JAKARTA - Despite its middle income status, Indonesia is dealing with what experts say are unexpectedly high rates of childhood stunting. Now, its government - starting with the the president - is declaring war on the issue and committing to boost its response to the challenge following a World Bank publication that says 37 percent of Indonesia's children were stunted in 2013, a rate on par with some far more impoverished nations of Sub-Saharan Africa.
Stunting is the medical condition that the World Health Organization defines as "impaired growth and development that children experience from poor nutrition, repeated infection, and inadequate psychosocial stimulation."
While Indonesia's health ministry and other agencies have been battling to address the problem for years, the administration of President Joko "Jokowi" Widodo has now elevated the issue to be a national priority, making it a point to include it in last year's Independence Day address.
"Before he mentioned it in the speech, I doubt it has ever been mentioned by a president in Indonesia," said Claudia Rokx, a lead health specialist at the World Bank and one of the authors of the landmark book released last month.
First 1,000 days
Health experts emphasize that the first 1,000 days of a child's life are vital for preventing stunting, requiring adequate breastfeeding and nutrition, stimulation and activity, clean water and sanitation, and timely treatment of conditions like diarrhea and malaria.
With more than one in three Indonesian children being stunted, this means around 9 million children in Southeast Asia's most populous country are suffering from developmental limitations.
Nusa Tenggara Timur, an impoverished province of eastern Indonesia, has the highest rate of stunting in Indonesia at 52 percent. Fifi Sumanti is a midwife on Komodo Island, known for its famous dragons and home to just 2,000 people. It is arid and most food must be brought in from other islands.
"Mothers here aren't used to giving their children enough vegetables and fruit. They're happier to give instant food to the children,' Sumanti told VOA. Hygiene awareness and access to clean water are also major problems, she said.
While the poorest parts of Indonesia suffer the highest rates of stunting, even among the richest proportion of Indonesians stunting is as high as 29 percent.
Dr. Brian Sriprahastuti, a senior advisor to the office of the President of Indonesia on the issue of stunting, said the reasons for Indonesia's stunting problem today go beyond the traditional factors of poverty and limited access to public services. "Now we have another hypothesis that behavior is the main problem of this stunting issue," Sriprahastuti said.
Sumanti, the midwife, agrees.
"We need to speak with [mothers] more about what stunting is and give greater care from the time mothers are first pregnant until they give birth, until the time the child is three years old," she said.
International donors are taking notice and urgent efforts are under way to address the issue.
"If you're malnourished during that first thousand days, the likelihood is that you would have suffered from irreversible brain damage," said Simon Flint, a donor with the Asian Philanthropy Circle, a Singapore-based charity. "Any intervention or expenditure on education," Flint said, "could be so much more effective later on in a person's life."
The group plans to launch a $10 million 1000 Days Fund by this March to support anti-stunting programs in Indonesia.
A new commitment
In the forward to the World Bank publication, the Indonesian president called current stunting rates "unacceptable" and pledged to prevent two million children from being stunted by 2021. "Eliminating stunting is therefore a main priority for our Government," he wrote. "The Government is fully committed to do whatever it may take to achieve this goal.
Jim Tong Kim, President of the World Bank Group, said the government is investing in what he said are "evidence-based interventions" across 100 districts, to be expanded to the country's 541 districts by 2021. "This initiative marks a decisive step up in the ambitions of the world's fourth-most populous nation to tackle stunting as part of its commitment to sustained, inclusive economic growth," he wrote.
According to Flint, Indonesia's "reasonably high average income conceals a fair amount of underlying inequality. Just for example, according to government figures, in 2016 around 30 million Indonesians were still living on less than a dollar a day. There's obviously a huge problem of inequality and lack of access among the poorest people."
Sriprahastuti of the President's Office said that the government was adopting a human rights-based approach. "For all pregnant women in Indonesia, everywhere, for all children under two, everywhere, we have to support them."
"They know they have a huge problem, they've recognized it now. They are ready to do something about it. They've thrown a lot of money into it. They have the highest-level commitment, and they know it can be done in Indonesia as well," said Rokx.
"Everything is in place for them to do it well, they just have to coordinate better, be persistent and make sure that these kids get the best start in life they can get."