Answering the Challenge of “Stunting-Free Generation” in the Midst of a Pandemic: Let’s Provide Access and Educate!

Have the Children’s Rights to Health Been Fulfilled?

It is not long before Indonesia will welcome the National Children’s Day (Hari Anak Nasional) again on July 23, 2021. Still taking the previous year theme, the theme of this year’s National Children’s Day is “Protected Children, Advanced Indonesia” with the tagline #AnakPeduliDiMasaPandemi (Children Care in Pandemic Times). In one of the official articles released by the Ministry of Women Empowerment and Child Protection, the theme and tagline of this year for HAN is expected to be a motivation that the pandemic will not dampen the commitment to celebrate HAN virtually without reducing its meaning.¹ However, before we get to this year’s HAN celebration, the big question is “Are children’s rights fully fulfilled?“

Before finding the answers to the questions above, it is important to understand that children have rights that are comprehensively regulated in the Convention on the Rights of the Child, which Indonesia has ratified through Presidential Decree No. 36/1990. One of the crucial rights for a child to live is the right to health. Article 6 and 24 of the Convention on the Rights of the Child, in particular, state that every child has the right to the best standard of health and medical care, clean water, nutritious food and a clean and safe living environment.² All adults and children need to have access to health information. The government must ensure that children can survive and grow up healthily.

As mandated in Article 4 of Law Number 23 of 2002 concerning Child Protection and its amendments (“Child Protection Law”), the right to health, in fact, is a reflection of the fulfilment of children’s rights to live, grow and develop in accordance with their dignity and honor. Article 8 of the Child Protection Law also stipulates that every child has the right to obtain health services and social security for their physical, mental, spiritual and social needs.

However, have you heard that 1 in 3 children under five in Indonesia is stunted or grows shorter than their age due to malnutrition³, or that 7 million Indonesian children are stunted⁴? So, is the right to health of Indonesian children really being fulfilled properly?

On Stunting during the Pandemic

Stunting is a chronic nutritional problem in toddlers which is characterized by a shorter height compared to their age.⁵ Stunting is caused by malnutrition in infants in the first 1000 days (or until the age of 2 (two) years) of life which lasts a long time and causes delays in brain development and child development. Due to chronic malnutrition, stunted babies grow shorter than the standard height of children for their age.⁶ The Study on the Nutritional Status of Toddlers in Indonesia (Studi Status Gizi Balita di Indonesia (SSGBI)) in 34 provinces in Indonesia in 2019 showed the stunting rate among Indonesian toddlers reached 27.67%,⁷ which means that out of 10 (ten) toddlers in Indonesia, 3 (three) of them are stunted. This figure is still relatively high considering that the WHO targets the stunting rate to be no more than 20% and Indonesia has passed that threshold. The Global Nutrition Report in 2018 also showed that Indonesia’s stunting prevalence from 132 countries was ranked 108^th globally, while in Southeast Asia, Indonesia’s stunting prevalence was the 2nd highest after Cambodia.⁸

Stunting in children occurs due to low access to nutritious food, low intake of vitamins and minerals, and poor food diversity and animal protein sources. In addition, the low access to health services including sanitation and clean water is also one of the factors that greatly affect the growth of children.⁹ The lack of access to nutritious food as well as sanitation and clean water is, of course, closely related to the poverty factor which is a classic and structural problem in Indonesia. In addition, other factors such as lack of education and information about nutritional needs in children, increasing urbanization rates, natural disasters, and maternal health conditions can also contribute to stunting in children.

 The problem of stunting in children during the Covid-19 pandemic is getting worse because many families have lost their income, thus they are unable to access nutritious food, sanitation, and clean water. Online surveys show that food insecurity is increasing with 36% of respondents stating that they “often” reduce their food portions because of financial problems. How ironic.¹⁰ Loss of household income can increase the risk of malnutrition in children and at the worst level, the risk of death in children with malnutrition is 12 (twelve) times the risk of death in children with good nutrition.¹¹ Not only economic factors, the Covid-19 pandemic has also disrupted the food supply chain so that the availability and affordability of healthy food is becoming increasingly difficult. This situation also increases the vulnerability of some children to domestic violence, neglect, child labour, and even increases the risk of children becoming victims of trafficking.¹² Children who are victims of violence, neglect and trafficking are also vulnerable to stunting.¹³ Moreover, health facilities are increasingly difficult to access because health services must cater to the burden of Covid-19 patients who are growing from time to time. Lack of access to healthcare facilities could reduce the detection of stunting in children and delay intervention.

