Indonesia suffers from a triple burden of malnutrition (TBM) problem. TBM refers to a population at threat of undernutrition, micronutrient deficiencies and overnutrition. Other problems in the country, such as poverty, low education levels, gender inequities and poor infrastructure, alongside frequent natural disasters and environmental and climate-related factors, further aggravate these deprivations.

Stunting and Wasting

A 2022 survey conducted by the Ministry of Health reveals that, in Indonesia, one in 12 children aged less than 5 five is wasted. Additionally, one in five is stunted. Stunting and wasting are two major nutritional problems Indonesian children face that need to be detected and treated.

Wasted children have skinny appearances, are low in weight and have small upper arm circumference. It stems from poor nutritional intake, low food quality and frequent illness in children. Out of all problems with malnutrition, wasting has the highest risk of death. The mortality risk for wasted children is 12 times more likely than for children with adequate nutrition.

Stunting, on the other hand, develops in a short period and is often a sign of chronic malnutrition. Stunted children are relatively shorter than those around them. A child becomes at risk of stunting when they are malnourished from pregnancy until the child is 2 years old or has lived 1,000 days of life.

Wasting and stunting often correlate, with both problems having the same risk factors and one condition making the other worse. When left untreated, wasted children are three times more likely to develop stunting and stunted children are 1.5 times more likely to become wasted. Child mortality rates also increase when they experience both stunting and wasting at the same time, which many children in Indonesia do.

The first two years of a child’s life are the best time to prevent both problems; however, if preventative measures fail, health workers must give immediate care and treatment to ensure the child’s survival.

Maternal Nutrition

Maternal nutrition also contributes to malnutrition, as many micronutrient deficiencies start with the mother. It begins from preconception and continues to adolescence. Indonesia has a high rate of maternal malnutrition alongside high rates of maternal and neonatal mortality. According to a malnutrition report published by UNICEF in 2018, one in two pregnant women is anemic, one in six is thin and one in three is short stature.

Indonesia’s government has been working hard to implement programs to combat malnutrition. Programs include postpartum vitamin A supplementation, supplementary feeding for undernourished pregnant women, nutrition education and counseling.

Obesity

The final major malnutrition problem faced by Indonesia is obesity. According to the Indonesia Health survey and the Family Life survey, the number of overweight adults in Indonesia has doubled in the past two decades. One in five school-age children is affected by obesity and overweight and obesity are among the top five death risk factors.

Genetics play a role; however, unhealthy diets and insufficient exercise are the primary causes. Individuals consume more calories than required and their bodies store them as excess fat. The high availability of unhealthy foods in schools and a sedentary lifestyle using phones and TV do not mix well regarding health.

Free Meals

Although combating malnutrition may seem challenging, Indonesia has made much progress. On Jan. 6, Indonesia’s President, Prabowo Subianto, launched a multibillion-dollar program to provide free meals to more than a quarter of Indonesian citizens, feeding around 570,000 on its opening day. This ambitious free meal program was the center of Subianto’s election campaign. However, it had no official launch date. The program initially involved only 190 kitchens that prepped meals for school children and pregnant women in no more than 20 provinces.

Subianto has big targets for the program and hopes that by 2029, 82.9 million of the country’s total 280 million will be reached and helped. The government and military will help prepare and distribute meals and the number of meal recipients hopes to increase to 3 million by March of this year, according to Dedek Prayudi, a spokesperson for the President’s office.

Spokespeople from the Office of the President have said that President Prabowo Subianto is considering ways to reach nearly 83 million of Indonesia’s population by the end of 2025, much earlier than the initial target of 2029. Subianto also stated that the program aims to fight the stunting of growth that afflicts 21.5% of Indonesian children younger than 5 and would raise farmers’ income. He hopes to develop the nation’s human resources so that they can achieve a “Golden Indonesia” by 2045.

Slow Progress

The government aims to reach 19.5 million schoolchildren and pregnant women in 2025. The budget is set at $4.3 billion to keep the annual deficit under a legislated ceiling of 3% of GDP. According to the 2023 Indonesian Health Survey, the national stunting prevalence was 21.5%, down around 0.8% from the previous year.  Although some progress has been made, it is still slow. The Indonesian government hopes this program will speed up the success rate in lowering the rate of malnourishment. So far, feedback has been positive.

Catharina Yenny Indratno, the principal of an elementary school in East Jakarta, said there had been a positive response from families and students. “Our children don’t really bring their own food from home. Their parents come from mid-low income, so their pocket money is small,” she said. She said, “With this program, it’s very good because they’ll have enough nutrients.” Parents also welcomed the program, as it helps reduce their daily burdens. One parent in West Jakarta stated: “Thank God, this helps us.”

MUFPP Community

Indonesia has also implemented other policies to combat malnutrition, including active participation in the Milan Urban Food Policy Pact (MUFPP) community. The MUFPP has collaborated with 15 cities in Indonesia to support the implementation of school meal programs. The Milan Pact is firmly committed to supporting the Indonesian government’s mission of implementing school meal programs via advocacy and facilitating learning exchange sharing. This is done with ASEAN, the Italian Ministry of Foreign Affairs and International Cooperation and the Italian Agency for Development Cooperation.

Indonesia still has a long way to go regarding combating malnutrition. However, developing this new program, alongside other policies the government is undertaking, will help reduce the problem massively.

– Ayat Aslam

Ayat is based in London, UK and focuses on Good News, Global Health for The Borgen Project.

Photo: Wikimedia Commons