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From newsdesk@igc.apc.org Fri Jun 2 08:01:37 2000
Date: Thu, 1 Jun 2000 23:44:24 -0500 (CDT)
From: IGC News Desk <newsdesk@igc.apc.org>
Subject: HEALTH-INDONESIA: Malnutrition Saps A Generation's Future
Article: 97473
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Copyright 2000 InterPress Service, all rights reserved.
Worldwide distribution via the APC networks.

Malnutrition Saps A Generation's Future

By Richel Dursin, IPS, 31 may 2000

JAKARTA, May 31 (IPS) - Indonesia may be on the path of economic recovery, but the effects of the debilitating financial crisis that hit East Asia three years ago will continue to be felt for years to come.

Indeed, one of them -- malnutrition -- is bound to haunt Indonesia for at least a generation, which is why experts are scrambling to soften its impact on the country. Among their recommendations to do this is to promote breastfeeding, which they say will help ease the malnutrition problem.

"The biggest challenge is to improve the quality of child feeding, which starts right away from birth with good breastfeeding practices," says Ernest Schoffelen, nutrition project officer of the United Nations Children's Fund (UNICEF) in Jakarta.

Indications show that malnutrition has become prevalent among Indonesian children in rural and urban areas following the economic crisis that gripped East Asia beginning 1997 and which claimed Indonesia as its worst victim.

Using weight for age as an indicator, results of the latest National Socio-Economic Survey (SUSENAS) reveal that around eight million out of 24 million Indonesian children under five years of age are suffering from malnutrition mainly due to lack of food intake and infections.

"Malnutrition retards the growth of children, both physically and mentally," says Schoffelen. "It has an influence up to the human resources and economic development of the whole nation."

He adds that the situation in Indonesia right now is particularly troubling. "What is worrisome," he says, "is that one-third of the Indonesian children under five years of age suffering from malnutrition are severely malnourished."

The findings have prompted dire predictions from some officials. "These (malnourished) children will likely face a dark future and they will become a serious social problem for the nation," says State Minister of Women's Empowerment Khofifah Indar Parawansa. "They would become the lost generation."

To be sure, the weakened purchasing power of Indonesians because of their country's financial misfortunes contributed greatly to the current situation. The percentage of malnutrition, in fact, is high in the eastern part of Indonesia where most people are poor.

But experts say bottle-feeding is also among the major factors leading to malnutrition. Here in Indonesia, they note, mothers tend to stop exclusive breastfeeding too early due to the premature introduction of complementary food or liquid other than breastmilk.

UNICEF is promoting exclusive breastfeeding of babies aged four to six months and complementary feeding onwards. It estimates that in Indonesia, the percentage of infants who are exclusively breastfed is 63 percent in the first month of life, 45 percent in the second, 30 percent in the third, 19 percent in the fourth, 12 percent in the fifth and only six percent in the six month.

Around 11 percent of Indonesian mothers end breastfeeding by 12 months of life and 75 percent of infants are given small tastes of food in the first hours and days after birth before the mother considers that breastmilk has begun to flow.

Some 200,000 infants in Indonesia are not breastfed at all, mostly from poor families for whom lack of breastfeeding greatly increases the risks of malnutrition, morbidity and mortality.

These days, Azrul Azwar, director general of community health at the Ministry of Health, says: "There is an increase in the number of mothers who do not want to breastfeed their babies because of lack of knowledge."

But this only compounds Indonesia's worsening problem of malnutrition. Says Azwar: "Before the crisis, we never had any pure malnutrition cases in this country. That is why we have a problem now. Doctors do not know how to treat malnutrition cases because they had never been exposed to these cases."

Apart from the "visible malnutrition" as seen in underweight children who are also short for their age, as well as wasting, a recent UNICEF study says there are many Indonesian children suffering "hidden hunger" malnutrition due to lack of micronutrients, particularly iron, vitamin A, iodine, calcium and zinc.

"Deficiencies of micronutrients contribute to poor growth and weaken the cognitive development and immunity of the children," Schoffelen says.

Most Indonesian children are fed rice porridge, locally known as "nasi bubur", which does not provide enough micronutrients.

Indonesian mothers also apparently do not appreciate the benefits of colostrum, considered by UNICEF as the "best breastmilk" since it contains antibodies that help protect the child against infections.

"The mothers normally throw away the first breastmilk because of its slightly yellowish colour. They think it is dirty and detrimental to the baby," Schoffelen says.

Prelacteal feeding or the giving of small tastes of food during the first hours and days of infants is widely practised in Indonesia. Up to 75 percent of babies are given some form of prelacteal feeding, which is regarded by UNICEF as harmful.

But apart from the lack of knowledge, the Ministry of Health attributes the reluctance of Indonesian mothers to breastfeed their babies also to the influence of advertisements by multinational companies.

Says Azwar: "The mothers want to appear attractive. Well- educated women know the benefits of breastfeeding, but in reality they do not want to breastfeed because they have their jobs."

In truth, the Ministry of Health has found out that 30 percent of the eight million children suffering from malnutrition come from middle-class families.

"To prevent malnutrition among children, there is a need to improve the child- feeding habits of the caregivers, especially the mothers. But educating the people is not enough if they cannot afford to buy quality food," Schoffelen says.

At present, UNICEF provides "nutritional" education to mothers and subsidises the price of micronutrient-fortified baby food, known to Indonesians as "Vitadele" and sold only at integrated health centres or "posyandus" located in seven provinces of the country where there is a big number of malnourished children.

A 500-gramme bag of Vitadele, which is sufficient for one week to feed a baby two meals a day, costs 500 rupiah (about six cents) at the health centres in the provinces of West Java, Central Java, East Java, East Nusa Tenggara, West Nusa Tenggara, South Sulawesi, and Papua.

But both the Ministry of Health and UNICEF concede that asking mothers to breastfeed their children is not sufficient to curb malnutrition. Schofellen says, "If the government is really serious in preventing malnutrition, it must allocate enough money from the state budget to the health sector."

For this year, the government only parcelled out 2.3 percent of the national budget or 4.7 trillion rupiahs (585 million dollars) to the health sector. "The money allotted for the health sector is not enough," says Azwar. "It is too small, but the corrupted money is more than that."



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