From Silence to Salience: How Childhood Stunting Became Indonesia’s Priority

• In Event: National and Transnational Global Health Policy: Towards a Healthier World

Abstract

Child malnutrition is responsible for approximately 45% of global child deaths (Black et al. 2013, 427) and, together with climate change, it leaves no country untouched (Swinburn et al. 2019, 791). Yet, why does child malnutrition often struggle to get political commitment at the national level? Three reasons may help explain this. First, malnutrition needs its own framing that speaks to the right audience to get traction. The multicausal nature of malnutrition makes the issue open to various interpretations. It can be seen as a health, food security, economic growth, intergenerational rights, or humanitarian issue (Gillespie et al. 2013, 554). Second, governments tend to prioritize addressing issues with high visibility (Ho 2022, 3), a characteristic malnutrition lacks. Compared to other problems, malnutrition is rather latent, and investing in the nutrition of dependents does not yield immediate and visible impacts. Third, nutrition practitioners and researchers are “more interested in the science of nutrition than in the messy business of shaping, promoting, and implementing nutrition policy” (Balarajan and Reich 2016, 3). They often believe providing scientific evidence is enough to influence policy decisions, but evidence is only one component in the policy-making process that is inherently political (Cullerton et al. 2016, 2071). Therefore, political choices must be made to reduce child malnutrition.

Political economies are inherent in the systemic causes of malnutrition. They are defined as “the competing interests, incentives, and ideologies of a range of different actors with direct and indirect interests in nutrition, and the resultant inequalities” (Nisbett et al. 2014, 422). One form of child malnutrition, stunting, serves as an accurate marker for poverty and underdevelopment. Children are defined as stunted if they are too short for their age: having a height-for-age z-score that is two standard deviations or more below the 2006 WHO child growth standard median. In 2013, one in three children under five in Indonesia was stunted, despite the country boasting the largest economy in Southeast Asia. Stunting had been a silent emergency in Indonesia for years. But just a few years later, in 2018, everyone from the President, Minister of Finance, to village leaders mentioned stunting after the National Strategy to Accelerate Stunting Prevention was launched. It was the first multi-sectoral strategy to address the many underlying causes of stunting, committing 23 ministries and agencies with an estimated $3.9 billion of funding per year. Based on Indonesia’s national surveys, stunting has dropped from 37.2% in 2013 to 21.6% in 2022. I aim to analyze the political economy of stunting policy and progress in Indonesia from 2007 to 2022 by answering a research question: How and why did stunting become a political priority in Indonesia as demonstrated by the adoption of National Strategy to Accelerate Stunting Reduction?

To answer the research question, a qualitative research design is applied by using process tracing as the analytical tool, and data will be collected through a summative content analysis on Indonesia’s policy and program documents as well as semi-structured key informant interviews or “elite” interviews. Interviewees include government officials, multilateral and bilateral donors, international and national non-government organizations, civil society organizations, and academic institutions at the national level. At the time of writing this abstract or proposal, I am based in Indonesia for four months to operationalize my primary data collection. I use an integrated approach by looking at some policy process theories focusing on agenda-setting and policy adoption to structure my investigations, and how they speak to my future findings in Indonesia. Adopting multiple theories is common and relevant to a policy study that derives various insights from a range of disciplines. In this light, I use a “complementary” approach that “uses multiple concepts or theories to produce a series of perspective with which to explain empirical outcomes” (Cairney 2013, 3).

Author

• Deviana Wijaya Dewi, Johns Hopkins University