Fathers’ Role to Prevent Stunting in the Family
Author: Andi Nur Zamzam Arman
Keywords: stunting, fathers’ role, family
Stunting is a condition of impaired physical and intellectual growth of a child that is caused by chronic malnutrition. According to the World Health Organization (WHO) (2016), stunting is indicated by low height for age of a child that is caused by inadequate nutrition or multiple infections that occur during the first 1000 days of life. In Indonesia, according to a 2019 survey, stunting prevalence rate among children under-five stood at 27.67 per cent (Izwardy, 2020). In contrast, WHO’s standard recommends countries to keep their stunting prevalence rate below 20 per cent. The rate of stunting in Indonesia suggests the severity of this condition and the urgency for Indonesia to take appropriate response measures.
There are a variety of factors that may lead to stunting in children, namely income and education level of parents (Bishwakarma, 2011; Ni’mah and Nadhiroh, 2015; Mzumara, Bwembya, Halwiindi, Mugode, Banda, 2018), the number of family members when stunting is experienced by children between 24 and 36 months (Nasikhah and Margawati, 2012), length at birth, non-exclusive breastfeeding during the first six months postpartum, mothers’ knowledge on nutrition, (Mzumara, Bwembya, Halwiindi, Mugode, Banda, 2018; Ni’mah and Nadhiroh, 2015; Beal, Tumilowicz, Sutrisna, Izwardy, and Neufeld, 2018), sex, access to maternal and child healthcare, and rural setting (Beal, Tumilowicz, Sutrisna, Izwardy dan Neufeld, 2018). According to a study conducted by Tran (2008), the lack of paternal engagement in childcare (for example, fathers who refuse to take their children for vaccination or care for a sick child) also contributes to stunting in children. Tran found that children whose fathers are not engaged in ensuring their healthcare are 1.7 times more at risk of being affected by stunting compared to children who enjoy paternal involvement.
Stunting greatly and adversely affects a child’s development. In children under five, Stunting has been linked to lower cognitive development (Alam et.al., 2020). This in turn hampers their learning ability and, in the long-term, their work productivity as well as other aspects of development. Childhood stunting may also develop into various pathological disorders that may increase the rate of morbidity and mortality, neurological disorders, and the risk of developing chronic diseases as adults (Onis and Branca, 2016; Stewart, Iannotti, Dewey, Michaelsen and Onyango, 2013). They include, such as, anaemia, diseases contributed by poor nutrition (UNICEF, 2016), tuberculosis, sepsis, meningitis, hepatitis (Olofin et.al., 2013) and degenerative diseases such as diabetes (UNICEF, 2013).
Moreover, stunting does not only affect the individual, but may spill widely to other aspects of a society. From the economic lens, World Bank data (2017) showed that for every one per cent of height loss in adults because of childhood stunting there was 1.4 per cent of economic productivity loss per person. A person who experiences childhood stunting may also generate lower income level than a person without childhood stunting (Grantham-McGregor et al., 2007). This shows that stunting contributes to impaired quality of human resource, work productivity, and the opportunity to improve an individual’s economic welfare.
The government of Indonesia has taken efforts to reduce the impacts, among others through nutrition-specific interventions and nutrition-sensitive interventions. The government has also set a target of reducing stunting prevalence rate to 14 per cent by 2024. This is a challenging goal but one that is crucial to meet, and it requires the collaboration of all stakeholders in the government and society, including family members at the household level. Maternal health is vital and is associated to child stunting. Stunting prevention interventions that target women as future mothers may start early for adolescents. Other than girls, pregnant women and postpartum mothers in the period of up to 24 months after childbirth are also appropriate target of interventions (Beal, Tumilowicz, Sutrisna, Izwardy, dan Neufeld, 2018). According to Onis and Branca (2016), stunted mothers are also at risk of adverse birth outcomes, such as stunted children, fetal mortality, and neonatal mortality, which makes them an important target of interventions.
Families play a central role in preventing child stunting. Beyond providing support to mothers to make sure they and their children receive quality healthcare from pregnancy to birth, fathers specifically should contribute to creating an ideal environment to maintain maternal and child health. Fathers’ engagement in health education and healthcare access for their spouses and children positively affect mothers’ nutrition and reduces the risk of child stunting (Comrie-Thomson et.al., 2015). For the purpose of prevention, this engagement needs to start as early as possible. Therefore, prospective fathers are also important to be the target of information and knowledge dissemination on their roles to prevent stunting. Men who are married and are planning to have a family should ensure their spouses’ condition early on. According to Comrie-Thomson, et al., (2015) stunting interventions that promote paternal engagement result in a significant difference in terms of child mortality and birthweight. In other others, the role of fathers can never be undermined when it comes to protecting and promoting the health and welfare of mother and child.
In a society with a patriarchal culture like Indonesia, a father holds a prominent role in the family. As the head of family, fathers typically have the power to make decisions, including in terms of nutrition intake and the care and services that families can access. The limited understanding of fathers and prospective fathers on their role in stunting prevention may result in their little support in childcare during the first 1000 days of life, as well as in their involvement to provide healthcare access to children. There are many ways that a father can do for stunting prevention in their families, including discussing birth planning with their spouses to avoid unwanted pregnancies and supporting the use of contraceptives to control the size of their families (Fink, Sudfeld, Danaei, Ezzati, and Fawzi, 2014). Fathers may also share the burden of birth control and planning by using male contraceptive methods. Additionally, fathers play a role in ensuring nutrition adequacy for all family members, providing emotional support, implementing healthy lifestyle, and creating a comfortable family life as well as equality for every member (Onis dan Branca, 2016). They also need to ensure that maternal and child healthcare needs are met; these include vaccination, consultation with medical personnel when ill, regular check up for mothers, sharing the burden of domestic chores, avoiding domestic violence, and fostering healthy communication with their spouses. (Comrie-Thomson et al., 2015).
However, for fathers to play an active role, they also need to have strong knowledge and understanding of that role from the beginning and even before fatherhood. Being equipped with that knowledge will allow fathers to make the right decisions and provide appropriate support to mothers and children before and during pregnancy and after childbirth, including during the first 1000 days of life until at least 24 months postpartum. Training and campaigns are some of the fundamental measures that can be done to raise awareness in fathers about their role (Bergström and Söderström Högling, 2017).
Stunting prevention is not an individual’s problem nor it is the sole responsibility of the government. Stunting prevention requires everyone’s efforts, including fathers as part of children’s closes environment. As described above, fathers’ engagement is crucial, and they need to be educated and taught about stunting prevention. Fathers can then take that knowledge and contribute to providing quality childcare in the first 1000 days of life, optimizing stunting prevention, and realizing quality, happy, and prosperous families.
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