Facing Stunting during the Pandemic

The worsening of stunting in children during the pandemic requires the Government to move quickly in addressing this problem if they do not want the quality of Indonesian human capital to be threatened. The government has clearly stated that reducing stunting is a national priority program even in the midst of a pandemic. Since 2013, the Government has issued Presidential Regulation No. 42 of 2013 concerning the National Movement for the Acceleration of Nutrition Improvement, mandating all stakeholders to participate in activities to accelerate nutrition improvement, such as campaigns, advocacy, dialogue, training, discussions, direct (specific) nutrition intervention activities carried out by the health sector, as well as indirect (sensitive) nutrition intervention activities carried out outside the health sector. Then, what real steps have been taken by the Government in dealing with stunting in children during the pandemic?

1. National Mental Health Service (SEJIWA)
   This service can be accessed through the telephone number 119 ext. 8, especially by women and children affected by Covid-19 including pregnant and lactating women. Through this SEJIWA service, both women and children can get education, consultation and assistance, especially regarding women and children in the midst of a pandemic. This SEJIWA service is also integrated with the hotline of the complaint unit of the Ministry of Women Empowerment and Child Protection (KemenPPPA) as well as the Regional Technical Implementation Unit for the Protection of Women and Children (UPTD PPA)/P2TP2A as well as the Child Protection Agency (LPA) and the existing Service Provider Forum (FPL) in all provinces and districts/cities, according to the location of the reporting party.

2. The #BERJARAK Movement (Bersama Jaga Keluarga Kita / Together Protecting Our Families)
   The Ministry of Women Empowerment and Child Protection has prepared a special official portal to provide information, education and communication regarding the protection of women and children during the pandemic, namely: Sejiwa Service – B E R J A R A K (kemenpppa.go.id). Various guidelines related to health services for pregnant women and toddlers during the pandemic are published on the site, such as: Guide to Breastfeeding in a Covid-19 Pandemic Situation, Guide to Balanced Nutrition During the Covid-19 Pandemic, and so on.

3. The Prosperous Child Village Program Pilot Project (Kampung Anak Sejahtera (KAS))
   The Ministry of Women Empowerment and Child Protection also implements the KAS program in 8 (eight) villages with high stunting rates, namely through the provision of additional food for toddlers; education on balanced nutrition and proper sanitation for children for families and pregnant women; child rights-based parenting training; reproductive health education for adolescents; and local food processing skills for complementary foods and healthy foods.

What we can do?

The government’s efforts should be appreciated, but it is impossible for the government to work alone in overcoming the stunting problem during this pandemic. What can we do? It is really simple, there are 2 (two) things we can do, starting with our family or closest relatives, namely: Providing Access and Educating.

One of the main factors causing stunting is the reduced access to nutritious food, sanitation, and clean water in low-income families and families who have lost their income due to the Covid-19 pandemic. Therefore, if we see people around us having difficulty accessing those, then we can take concrete action by giving them access. We can share healthy food ingredients, vitamins, hygiene kits, and clean water with them.

In addition, we can also contribute by educating people around us about the importance of nutrition for children, the health of pregnant women and reproductive health of adolescents. We can help them know and understand important things, such as: how to process food ingredients properly and correctly, how to breastfeed, and so on. In addition, we can also direct every woman and child we know to access the official Sejiwa Service portal – B E R J A R A K (kemenpppa.go.id) or contact SEJIWA service, if they experience problems during the pandemic. This information can always be shared from casual and simple conversations with people around us, especially with women and children.

Let’s provide access and educate to create a “Stunting Free Generation” in the midst of a pandemic!

Writer: Patricia Cindy
Editor: Rheka Rizqiah Ramadhani
Translator: Clarissa Cita Magdalena

***

References:

^[1] Kementerian Pemberdayaan Perempuan dan Perlindungan Anak RI, “Pedoman Pelaksanaan Hari Anak Nasional (HAN) 2021,” <KEMENTERIAN PEMBERDAYAAN PEREMPUAN DAN PERLINDUNGAN ANAK (kemenpppa.go.id)> diakses pada tanggal 11 Juli 2021, pkl. 17.24 WIB.

