Reducing Stunting Rates Through Intervention for Adolescent Girls and Pregnant Women's Nutrition

Ridwan Fadjri Nur ¹ , Mila Yusnita ² , Sumiyati ³ , Azis Hakim ⁴

1)  Student at Master of Administrative Science Study Program, Krisnadwipayana University, Jakarta, Indonesia, email: milayusnita25@gmail.com

2)  Head of Master of Administrative Science Study Program, Krisnadwipayana University, Jakarta, Indonesia, email: dr_azishakim@unkris.ac.id

Abstract: The condition of stunted physical and mental growth of children is a serious problem in human development in various countries, including Indonesia. Young women, as future mothers, have an important role in preventing stunting in the next generation. This article reviews the important role of maternal nutrition in efforts to reduce stunting rates in adolescent girls. First, this article will outline the risk factors for stunting that are often found in adolescent girls, such as malnutrition during their growth years, limited access to nutrition education, and limited knowledge regarding the importance of balanced nutrition. Next, we will discuss how good maternal nutrition during pregnancy and breastfeeding has a significant impact on child growth. Adequate and balanced maternal nutrition will provide children with good basic capital for their growth and development. Increase awareness of adolescent girls about the importance of balanced nutrition, through nutrition education in schools, outreach in the community, and better access to reproductive health services. In this context, the role of families, educators and the government in supporting young women to have a good understanding of nutrition will be emphasized, specifically maternal nutrition plays a key role in efforts to reduce stunting rates in future generations. Young women are a group that needs special attention in this effort, because they will become future mothers who will shape the quality of their children's growth and development. Comprehensive efforts, ranging from nutrition education to systematic support in getting good nutrition during pregnancy and breastfeeding,

Keywords : adolescent girls, nutrition for pregnant women, stunting

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Introduction

Stunting is a global problem that requires cooperation between countries and international organizations to overcome. A number of efforts have been made to reduce stunting rates in various countries. Many countries have launched child nutrition programs aimed at improving the nutritional status of children through the distribution of nutritious food and nutritional supplements. Health is a priceless treasure. Every human being has the right to grow and develop healthily, free from all forms of disease and obstacles that could interfere with their potential. However, the reality is that millions of children around the world face a serious threat to their health and development called stunting. Stunting is a global health problem that affects the physical growth and cognitive development of children throughout the world. The problem of health and malnutrition is one of the indicators to measure the prosperity of a country for its citizens. A country is said to be prosperous and advanced if the people or citizens live prosperously and independently. Stunting is not only a medical problem, but also a deep social, economic and humanitarian problem. .

Indonesia is one of the countries that has a high prevalence of stunting, when measured from the tolerance figure set by the World Health Organization or WHIO where the threshold is below 20 percent. Various efforts have been made by the government to improve nutrition for toddlers and toddlers, and these efforts are starting to bear fruit, as can be seen from the downward trend based on the results of the Indonesian nutritional status survey (SSGI) over the last 2 years which shows that Indonesia's stunting prevalence rate in 2021 is at 24.4 percent and will fall again to 21.6 percent in 2022 or down 2.8 percent from the previous year.

Based on the target of the Medium Term Development Plan (RPJMN) 2020 – 2024 and Presidential Regulation number 72 of 2021 concerning the Acceleration of Stunting Reduction, the figure is set at 14 percent in 2024, of course reducing the stunting rate by 7.6 percent in approximately 1.5 years. the future is not an easy matter. For this reason, efforts and synergy of all components and programs are needed that are right on target so that the goal of reducing the stunting rate can be achieved according to all of our hopes. We all realize that stunting is not a case that originates from a concentrated issue, but is a complex issue that can be caused by various possible factors that cause children to fail to grow and develop optimally so that it can affect human resources in the future. The various causes of stunting are poor parenting patterns, inadequate antenatal care services for mothers, barriers to household access to nutritious food, barriers to access to clean water and sanitation, and infectious diseases suffered by children. Apart from that, there are still causes of stunting. socio-economic, cultural and political factors (Carolina, 2021)

    Stunting cases that occur in Indonesia are not only monopolized or born from families with certain socio-economic conditions, such as from poor families, or from families with low levels of education or also from people who live in remote or rural areas, but stunting cases can also occur in families. at any socio-economic level regardless of demographic factors, one thing is certain that stunting is caused by chronic malnutrition experienced by children, especially in the first 1000 days of life (HPK). For this reason, in order to reduce the stunting rate, children who are detected to be stunted cannot immediately undergo treatment interventions. However, it must start from upstream, from adolescence, especially adolescent girls, and improving maternal nutrition.

