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.

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!

The conversation on early childhood education and development (ECED) has been gaining momentum, helped by our increasingly informed and coordinated approaches to champion human capital development and address stunting.

The Indonesian government has led the way with launching of the “first 1,000 days” movement in 2013 and the recent emphasis on the one-year preschool education as the minimum standard for regional governments. The government also launched a National Strategy to Accelerate Stunting Prevention in 2017, committing an estimated $14.6 billion to converge nutrition interventions across 514 districts and 98 cities. This created many opportunities for diverse stakeholders to contribute to and complement ECED efforts.

According to the Ministry of Health, approximately 30.8 per cent of Indonesia’s children under five suffer from stunted development, an improvement from 37.2 per cent in 2013. This figure, however, still reflects the persistently high prevalence of stunting – a pertinent issue in the nation’s journey in human capital development.

Access to and quality of early childhood services also vary significantly between geographies and social strata. A child born into a family from the richest quintile is 1.5x more likely to be enrolled in an early childhood center than a child from a family in the poorest quintile.

Uneven development across emerging economies has led to inequalities that exacerbate the impediments to developing good ECED programs. Indonesia is no exception. On the one hand, we can build the good momentum created by country’s sustained investment in human capital and the maximized development opportunities brought about by the demographic dividend in the next decade; on the other, we continue to observe Indonesia’s stubborn Gini coefficient (around 0.4) and relatively high figures in developmental delays, further worsened by the triple malnutrition burden.

We are all key stakeholders in human capital development. We should find ways in our different capacities to either support or participate in this endeavor.

The United Nations International Children’s Emergency Fund (UNICEF) shared that ECED is one of the most cost-efficient investments in human capital, playing an important role in a country’s sustainable development.

Studies in the United States estimate benefits of $7 to 16 for every dollar invested. Nobel Prize winning economist James Heckman said every dollar invested in zero-to-five early childhood education for disadvantage children carries a 13 percent annual return on investment. Conversely, if we give poor attention to ECED, society will have to bear the overheads of poor health, poor education and economic dependency, among others.

ECED is an inter-disciplinary and multisectoral intervention that foregrounds the early nurturing and development of our next generation. It intersects many targets articulated in the United Nations Sustainable Development Goals (SDGs). The SDGs address poverty, hunger, health, education, sanitation, inequality and strengthening institutions, to name a view. Each goal is specific to a country’s needs, and the SDGs are also very notable considerations in the battle against stunting.

A wealth of ECED research and solutions already exist from economists, nutritionists, healthcare professionals, educators, and policy-makers. The establishment of parenting centres, capacity building across early childhood  educators and increased research funding are just some examples of this progress. Most pertinently, these represent a growing consensus among the experts that mitigating developmental delays deserves greater awareness and simultaneous support from families, communities and institutions.

Development delays, according to Stanford University’s Rural Education Action Program (REAP) co-director and development economist Professor Scott Rozelle, encompasses cognitive delays, language delays, socio-emotional delays and motor delays. His research of more than 3,300 infants and toddlers in rural China sub-populations have revealed – startlingly – that 85 percent suffer at least from one of these development delays., primary due to lack of nutrition and engaged parenting and caregiving.

With active and systematic application of solutions in nutrition and stimulation, we can make the strides we need in fighting stunting, and bring about desired human capital outcomes in 2030.

In Indonesia, government spending alone – 20 per cent of the state budget is spent on education – may not bring about the desired lasting impact. The involvement of many stakeholders will help build momentum towards attaining better ECED outcomes. This marks a catalytic shift from “government” to “governance” in human capital development.

Tanoto Foundation has supported the renovations and building of many community-based ECED centers (PAUD) in Java and Sumatra. Capitalizing on our on-the-ground experience, we have been hosting forums and spearheading research in the field. In 2018, together with the National Poverty Eradication Acceleration Team (TNP2K) and the Presidential Office Staff (KSP), we conducted training for stunting prevention for nearly 500 community health workers. We also provided a research grant to identify the barriers that prevent good maternal, infant, and young child feeding practices in Indonesia.

Our most recent event, held concurrently in Jakarta and Singapore, comprised of ECED professionals, researchers, healthcare experts, as well as representatives from government, non-government and charitable organizations. The participants included  the professor Rozelle, who spent decades studying education, agriculture and economics in China; Professor Netty Herawati, the chair of HIMPAUDI, the Association of Indonesian ECED Teachers, which champions professional development and excellence in the sector; Professor Fasli Jalal, Tanoto Foundation’s Adviser and a key influencer on national education, family welfare, and nutrition; and Dr Gutama, a long-time early childhood development champion who currently serves in the National Early Childhood Education Accreditation Body.

The discussion was a diverse yet inspiring exchange of transnational perspectives on ECED, stunting and human capital investment, at varying levels of urgency and emphasis.

We did, however, share a common sentiment and purpose in early interventions in ECED, a holistic  endeavor that covers education, caregiving, nutrition, healthcare, familial engagement, community awareness and inter-institutional support. At the same time, there were also made to broaden ECED’s scope to include antenatal nutrition and care, vis-à-vis prevailing discourses on “zero-to-three” and “the first 1,000 days”.

We gladly welcome more parties of diverse capabilities to develop meaningful ideas and solutions for accelerating our human capital development. It is a long road of awareness-building, learning, collaboration and mobilizing resources and expertise to address tough issues such as stunting.

Nevertheless, we need to continue our committed pursuit of positive developmental outcomes that are not only measured in economic terms, but also expressed in the form of communities and individuals that are able to realize their potential and live valued, dignified lives.

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This article was copied from Jakarta Post, May 10 2019, “Early start to human capital development”, written by Belinda Tanoto, member of the Board of Trustees at Tanoto Foundation.