The Intricate Facts of Stunting
Stunting remains a significant public health issue worldwide. According to estimates from the World Health Organization (WHO), stunting affected 150.2 million children under the age of five in 2024. At the national level, the 2024 Indonesia Nutritional Status Survey reported 19.8% of the population suffered from stunting. Moreover, the 2022 Nutritional Status of Indonesia and the 2023 Indonesian Health Survey indicated an increase in the stunting prevalence rate in Depok City, rising from 12.6% in 2022 to 14.3% in 2023. Even at the local level, the pattern remains evident. These trends underscore the urgent need for ongoing efforts to prevent stunting across all levels of government.
Many people believe that inadequate food intake is the only factor contributing to stunting. Even so, is nutrition the only thing that affects its occurrence? A health condition known as stunting is a result of a child’s growth and development failing because of chronic malnutrition. If it happens within the first 1,000 days of life, the risk increases even further (Laily & Indarjo, 2023).
The Thematic Report of the 2023 Indonesian Health Survey revealed that the 24–35 months age group had the highest prevalence of stunting at 26.2% in 2022 and 25.8% in 2023. However, the prevalence was roughly 10% lower in the 36–47 months and 48–59 months age groups compared to the 24–35 months group. These findings highlight that the early years, especially those under three, are a very vulnerable period for stunting and calls for suitable dietary interventions as well as a nurturing environment.
Figure 1. The increased prevalence of stunting in Depok City
Source: https://layanandata.kemkes.go.id/, 2022 & https://www.badankebijakan.kemkes.go.id/, 2023
Growth-inhibiting Factors
Figure 2. Faecal-Oral route of disease transmission
Source: https://www.yaclass.in/, 2025
- An Immediate Cause
Stunting is directly caused by maternal nutritional intake during pregnancy, childhood infections, and inadequate nourishment for toddlers (Nisa & Sukesi, 2022). Anemia and Chronic Energy Deficiency (CED) during pregnancy increase the risk of low birth weight and short stature. These circumstances can raise the infant’s risk of acute malnutrition and infectious disease development, as well as the newborn’s chance of morbidity, and even death (Setiawan et al., 2018).
- The Indirect Aspects
Meanwhile, environmental hygiene and sanitation conditions are indirect factors that also have a significant impact on the incidence of stunting. It includes handwashing practices, ownership of toilets, drinking water sources, and the physical quality of the water used (Nisa & Sukesi, 2022). A higher prevalence of infections in toddlers and malnutrition-related illnesses mediates the relationship between stunting and inadequate environmental sanitation. Children with infections may develop loss of appetite. Additionally, these illnesses deplete the proteins and calories that should be used to support growth. As a result, the child’s body has a harder time absorbing vital nutrients (Amartya, 2024).
The Impact of Stunting
- Direct Effects
Stunting can cause metabolic problems, hinder physical growth, impair brain development and intelligence, and increase medical expenses in the short term (Laily & Indarjo, 2023). Children with stunting typically have shorter stature and slower skeletal development. This disorder is linked to the brain’s impaired growth and development, which includes delays in the maturation process of nerve cells. As a result, the brain cannot produce the best impulses to regulate fine and gross motor skills (Pantaleon et al., 2015). Additionally, compared to their peers who are developing excellently, children with stunting, during the first two years of life, are more likely to have an IQ below 89 (Daracantika, 2021).
- Long-Term Impacts
Stunting can lead to suboptimal physical and cognitive development in the long run. Stunted children are more prone to illness due to weaker immune systems. In addition, adult degenerative diseases such as diabetes, obesity, heart disease, cancer, stroke, and disability are more likely to develop in people who are stunted (Laily & Indarjo, 2023). According to research by Ekholuenetale et al. (2020), children with stunting experience a 7% decrease in cognitive development compared to their non-stunted peers.