Research Method

This research uses a qualitative descriptive design with data collection methods commonly used in qualitative descriptive research, which aims to describe or illustrate a phenomenon. This research tends to be exploratory and prioritizes an in-depth understanding of the context and characteristics of a phenomenon. The data used comes from the latest census data from the 2022 Family Data Collection by taking related variables in the discussion and analyzing them based on general phenomena that occur as well as conducting an analysis of the relationship between stunting cases that occur in Indonesia with data variables and several existing theories.

Result and Discusion

Result

Stunting is a growth and development disorder in children which is caused by chronic malnutrition over a long period of time, which results in suboptimal physical growth or height, delayed cognitive development and the risk of chronic health problems in adulthood and has an impact on Productivity and Economic Welfare, Individuals who experience stunting may have limitations in their physical and cognitive abilities, which in turn may limit their opportunities in terms of education and employment. This can have an impact on productivity and economic welfare at the individual and community levels, therefore a special strategy is needed to reduce the prevalence of stunting. Treatment so far has not targeted targets that result in children becoming stunted, the target focus is still on providing additional feeding services and other nutritional interventions, but has not targeted the focus on young women who will later marry and become mothers. A mother's nutrition must be considered, especially during pregnancy. Based on several literatures, it was found that a mother who experiences anemia during pregnancy is a trigger for giving birth to a stunted child. This is illustrated by several medical research results that support the relationship between anemia in pregnant women and the possibility of giving birth to a child with growth. physically hampered. The following are some general findings that can be taken from the literature, including:

1.     Effect on the Availability of Nutrients: Anemia can indicate a deficiency of iron and other  nutrients in pregnant women. Iron deficiency can affect the production of hemoglobin which is necessary for oxygen transport to the fetus. Lack of iron and other essential nutrients can cause fetal growth disorders.

2.     Inhibition of Fetal Growth: Anemia in pregnant women can inhibit fetal growth due to lack of oxygen needed for cell and tissue development. This can contribute to the risk of stunting in children after birth.

3.     Risk of Premature Birth: Several studies show that pregnant women with anemia have a higher risk of premature birth. Premature birth itself can be a risk factor for stunting in children.

4.     Iron Deficiency in Early Life: Anemia in pregnant women can cause iron deficiency in the final baby, because the baby gets iron reserves from the mother during pregnancy. Iron deficiency in babies can affect their growth and development

Discusion

Stunting handling in 2021 targets families at risk of stunting, with a focus on assistance provided by the Family Assistance Team (TPK) to young women and maternal nutrition, especially during pregnancy. This treatment has a positive impact, this can be seen from the results of the Indonesian Nutrition Status Survey (SSGI) based on stunting reduction trend in 2013 – 2019.

From the data above, it can be explained that the handling of stunting in 2013 - 2019 is still not focused on targeting the causes of stunted children or in other words preventing stunting from upstream to the birth of stunted children, so it can be seen from this data that the average reduction is still around 1.3 percent - 1.7 percent per year, after Presidential Regulation Number 72 of 2021, the handling of stunting in Indonesia is more focused on families at risk of stunting, targeting young women, prospective brides, pregnant women, postpartum mothers and caring for toddlers and toddlers, targeting groups This target is handled more comprehensively and all targets are accompanied by a Family Assistance Team (TPK) to monitor assistance and development so that the health of the target group becomes better, and this has proven successful in reducing the stunting rate by 2.8 percent - 3 percent in 2021 and in 2022, this is certainly very exciting because the process of making Indonesia golden by 2045 will most likely be achieved slowly and surely, therefore several things need to be concentrated on to continue to be carried out on an ongoing basis, including:

1.     Effectiveness of Interventions on Adolescent Girls: The results show that focusing on adolescent girls can be an effective strategy because they have the potential to change eating patterns and understand the importance of nutrition for children's growth.

2.     The importance of maternal nutrition during pregnancy in preventing stunting: the involvement of maternal nutrition during pregnancy in nutrition programs has a positive impact on child growth. Increased compliance with nutritional and maternal health care guidelines can reduce the risk of stunting.

3.     The Importance of Nutrition Program Integration: Integration of nutrition programs within existing health systems is critical for sustainability and increasing intervention coverage.

4.     Influence of Family Environment: Family support plays a key role in the success of the intervention. Therefore, involving families in nutrition programs can increase their positive impact.