^[2] UNICEF Indonesia, “Konvensi Hak Anak: Versi Anak-Anak,” <Konvensi Hak Anak: Versi anak anak | UNICEF Indonesia> diakses pada tanggal 11 Juli 2021, pkl. 17.41 WIB.

^[3] Databoks, “Cek Fakta, 1 dari 3 Balita di Indonesia Mengalami Stunting/Kerdil,” <Cek Fakta, 1 dari 3 Balita di Indonesia Mengalami Stunting/Kerdil | Databoks (katadata.co.id)> diakses pada tanggal 11 Juli 2021, pkl. 18.03 WIB.

^[4] UNICEF Indonesia, “COVID-19 dan Anak-Anak di Indonesia, Agenda Tindakan untuk Mengatasi Tantangan Sosial Ekonomi, 11 Mei 2020,” <COVID-19-dan-Anak-anak-di-Indonesia-2020_1.pdf (unicef.org)> diakses pada tanggal 18 Juni 2021 pkl. 18.53 WIB.

^[5] Kementerian Kesehatan RI, “Situasi Balita Pendek (Stunting) di Indonesia,” Pusat Data dan Informasi Kementerian Kesehatan RI, <Situasi Balita Pendek (Stunting) di Indonesia> diakses pada tanggal 12 Juli 2021, pkl. 15.46 WIB

^[6] Kedeputian Bidang Advokasi, Penggerakan dan Informasi (ADPIN), “Indonesia Cegah Stunting,” Badan Kependudukan dan Keluarga Berencana Nasional, <Indonesia Cegah Stunting (bkkbn.go.id)> diakses pada tanggal 11 Juli 2021, pkl. 18.09 WIB.

^[7] Yoanes Litha, “UNICEF Indonesia: Pandemi Diprediksi Tingkatkan Jumlah Kasus Stunting,” VOA Indonesia, <UNICEF Indonesia: Pandemi Diprediksi Tingkatkan Jumlah Kasus Stunting (voaindonesia.com)> diakses pada tanggal 11 Juli 2021 pkl. 18.18 WIB.

^[8] Kementerian Pemberdayaan Perempuan dan Perlindungan Anak, “Pandemi Covid-19, Stunting Masih Menjadi Tantangan Besar Bangsa,” Siaran Pers Nomor: B-290/Set/Rokum/MP 01/11/2020, <KEMENTERIAN PEMBERDAYAAN PEREMPUAN DAN PERLINDUNGAN ANAK (kemenpppa.go.id)> diakses pada tanggal 11 Juli 2021 pkl. 19.13 WIB.

^[9] Widyawati, “Ini Penyebab Stunting pada Anak,” Biro Komunikasi dan Pelayanan Masyarakat Kementerian Kesehatan RI, <Ini Penyebab Stunting pada Anak – Sehat Negeriku (kemkes.go.id)> diakses pada tanggal 11 Juli 2021 pkl. 18.33 WIB.

^[10] UNICEF Indonesia, “COVID-19 dan Anak-Anak di Indonesia, Agenda Tindakan untuk Mengatasi Tantangan Sosial Ekonomi, 11 Mei 2020”.

^[11] UNICEF Indonesia, “Indonesia: Angka Masalah Gizi pada Anak Akibat Covid-19 dapat Meningkat Tajam Kecuali Jika Tindakan Cepat Diambil,” <Indonesia: Angka masalah gizi pada anak akibat COVID-19 dapat meningkat tajam kecuali jika tindakan cepat diambil (unicef.org)> diakses pada tanggal 11 Juli 2021 pkl. 19.07 WIB.

^[12] World Health Organization (WHO), “Joint Leaders’ statement – Violence against children: A hidden crisis of the COVID-19 pandemic,” <Joint Leaders’ statement – Violence against children: A hidden crisis of the COVID-19 pandemic> diakses pada tanggal 11 Juli 2021, pkl. 22.20 WIB.

^[13] United Nations Office on Drugs and Crime (UNODC), “An Introduction to Human Trafficking: Vulnerability, Impact and Action,” <An Introduction to Human Trafficking: Vulnerability, Impact and Action> diakses pada tanggal 11 Juli 2021, pkl. 22.40 WIB.

Article

Databoks, “Cek Fakta, 1 dari 3 Balita di Indonesia Mengalami Stunting/Kerdil,” <Cek Fakta, 1 dari 3 Balita di Indonesia Mengalami Stunting/Kerdil | Databoks (katadata.co.id)> diakses pada tanggal 11 Juli 2021, pkl. 18.03 WIB.