Using The Five Pillars of Community Based Total Sanitation to Prevent Stunting
Improving environmental quality by applying the five pillars of Community Based Total Sanitation (CBTS) is one strategic intervention for preventing stunting. The goal of the CBTS program is to prevent environment-based diseases by promoting a culture of clean and healthy living. Moreover, this program builds community capacity and strengthens government commitment to increase access to basic sanitation and safe drinking water (Kementerian Kesehatan, 2017).
Since the Ministry of Health implemented the CBTS approach in 2008, access to sanitation services has become much more accessible, rising from 48.56% in 2008 to 67.80% in 2016. Furthermore, the application of the CBTS approach in drinking water programs increased access from 46.45% in 2008 to 71.14% in 2016 (Dinas Kesehatan DI Yogyakarta, 2018). These are the five pillars of Community Based Total Sanitation.
- Open defecation
- Washing hands with soap
- Managing drinking water and household food
- Securing household waste
- Securing household liquid waste
Families and Adolescents’ Strategic Role in Preventing Early Stunting
Figure 3. Conceptual framework of effect of water, sanitation and hygiene on stunting
Source: https://www.researchgate.net/, 2021
- The Role of Pregnant Women and Women of Childbearing Age
Pregnant women and women of childbearing age who are malnourished and anemic are more likely to give birth to low birth weight babies. These babies are more susceptible to undernutrition and may potentially develop long-term stunting (Laily & Indarjo, 2023). Mothers who practice good hygiene, such as washing their hands frequently, can reduce their child’s risk of stunting by up to 15% (Nisa & Sukesi, 2022).
- Teenagers’ Roles, Especially Those in Middle School
Teenagers are growing up quickly as they transition to adulthood. At this stage, they begin to develop their eating patterns, mindset, and understanding of the importance of good nutrition and health. Teenagers who plan to become parents must be knowledgeable about stunting prevention to break the cycle of nutritional problems across generations. A lack of awareness and negative attitudes towards healthy diet can increase the risk of stunting in their future children. On the other hand, adolescents with higher education levels have the potential to influence their families and communities (Annisa & Ikasari, 2025).
- Parent’s Role
Children primarily rely on their parents as their main source of information. Parents can teach their children the importance of clean and healthy living habits, balanced nutritional intake, and healthy eating patterns. Early instillation of these values can be a key starting point for preventing stunting. Therefore, in addition to being implemented in communities and schools, educational interventions also need to be reinforced at home (Annisa & Ikasari, 2025).
The Envicare Program
Figure 4. Envicare 2025
Source: Personal documentation, 2025
Adolescent girls who are entering their reproductive years and may become mothers, middle school students, and parents are the three main groups that need to be the focus of comprehensive interventions to support stunting prevention efforts. One such educational initiative is the Envicare 2025 program. Envicare is a collaboration between the Social Concern Department and the Education and Research Department of Envihsa FKM UI. Through the distribution of materials and practical implementation, this program aims to address environmental health issues within the community.
The theme of Envicare 2025 is “Agents of Hygiene: Preventing Stunting, Shaping a Brighter Future”. The target groups of this activity are parents and middle school boys and girls. This choice is based on the importance of teenagers as future parents and the critical role of families in creating an environment that supports children’s optimal growth and development. The program will be divided into three sessions and run over two days. All seventh-grade students will participate in a session on the first day, while adolescent girls and their parents will attend on the second day.
In addition to educating people about reproductive health and anemia prevention, this intervention focuses on preventing stunting through the application of the five pillars of the Community Based Total Sanitation (CBTS) approach. Alongside face to face activities, Envicare 2025 provides parents and students access to intervention modules and educational posters, which are displayed in every seventh-grade classroom as visual reminders and reinforce the key points of the intervention.
Closing
The complexity of the stunting problem shows that it cannot be solved by nutrition interventions alone. Preventing stunting is significantly supported by factors such as sanitation, environmental hygiene, and the strategic role of families, including teenagers. Therefore, to break the cycle of stunting and ensure that every child has the opportunity to reach their full potential, a comprehensive strategy that integrates education and interventions, such as the Envicare 2025 Program, is essential.