Literature Review

Indonesia has a fairly large number of young women, based on the 2022 Family Data Collection released by the National Population and Family Planning Agency (BKKBN), there are 27 million young women in the age category 10 – 24 years (definition of the BKKBN youth category). The number of teenagers is so large, it would be appropriate to intervene to handle and prevent stunting starting from adolescence. The government must focus on improving the health of teenagers through programs that target teenagers directly, such as the reproductive health program (Kespro) for teenagers in schools and other programs. which aims to improve the health and nutritional status and literacy of adolescents at school. Based on the statement by the World Health Organization, stunting does not only occur in children, but also in adolescents. Adolescence is an important phase in human development when social, biological and psychological development occurs (WHO, 2014b), and from the results of research conducted in Bantul Regency, Province DIY, it was concluded that some young women already understand the meaning of stunting, but do not yet know the critical role that teenagers can play before entering pregnancy (Rosyada et al., 2020), From these results it can be seen that preparations for marriage and pregnancy preparations that teenagers will go through in the future, still need to strengthen information through various media, both social media and direct outreach to schools regarding communication, information and education (KIE) so that teenagers know about health. reproduction, nutrition and other things you need to know. Therefore, teenagers are the most important point in handling stunting and it is necessary to prevent various conditions that cause health problems in teenagers which are caused by a lack of proper nutritional intake, especially protein, vitamins and important minerals such as iron, calcium, vitamin D and vitamin A, an unbalanced diet or low quality of food consumed, thyroid disorders or growth hormone problems and lack of access to health care for periodic health checks, as well as minimal knowledge regarding access to nutritional education during puberty, at which time the body will experiencing significant hormonal changes.

A young woman before marriage must ensure that they are not deficient in iron. Iron deficiency in young women can result in or be susceptible to anemia. If they then conceive, become pregnant or give birth, they could be at risk of pregnancy complications, premature birth, low birth weight babies, all of which will lead to the possibility of stunting in children. We realize that young women will one day marry and become mothers , preparation before becoming a mother or preparation before pregnancy is very important to pay attention to health, both before pre-conception until the conception period and making sure not to be anemic when pregnant. Another thing that needs to be considered is the efforts and hard work of all of us to provide Communication Information and Education (KIE) to young women to delay pregnancy if problems are found during health checks at health facilities/Puskesmas before marriage, apart from early pregnancy among Adolescence is one of the biggest risk factors for low birth weight and will significantly impact the possibility of children experiencing stunting.

    For teenagers, preparations for marriage and pregnancy really need to be planned. Poor planning will have an impact on several conditions, such as the mother's soul not being ready to have a baby ( baby blues ), which will disrupt a mother's mental health, so that the daily cycle changes, such as lack of sleep and other things that can lead to harm to herself or the baby. It's like what we read and hear a lot in electronic media, television and print. Planning is often ignored by prospective brides and grooms. Often things such as building rental, pre-wedding photos, and so on are more important than the initial health check of the prospective bride and groom. In fact, it is important to know the health condition of the prospective bride and groom in order to minimize risk factors for stunting , appropriate treatment accompanied by IEC and behavioral changes are the keys to success in reducing stunting rates . In addition to efforts to prevent early marriage and pregnancy among teenagers as well as providing adequate nutrition, especially for teenage girls, to prevent anemia, the government is also obliged to ensure that every teenager has universal access to sexual and reproductive health services.

Adolescents will go through several phases, one of which is the adult phase, marriage and pregnancy are one of the most important moments in a woman's life. This is the moment when a woman carries within herself the potential of a new life that will become the next generation. Therefore, maintaining the health of pregnant women is a top priority to ensure the birth of a healthy baby and a strong mother. In this narrative, we will discuss the importance of the care and health of pregnant women, as well as various aspects that must be considered during pregnancy. Prenatal care is a crucial first step in ensuring the health of pregnant women. This treatment includes regular visits to a gynecologist or midwife. During this visit, various tests such as ultrasound, blood tests, and blood pressure monitoring may be performed to monitor the progress of the pregnancy. In addition, prenatal care also involves monitoring nutrition and adjusting diet so that pregnant women get adequate nutrition for themselves and their babies. During pregnancy, a pregnant woman's diet plays an important role in the growth and development of the baby. Adequate and balanced nutrition is the key to maintaining maternal and fetal health. Foods high in nutrients such as vegetables, fruits, protein, and whole grains should be part of your daily diet. Apart from that, intake of folic acid, iron and calcium is also very important.

