Indonesia has made impressive gains in poverty reduction in recent years, but some unfavorable childhood nutrition figures bode ill for the economy and the country’s achievement of a key Millennium Development Goal (MDG).
Recent national data on the prevalence of underweight children shows that while the numbers have trended down in recent years (from 31% in 1989 to 17.9% in 2010) there was an upward shift in 2013 to 19.6%. This leaves the country struggling to reach the MDG target for underweight children of 15.5% by 2015. There are also substantial regional disparities in the data. The percentage of underweight children in East Nusa Tenggara and West Papua are both above 30%, more than three times higher than provinces with the lowest percentages, such as Bali and Jakarta.
Indonesia also has the fifth highest number of stunted children in the world with more than 7.6 million in 2010. Stunting is an indicator of chronic poverty and its impact on child development is irreversible. Nutritional deficiency in early life increases susceptibility to infection and illness, and can cause reduced adult physical stature, and impaired cognitive abilities, all of which have long term negative consequences both for the individual and society. It is estimated that annually, Indonesia loses over US$2.6 billion in GDP due to vitamin and mineral deficiencies in children which results in less productive adults.
While the number of malnourished children is alarming, Indonesia is also seeing a significant rise in overweight young children, especially in urban areas, due to changing lifestyles and dietary habits. Nationally, the number of overweight children aged 5-12-years reached 18.8% of the child population in 2013, with Jakarta having the highest prevalence at 30%. Overweight children have a tendency to suffer from chronic degenerative diseases when they are adults, which puts a burden both on health spending, and the wider economy.
Taken together these two facets of nutrition are imposing a double burden on Indonesia. So what’s causing these nutritional outcomes?
Poor maternal nutrition and poor dietary intake are key areas of concern, interlinked with changes in dietary patterns and urbanization factors. These contribute to chronic nutritional and health problems, including stunting. Poorer and less educated families are also likely to be without adequate access to water and sanitation, and their children are at greater risk of malnutrition.
Another factor appears to the relative absence of poor households’ access to appropriate information and, when necessary, services. As a result, the percentage of children who are not having their growth progress monitored rose from 25.5% in 2007 to 34.3% in 2013.
The still high prevalence of underweight, malnourished and obese children may cause significant economic losses to Indonesia over the next 10-20 years when these children reach their productive ages and when the country is ready to draw on its ‘bonus demographic’ –where the working age population is higher than its dependent population. Many of the new entrants into the labor market will be less productive than they might otherwise have been if they had been better nourished. There is also the inter-generational problem in which poor maternal nutrition results in malnourished, stunted children who in turn eventually have offspring who suffer the same fate.
In response, there is a strong argument for government-led nutrition interventions. Economists agree that nutrition offers the best return on investment, with every $1 invested in nutrition generating as much as $138 in better health and increased productivity. Investing just 0.05% of total public spending over the next 5 years would halve the number of underweight children in Indonesia.
There is also a compelling case for blanket supplemental feeding in certain areas, along with accelerated health and nutrition programs focused on poor households and under-served areas. Outreach efforts and school health programs need to be revitalized, along with improved access to water and sanitation, and strengthened food security. Interventions to improve nutrition also need to be throughout the life cycle including, babies, children, and pregnant women.
Improving nutritional outcomes requires working closely with local governments since they have the grassroots knowledge of local nutritional issues. Here, ADB could pay a valuable role in bringing together governments and food manufacturers to address specific on-the-ground community nutritional needs.
The clear message is that Indonesia needs an integrated and accelerated program of human capital development which includes nutrition-focused interventions, in order to be able to fully draw on the demographic dividend and improve its economic competitiveness. Currently Indonesia’s human development index ranking is 111 out of 182 countries.