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The Woes Of Indonesia’s Children

According to Flint, Indonesia’s “reasonably high average income conceals a fair amount of underlying inequality.

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Two sick children wait for treatment after being admitTed to a hospital in Agats, Asmat District, after the government dispatched military and medical personnel to the remote region of Papua to combat malnutrition and measles, Indonesia. VOA

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.

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“If you’re malnourished during that first thousand days, the likelihood is that you would have suffered from irreversible brain damage,”

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.

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Health experts emphasize that the first 1,000 days of a child’s life are vital for preventing stunting. Pixabay

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.

“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. It is thus, Flint said, “critically important” to prevent stunting to ensure “any intervention or expenditure on education,” adding it “could be so much more effective later on in a person’s life.”His 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.

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“I doubt it has ever been mentioned by a president in Indonesia,” said Claudia Rokx, a lead health specialist at the World Bank. Pixabay

Jim Yong 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.”

Also Read: A Majority of Children Die Due to lack of Basic Healthcare Facilities: UN

“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.” (VOA)

Next Story

New York City’s Mandatory Measles Vaccination Order Stands Still

The health department's lawyers argued that quarantining was ineffective because people carrying the virus can be contagious before symptoms appear.

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Materials are seen left at demonstration by people opposed to childhood vaccination after officials in Rockland County, a New York City suburb, banned children not vaccinated against measles from public spaces. VOA

Brooklyn judge on Thursday ruled against a group of parents who challenged New York City’s recently imposed mandatory measles vaccination order, rejecting their arguments that the city’s public health authority exceeded its authority.

In a six-page decision rendered hours after a hearing on the matter, Judge Lawrence Knipel denied the parents’ petition seeking to lift the vaccination order, imposed last week to stem the worst measles outbreak to hit the city since 1991.

The judge sided with municipal health officials who defended the order as a rare but necessary step to contain a surge in the highly contagious disease that has infected at least 329 people so far, most of them children from Orthodox Jewish communities in the borough of Brooklyn.

Another 222 cases have been diagnosed elsewhere in New York state, mostly in a predominantly ultra-Orthodox Jewish neighborhood of Rockland County, northwest of Manhattan.

The New York outbreaks are part of a larger resurgence of measles across the country, with at least 555 cases confirmed in 20 states, according to the U.S. Centers for Disease Control and Prevention.

Health experts say the virus, which can cause severe complications and even death, has spread mostly among school-age children whose parents declined to get them vaccinated. Most profess philosophical or religious reasons, or cite concerns — debunked by medical science — that the three-way measles-mumps-rubella (MMR) vaccine may cause autism.

The judge rejected the parents’ contention that the vaccination order was excessive or coercive, noting it does not call for forcibly administering the vaccine to those who refuse it.

He also dismissed assertions in the petition disputing the “clear and present danger” of the outbreak. “Vaccination is known to extinguish the fire of contagion,” the judge said.

FILE PHOTO: A sign warning people of measles in the ultra-Orthodox Jewish community of Williamsburg in New York City, April 11, 2019.
A sign warning people of measles in the ultra-Orthodox Jewish community of Williamsburg in New York City, April 11, 2019. VOA

Secret identities

The vaccination order, which was extended this week, requires residents of certain affected Brooklyn neighborhoods to obtain the MMR vaccine unless they can otherwise demonstrate immunity to measles, or face a fine.

The court challenge was brought in Brooklyn’s Supreme Court by five people identified only as parents living in the affected neighborhoods. Their identities were kept confidential to protect their children’s’ privacy, their lawyers said.

In court on Thursday, they told Knipel the city had overstepped its authority and that quarantining the infected would be a preferable approach.

Robert Krakow, an attorney for the parents, estimated that just 0.0006 percent of the population of Brooklyn and Queens had measles. “That’s not an epidemic,” he said. “It’s not Ebola. It’s not smallpox.”

The health department’s lawyers argued that quarantining was ineffective because people carrying the virus can be contagious before symptoms appear.

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The vaccination order, which was extended this week, requires residents of certain affected Brooklyn neighborhoods to obtain the MMR vaccine unless they can otherwise demonstrate immunity to measles, or face a fine. Pixabay

The judge cited 39 cases diagnosed in Michigan that have been traced to an individual traveling from the Williamsburg community at the epicenter of Brooklyn’s outbreak.

Also Read: Short-Circuit Likely The Cause of Notre Dame Fire, Claims Police Investigators

The surge in measles there originated with an unvaccinated child who became infected on a visit to Israel, where the highly contagious virus is also running rampant.

The number of measles cases worldwide nearly quadrupled in the first quarter of 2019 to 112,163 compared with the same period last year, the World Health Organization said this week. (VOA)