The Fault in Our Path and the girls of our future

Yessi Crosita

Where does health start? And where will it leads us?

Nowadays some people speak about early marriage as if it is harmless, however if we just look a little bit closer maybe the idea is not as innocent as we think and how it relates to our health as a nation and our never ending struggle to combat malnutrition. So let me guide you through it……

Indonesia has been long battled stunting, yet in spite of the steady progress in the nation’s economy and poverty reduction the change in the prevalence of chronic malnutrition indicated by stunting is ghastly. In Indonesia around 8, 4 million children under the age of 5 are stunted or simply put 1 out of 3 Indonesian children under five years old are stunted. Gloomier still is the fact that the number was increasing from 35,6% in 2010 to 37, and 2% in 2013. Stunting cases are also not uncommon in the richer families however children from rural area and coming from farmers household suffer more than their counterparts living in urban area.

We are so used to see short children and their short parents, we accustomed to the idea that Indonesian are mostly short and it goes without notice. Moreover, the idea of measuring one’s height is a new idea for our public health system, how many community health post practice height measurement? not many if we are honest. Yet stunting is not only about being short, height is just a proxy for a much bigger problem. When a child is stunted, all of the system in their body are stunted. Their brain, their immune system, basically all the growth of their organs are stunted. Worse still if the child is a girl her womb will also be stunted. The lost of potential is enormous.

In Indonesia studies shows that mothers’ age, mother’s education, access to clean water and sanitation and access to health care strongly correlate to stunting. In short, without trying to simplify things, mothers are key. In Indonesia they are still the dominant care taker and we need to realize that her role and health started way before the child is born, beyond the first 1000 days of life if we want to admit. Thus, if we let them grow in sub optimal environment their sub optimal growth is our future.

Health started far before the baby is born, even before conception. Freely citing Barker in his book nutrition in the womb, if a girl born with all of the eggs she will ever produce in her lifetime and the health of the eggs and her organs including her womb are actually determined by the nutrition given by her mother, thus the health of her child is determined by the health of her eggs and her womb, which was determined by the health of her mother and her grandmother and so on and so forth, so where does it begin? It all begins with better nutrition for girls.

Once the fetus is conceived, they literally eating up their mothers. Babies born from a healthy mother with a history of well nourishment before pregnancy are healthier despite the external calamities as extreme as great famine during the WW II happened during pregnancy. And once these babies are born, they are better adapted to the life outside the womb they suffer less chronic deseases once they are old. This reasoning highlight the importance of girl’s nutrition, beyond improving only of her health but to transform our future.

Let us go back to Indonesia, why this reasoning need to be shouted out loud. First, our girls are born smaller and shorter compared to our boys. Second the prevalence of women in child bearing age suffering from malnutrition is high, almost a quarter of pregnant women age 15 to 49 years old in Indonesia are suffering malnutrition.The third which in my opinion contribute to the cycle of malnutrition is the high prevalence of child marriage, in Indonesia based on 2012 data it is 17% or almost 1 out of 5 women; this is the second highest in the South East Asia. Research on adolescent pregnancy in 55 developing countries shows that prevalence of low birth weight and stunting under the age of 2 have a strong correlation to mother’s age, the younger the mother the higher the risk of malnutrition for their babies. When the mother’s body need the nutrients for her own growth there will be a competing interest between mother and baby.

The prevalence of low birth weight, short birth, malnutrition in pregnancy as well as child marriage are higher in rural compared to urban area and higher among those who are economically underprivileged. It is difficult to not see the connection, this should also partly explain the rural urban disparity in stunting prevalence aside from health service, economy and hygiene sanitation. Thus in order to reduce stunting it is important to advocate gender equality and end child marriage. It will let the girls grow before they nurture the next generation both our future girls and boys.

The paradox is the biggest reason for child marriage in Indonesia is to climb out of poverty, but in fact these girls most often than not still stay in poverty despite the marriage. Moreover child’s marriage takes away the right to education of these young girls. Thus lowering their already low knowledge about self-care and baby care. With their lack of education and now malnourished child, they actually perpetuate the circle of poverty. Therefore, it is timely to rethink the path we pursue in reducing stunting and reshaping our future. We should go beyond the first 1000 day of life and should also go beyond nutrition and economic measures. Nutrition and education of young girls should be the heart of the solution, let us invest more in the girls of our future because our health starts there.

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