Kedeputian Bidang Advokasi, Penggerakan dan Informasi (ADPIN), “Indonesia Cegah Stunting,” Badan Kependudukan dan Keluarga Berencana Nasional, <Indonesia Cegah Stunting (bkkbn.go.id)> diakses pada tanggal 11 Juli 2021, pkl. 18.09 WIB.

Kementerian Kesehatan RI, “Situasi Balita Pendek (Stunting) di Indonesia,” Pusat Data dan Informasi Kementerian Kesehatan RI, <Situasi Balita Pendek (Stunting) di Indonesia> diakses pada tanggal 12 Juli 2021, pkl. 15.46 WIB

Kementerian Pemberdayaan Perempuan dan Perlindungan Anak, “Pandemi Covid-19, Stunting Masih Menjadi Tantangan Besar Bangsa,” Siaran Pers Nomor: B-290/Set/Rokum/MP 01/11/2020, <KEMENTERIAN PEMBERDAYAAN PEREMPUAN DAN PERLINDUNGAN ANAK (kemenpppa.go.id)> diakses pada tanggal 11 Juli 2021 pkl. 19.13 WIB.

Kementerian Pemberdayaan Perempuan dan Perlindungan Anak RI, “Pedoman Pelaksanaan Hari Anak Nasional (HAN) 2021,” <KEMENTERIAN PEMBERDAYAAN PEREMPUAN DAN PERLINDUNGAN ANAK (kemenpppa.go.id)> diakses pada tanggal 11 Juli 2021, pkl. 17.24 WIB.

UNICEF Indonesia, “COVID-19 dan Anak-Anak di Indonesia, Agenda Tindakan untuk Mengatasi Tantangan Sosial Ekonomi, 11 Mei 2020,” <COVID-19-dan-Anak-anak-di-Indonesia-2020_1.pdf (unicef.org)> diakses pada tanggal 18 Juni 2021 pkl. 18.53 WIB.

UNICEF Indonesia, “Indonesia: Angka Masalah Gizi pada Anak Akibat Covid-19 dapat Meningkat Tajam Kecuali Jika Tindakan Cepat Diambil,” <Indonesia: Angka masalah gizi pada anak akibat COVID-19 dapat meningkat tajam kecuali jika tindakan cepat diambil (unicef.org)> diakses pada tanggal 11 Juli 2021 pkl. 19.07 WIB.

United Nations Office on Drugs and Crime (UNODC), “An Introduction to Human Trafficking: Vulnerability, Impact and Action,” <An Introduction to Human Trafficking: Vulnerability, Impact and Action> diakses pada tanggal 11 Juli 2021, pkl. 22.40 WIB.

Widyawati, “Ini Penyebab Stunting pada Anak,” Biro Komunikasi dan Pelayanan Masyarakat Kementerian Kesehatan RI, <Ini Penyebab Stunting pada Anak – Sehat Negeriku (kemkes.go.id)> diakses pada tanggal 11 Juli 2021 pkl. 18.33 WIB.

World Health Organization (WHO), “Joint Leaders’ statement – Violence against children: A hidden crisis of the COVID-19 pandemic,” <Joint Leaders’ statement – Violence against children: A hidden crisis of the COVID-19 pandemic> diakses pada tanggal 11 Juli 2021, pkl. 22.20 WIB

Yoanes Litha, “UNICEF Indonesia: Pandemi Diprediksi Tingkatkan Jumlah Kasus Stunting,” VOA Indonesia, <UNICEF Indonesia: Pandemi Diprediksi Tingkatkan Jumlah Kasus Stunting (voaindonesia.com)> diakses pada tanggal 11 Juli 2021 pkl. 18.18 WIB.

Additional

Republik Indonesia. Undang-Undang Nomor 35 Tahun 2014 tentang Perubahan atas Undang-Undang Nomor 23 Tahun 2002 tentang Perlindungan Anak. Lembaran Negara Tahun 2014 No. 297. Sekretariat Negara. Jakarta.

UNICEF Indonesia, “Konvensi Hak Anak: Versi Anak-Anak,” <Konvensi Hak Anak: Versi anak anak | UNICEF Indonesia> diakses pada tanggal 11 Juli 2021, pkl. 17.41 WIB.