation and SMERU Collaborate to Develop Nutritional Status Map

    Tanoto Foundation, an independent family philanthropy organisation founded by Sukanto Tanoto and Tinah Bingei Tanoto in 1981, recently collaborated with SMERU Research Institute, an independent institution experienced in poverty and inequality research in Indonesia, to compile information about the nutritional status of children under five years old in the country at the sub-district and village levels.

    There were three types of nutritional data collected: HAZ based on children’s height and age, WAZ based on children’s weight and age, and WHZ based on children’s height and weight.

    The data is now accessible in the form of a Nutritional Status Map, which shows the nutritional status of children under five years old in six selected districts.

    The six districts –  Rokan Hulu (Riau), Central Lampung (Lampung), Tasikmalaya (West Java), Pemalang (Central Java), Jember (East Java) and South Central Timor (East Nusa Tenggara) – are all part of Indonesia’s list of 100 priority districts for stunting reduction.

    Previously, the only data available was at the wider national, provincial and district levels from RISKESDAS (Basic Health Research) conducted by the Indonesian Ministry of Health in 2013.

    Methodology

    According to SMERU, the Nutritional Status Map was created using the Small Area Estimation (SAE) method which is a common and reliable tool used to gauge poverty levels.

    Field visits were also conducted during the preparation of the map, to verify findings about the children’s nutritional status in 2019.

    As part of research for the map, the SMERU Institute also relied on Indonesia’s 2010 Population Census as well as 2011 RISKESDAS Podes (Village Potential) data which include information about villages such as availability of basic education and health facilities and number of health workers.

    Findings

    The nutritional status of children under five years old varied from one district to another, and there is no common reason shared among villages with high prevalence of nutritional issues.

    However, several factors were identified as indirect influences on the children’s nutritional status, including the level of education of toddlers’ parents, improved sanitation, access to clean water, the type of jobs held by parents, and the level of good nutrition intake by mothers and children (which  is dependent on mothers’ understanding of its significance).

    The nutritional status in the sample verification villages tended to improve over the 2013-2019 period. In Rokan Hulu Regency, there was a very encouraging decline, from 59.20% in 2013 to 27.25% in 2018.

    The existence of nutritional maps at the sub-district and village levels assists the Indonesian government in developing more targeted programmes and implementing stunting prevention policies with more efficient use of budgets and other resources.

  • How Tanoto Foundation Enable Parents to Establish and Sustain Exclusive Breastfeeding

    How Tanoto Foundation Enable Parents to Establish and Sustain Exclusive Breastfeeding

    It’s a common consensus that babies should be exclusively breastfed for the first six months of life – in Indonesia it’s even a protected right under article 128 of Health Act no. 36 of 2009.

    The benefits are overwhelming. In the early period of life, babies given breast milk have a mortality rate six times lower than babies who do not receive breast milk, making breastfeeding an important component of achieving Goal 3 of the UN’s Sustainable Development Goals, which aims to ensure healthy lives and promote well-being for all.

    Babies who are breastfed also show better development in height, weight, cognitive functions, language and mental health.

    But despite this, Indonesia still lags behind. That’s significantly below the target of 50 per cent by 2025 set by the World Health Organization.

    Lack of breastfeeding is one of the causes of Indonesia’s persistent problem with stunting, which is defined as children under the age of two years who have not reached a standard height, a condition that can carry through to their adult lives without proper treatment.

    The brain is highly plastic during the first three years of life, with this period accounting for approximately 80 per cent of brain development. Breastfed infants have higher IQs than those who have never been breastfed, and this difference actually increases between the ages of three and seven, long after the child has moved onto solid foods.

    Both physically and mentally, the first few years of life play a crucial role in development, dictating the future prospects of each individual.

    It’s for this reason that Tanoto Foundation launched the SIGAP (Strengthening Indonesia’s early Generation by Accelerating Potential) program to ensure that every Indonesian child, from the womb until the first three years of his or her life, enjoys optimal growth and development through quality care so that they are ready to learn when entering education.

    The role of fathers

    Although many people understand the importance of exclusive breastfeeding for the first six months, there is lower awareness of the many challenges breastfeeding mothers may face.

    Research shows that the main challenge in Indonesia is a lack of knowledge, with many women opting for formula milk rather than breastfeeding. Medical practitioners have a key role to play here, as they can provide information and motivation to new mothers.

    But mothers are not the only ones who need educating – fathers have an important part to play too.

    Several studies in the last decade show that fathers do not understand the importance of breastfeeding, often having greater awareness of the benefits of formula milk due to exposure in the media.

    Another study in the US in 1994 showed that strong approval from the father resulted in a 98.1 per cent incidence of breastfeeding, versus 26.9 per cent where the father was indifferent.

    Fathers may not be able to breastfeed themselves, but they can help, whether by encouraging the mother or by helping create the calm, relaxed conditions which are ideal for feeding.

    Recognizing the importance of this, the SIGAP program often collaborates with activists from the ASI Ayah community to create open discussions that they are easily digested by an audience of new fathers.

    The latest discussion forum was held on September 11, 2019, titled ‘Investments; let’s get to know the factory!’ which invites fathers to gradually understand the physical and psychological processes that can influence breastfeeding success.

    Through this event, the Tanoto Foundation invited facilitators from AyahASI Indonesia to give presentations on matters that are still considered taboo but are vitally important, such as understanding the physical changed of the breasts during pregnancy to postpartum, and how milk production can be stimulated.

    Typically many fathers in Indonesia consider these topics off limits to talk about, let alone learn about, so by tackling this in a relaxed environment the sessions can help change perceptions and explain to fathers the important role they can play.

    The need for nursing spaces

    One of the challenges mothers face can be finding a suitable space for breastfeeding, especially in the office.

    Some of these rights are enshrined in Indonesian law, including a requirement for the government to provide facilities for breastfeeding, and for employers to allow working mothers to nurse during office hours.

    But it’s not just facilities – companies should also provide psychological support to mothers to ensure they feel able to breastfeed in the office. If they feel that breastfeeding is encouraged in the workplace, they are more likely to feel comfortable doing so.

    At Tanoto Foundation’s office in Jakarta we set up a dedicated breastfeeding room, complete with comfy chairs, soothing décor, and a fridge for mothers who need to store pumped milk. It’s a simple gesture, but one that is vital in encouraging mothers to keep breastfeeding.

    Outside help

    New mothers are often left to deal with the housework as well as their new childcare responsibilities. In many cases this lack of rest results in depression, with negative consequences for both mother and baby. Family members can help alleviate the burden by taking over some of the household chores.

    Community leaders also have a role to play by acknowledging the importance of breastfeeding exclusively for the first six months, and encouraging family, friends and neighbours to create a supportive environment.

    The most important thing is to start building social narratives that position exclusive breastfeeding as a necessity, not just a choice.

    Breastfeeding is an important foundation for a healthy and prosperous future generation. More than that, breastfeeding plays a role in promoting sustainable economic development.  , while benefitting the environment by replacing manufactured milk formula with a natural alternative.

    Breastfeeding also promotes bonding between parents and babies, benefitting the baby’s sense of security, social-emotional, and mental health. Let’s support breastfeeding mothers together!