(Oct 31): The stunting issue has become a public concern in Malaysia, but there is still a lack of understanding. Though policymakers and the public emphasize the immediate causes of stunting, such as inadequate nutrition, they often disregard the underlying factors.
Fundamentally, stunting manifests as a child’s inability to attain their potential height for their age. According to the World Health Organization (WHO), a child is considered stunted when their height deviates by more than two standard deviations from the median Child Growth Standards for their age. This condition goes beyond mere height disparity and signifies chronic malnutrition among children.
Numerous studies unveil a crucial fact: during the initial five years, all children globally possess identical growth potential, regardless of their ethnicity or race. This critical period, particularly the first two years post-birth, marks the prime phase for children’s rapid growth and brain development. However, stunting disrupts this development due to inadequate nutrition. This deficiency results in not only physical shortness but also compromises cognitive abilities and academic performance, perpetuating a cycle of underachievement and limiting future job prospects.
Additionally, stunted individuals exhibit weakened immunity, rendering them more susceptible to diseases. Furthermore, long-term health issues like obesity, high blood pressure, type-2 diabetes, and heart disease often plague those who experienced stunting during their childhood. This trend exerts additional strain on public healthcare systems. Moreover, the vicious cycle continues as stunting’s consequences transcend generations.
Women who were stunted as children have a heightened likelihood of giving birth to stunted offspring. This highlights the extensive economic and social ramifications of stunting, with potential impacts on a nation’s economic progress. A study by the World Bank estimates that a nation could lose up to 7% of its per capita income due to stunting.
Turning to Malaysia’s context, despite advancements in maternal and child healthcare access and quality, the prevalence of stunting has remained stagnant over the past decade. Data from the 2019 National Health and Morbidity Survey indicates that a staggering 21.8% of Malaysian children are stunted. This rate is three times higher than the average in upper-middle-income countries and surpasses even lower-middle-income nations like Ghana (17.5%) and regions plagued by conflicts, such as Iraq (12.6%) and Palestine (7.4%). In contrast to the global decline in stunting, Malaysia has witnessed an unfortunate increase since 2010.
Tragically, the Covid-19 pandemic exacerbated this situation. A 2020 Unicef study revealed that the pandemic altered the dietary habits of low-income urban families due to income reduction. This transformation manifested as increased consumption of inexpensive yet unhealthy options like instant noodles, reduced intake of fruits, and substitution of animal protein with eggs. Approximately one in five Malaysian families now struggle to provide diverse foods to their children, forced to prioritise affordability amidst rising living costs and food inflation.
Comparing this scenario with Bima City, an Indonesian town on Sumbawa Island, unveils a success story. Despite facing challenges such as flash floods, Bima City has witnessed a remarkable reduction in stunting over five years, declining from 36.5% in 2017 to 14.8% in 2022. This progress can be attributed to a conditional cash assistance programme that entails cash transfers to poor households for purchasing children’s food, providing micronutrient interventions for toddlers and pregnant women, and imparting health and nutrition education to parents. This programme is supplemented by improvements in sanitation and healthcare facilities, innovative public health initiatives, and direct engagement with communities through regular health facility visits.
In conclusion, stunting represents more than nutritional deficiency; it mirrors deep-rooted social inequalities. While inadequate nutrition remains a pivotal cause, it arises from gaps in nutritional understanding, insufficient child-rearing practices, poverty, and food security. The case of Bima City emphasizes that addressing child malnutrition necessitates a multifaceted, collaborative approach involving government bodies, private sectors, non-governmental organisations, and the general populace. Seamless cooperation across social security, education, healthcare, nutrition, and sanitation sectors is imperative to pave the way for healthier child development. By embracing comprehensive measures, societies can break the cycle of stunting and nurture healthier generations poised for a brighter future.
Dr Romi Bhakti Hartarto is a post-doctoral research fellow at the Ungku Aziz Centre for Development Studies, Universiti Malaya; and assistant professor at the Department of Economics, Universitas Muhammadiyah Yogyakarta, Indonesia.