Pregnant women should avoid alcohol, smoking and illegal drugs, because they can have a negative impact on fetal development. Although pregnancy is a time that requires more rest and attention to the body, proper exercise is also very important. Light physical activities such as walking, swimming, or yoga can help strengthen muscles and keep the body in good condition. However, pregnant women should consult a doctor before starting or continuing their exercise routine. During pregnancy, the mother's body experiences various physical changes. The belly gets bigger, the breasts may be larger and more sensitive, and hormonal changes can affect the skin and hair and some pregnant women may experience significant weight gain. Therefore, it is important to understand that these changes are a normal part of the pregnancy process and ensure regular check-ups with your doctor or midwife to ensure everything is going well.

There are several complications that may occur. Some examples include preeclampsia, gestational diabetes, or anemia of pregnancy. Therefore, it is important to undergo regular prenatal examinations and adhere to the advice of medical personnel. Quickly identifying complications early can reduce the risks associated with pregnancy. Apart from physical care, mental and emotional care is also very important during pregnancy. Hormonal changes can affect a pregnant woman's mood, and excessive stress can have a negative impact on the health of the mother and fetus. Therefore, it is important to seek support from family, friends, or even mental health professionals if necessary. Prenatal care also includes education about childbirth and baby care, which can help the mother feel more confident in her new role. When the time comes for delivery, the health care of pregnant women is still the main focus. During labor, the medical team will monitor the mother and fetus to ensure that everything is going well. Sometimes, medical intervention such as a cesarean section may be necessary to maintain the health of the mother and baby. After the birth of the baby, the care of the pregnant woman should not be neglected. This is the time when the mother needs to recover from childbirth and adjust to her new role as a mother. Postnatal care includes monitoring maternal health, supporting lactation, and attention to maternal mental health postnatally.

    A mother's pregnancy is the most important point in reducing the risk of stunting in children. This is where it is important to intervene so that during the pregnancy period it can run well and smoothly, so that undesirable events such as the fetus not developing, or the mother's unhealthy condition and The intake consumed by pregnant women does not meet the nutritional elements that start from the initial process of pregnancy from the formation of the fetus in the stomach. Looking at the Family Data Collection data released by the BKKBN in 2022, the number of couples of childbearing age who are pregnant is 1.2 million, which means there is the potential for millions of children to be born stunted if the pregnancy process does not receive good care and is properly accompanied by The Family Assistance Team (TPK) was formed with the task of providing counseling, facilitating social assistance for underprivileged families as well as providing assistance to pregnant women until postpartum. Apart from the things mentioned above, efforts to reduce stunting to realize the target of 14 percent by 2024 can also be carried out with convergence actions in each province, district/city, sub-district and village to provide mutual support in accordance with the main tasks. their respective functions. If the assistance of prospective brides and grooms and all sectors, both central government, regional and private, as well as stakeholders work together to help provide services to the community, of course a reduction in stunting rates can be achieved over the next 10-20 years. Indonesia has human resources that are able to compete with other countries so that the target of the Golden Generation in 2045 can be achieved.

Conclusion

Before getting married, young women must ensure that they are not deficient in iron, because iron deficiency can have an impact on pregnancy complications and the risk of stunting in children. Apart from that, it is important to provide Information Communication and Education (KIE) to young women to postpone pregnancy if health problems are found. Prevention of early marriage and pregnancy among teenagers as well as fulfilling nutrition are the main keys to reducing stunting rates.

The care and health of pregnant women is also very important in reducing the risk of stunting. Prenatal care, a balanced diet, proper exercise, and mental and emotional care during pregnancy must be carefully considered. Apart from that, postnatal care should not be neglected either.

Data shows that there is the potential for millions of children to be born stunted if the pregnancy process does not receive good care. Therefore, the role of the Family Assistance Team (TPK) and collaboration between various government and private sectors is very important in efforts to reduce stunting in Indonesia.

Reducing the stunting rate can help Indonesia achieve the target of the Golden Generation in 2045 by having healthier and more competitive human resources.

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References

Carolina, O (2021), Analysis of Specific Integrative Stunting Nutrition Intervention Services in the Working Area of the Pademangan District Health Center, North Jakarta, Jurnal Medika Hutama

Rahayu Widaryanti, Perceptions about preventing stunting in adolescents in the city of Yogyakarta, National Health Seminar Journal

Pocket Book of 2022 Indonesian Nutrition Status Survey (SSGI) Results, Health Development Policy Agency, Indonesian Ministry of Health 2023

2023 Family Data Collection Portal, Number of Individuals in Families by Age Group, National Population and Family Planning Agency

2023 Family Data Collection Portal, Number of Pregnant PUS, National Population and Family Planning Agency.

Presentation of the Ministry of Health in 2023, Socialization of SSGI Results in 2023