Reference
Annisa, D.N. and Ikasari, F.S., 2025. Gambaran pengetahuan dan sikap anak usia remaja tentang pencegahan stunting di SMP Negeri 1 Martapura: Overview of knowledge and attitudes of adolescent children on stunting prevention at SMP Negeri 1 Martapura. Journal of Intan Nursing, 4(1), pp.7–14.
Amartya, P., 2024. Pengaruh media audio visual tentang sanitasi total berbasis masyarakat (STBM) terhadap tingkat pengetahuan ibu hamil dalam upaya pencegahan stunting di wilayah kerja Puskesmas Andalas Padang tahun 2024. Doctoral dissertation. Sekolah Tinggi Ilmu Kesehatan Alifah Padang.
Badan Kebijakan Pengembangan Kesehatan, 2023. Survei Kesehatan Indonesia. [online] Available at: https://www.badankebijakan.kemkes.go.id/hasil-ski-2023/ [Accessed 24 March 2025].
Daracantika, A., 2021. Systematic literature review: Pengaruh negatif stunting terhadap perkembangan kognitif anak. Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan, 1(2), p.6.
Dinas Kesehatan DI Yogyakarta, 2018. Orientasi STBM Stunting. [online] Dinas Kesehatan DI Yogyakarta. Available at: https://www.dinkes.jogjaprov.go.id/berita/detail/orientasi-stbm-stunting [Accessed 24 March 2025].
Ekholuenetale, M., Barrow, A., Ekholuenetale, C.E. and Tudeme, G., 2020. Impact of stunting on early childhood cognitive development in Benin: Evidence from Demographic and Health Survey. Egyptian Pediatric Association Gazette, 68(1), pp.1–11.
Kemenkes RI, 2017. Prosiding Promkes. Jakarta: Kementerian Kesehatan Republik Indonesia.
Kementerian Kesehatan Republik Indonesia, 2022. Survei Status Gizi Indonesia (SSGI) 2022. [online] Available at: https://layanandata.kemkes.go.id/katalog-data/ssgi/ketersediaan-data/ssgi-2022 [Accessed 24 March 2025].
Kementerian Koordinator Bidang Pembangunan Manusia dan Kebudayaan Republik Indonesia, 2025. Prevalensi stunting tahun 2024 turun jadi 19,8 persen, pemerintah terus dorong penguatan gizi nasional. [online] Available at: https://www.kemenkopmk.go.id/prevalensi-stunting-tahun-2024-turun-jadi-198-persen-pemerintah-terus-dorong-penguatan-gizi [Accessed 27 June 2025].
Laily, L.A. and Indarjo, S., 2023. Literature review: Dampak stunting terhadap pertumbuhan dan perkembangan anak. HIGEIA: Journal of Public Health Research and Development, 7(3), pp.354–364.
Nisa, D.M.K. and Sukesi, T.W., 2022. Hubungan antara kesehatan lingkungan dengan kejadian stunting di wilayah Puskesmas Kalasan Kabupaten Sleman. Jurnal Kesehatan Lingkungan Indonesia, 21(2), pp.219–224.
Pantaleon, M.G., Hadi, H. and Gamayanti, I.L., 2015. Stunting berhubungan dengan perkembangan motorik anak di Kecamatan Sedayu, Bantul, Yogyakarta. Jurnal Gizi dan Dietetik Indonesia, 3(1), pp.10–21.
Setiawan, E., Machmud, R. and Masrul, M., 2018. Faktor-faktor yang berhubungan dengan kejadian stunting pada anak usia 24–59 bulan di wilayah kerja Puskesmas Andalas Kecamatan Padang Timur Kota Padang tahun 2018. Jurnal Kesehatan Andalas, 7(2), pp.275–284.