Understanding the Crucial Role of Parents in Preventing Early Stunting in Teenage Daughters

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author :

Yusdam Arrang Bua

yusdamraangbua@gmail.com

Title :

Understanding the Crucial Role of Parents in Preventing Early Stunting in Teenage Daughters

 

Abstract–

Background:  The first 1000 days of life are critically important to prevent stunting because it is a golden period of child growth, which starts when a child is in the womb until two years old. For this reason, the role of the mother is required to be the leading actor in its’ stunting prevention. But actually, the prevention can be done earlier when the mother is a teenager. In this case, it demands the role of her parents to become the leading actor in stunting prevention. Parents play an essential role in preventing early stunting by preparing their teenage daughters to become the agent of change to prevent stunting in the future.

 

Aims/Objective: This study aims to examine the crucial role of parents in preventing early stunting in teenage daughters.

 

Methods: This study used a qualitative approach that applies the library research method. The source of data in this study was collected from books, reports, journal articles, and news articles. Then, the data obtained are analyzed descriptively.

 

Findings: The results show that the role of parents in preventing early stunting can be done through nutritional and health interventions. Those interventions are (1) providing a balanced nutritious diet; (2) monitoring teenage girls’ nutrition and health (preventing anemia); (3) conducting education about balanced nutrition; (4) conducting education about reproductive health; and (5) implementing the Clean and Healthy Living Behaviors (PHBS). In its implementation, parents must use an authoritative parenting style as the key to the effectiveness of the intervention. By doing that, the young girls can bear positive outcomes to prevent stunting. The outcomes are (1) healthy teenage girl. Because of her sufficient nutrition, a healthy teenage girl will give birth to a healthy child; (2) the authoritative parenting style used by parents affects the teenage daughter’s parenting style in the future because the authoritative parenting style is an effective parenting style for children.

 

Implication: The results of this study can be used as reference material for socialization about the crucial role of parents in preventing early stunting in teenage daughters

 

Keywords–

authoritative parenting style, nutritional and health interventions, parents’ role, stunting prevention,

 

  1. Introduction

“Indonesia is experiencing a stunting emergency,” said the Head of BKKBN of the Republic of Indonesia, Hasto Wardoyo (liputan6, 2020). A study of the Nutritional Status of Toddlers in Indonesia (SSGBI) supports this condition. SSGBI shows that the prevalence of stunting in Indonesia is 27.67%, higher than in Southeast Asia, which is 24.7% and exceeds the global prevalence of 21.3% (Khairani, 2020). In 2019, it was estimated that 3 out of 10 Indonesian children were stunted, or around 6.6 million stunted toddlers (Mursita, 2020). The stunting emergency condition is also emphasized through BKKBN’s prediction. BKKBN predicts that in 2024, there will be 20 million babies born, and 7 million of them have the potential to be stunting (Kompas, 2021).

In a simple understanding, stunting is a condition where toddlers have less length or Height when compared to their age (Kementerian Kesehatan RI, 2018). Stunting is a condition of growth and development failure in children under five due to malnutrition experienced during the children in the womb until the child is two years old. Stunting conditions will be seen after the baby is two years old, characterized by the child being unintelligent, short, and at risk of cardiovascular disease, stroke, and diabetes (bkkbn, 2021b). Based on UNICEF/WHO/World Bank’s (2012) report, 165 million children under five were stunted. Many school-age children, adolescents, and adults suffer the consequences of the stunting they experience during their early years of life (Bloem, n.d.). The detrimental impact of stunting is lurking for individuals and threatening Indonesia’s future because it is related to the quality of Indonesia’s human resources, which will not be able to work properly and maximize their potential in the productive age (Ramadhani, 2021).

In handling the stunting problem and breaking the chain of stunting in the life cycle, the action must be started before the child is born, even from adolescence (Ekayanthi & Pudji Suryani, 2019). Experts say that the problem of stunting occurs in the first 1000 days of life. Some experts emphasize that it is longer than that since the mother is still a teenager. It is because, when she married, during her pregnancy period, then she got malnourished, the condition will put her at the risk of giving birth to a stunting child (bkkbn, 2021b). Poor nutrition status among adolescents is an essential determinant of poor health outcomes, especially for girls. They are more likely to give birth to low birth weight infants (Melaku et al., 2015). A study showed that stunting risk correlates with a baby’s birth weight of less than 2,500 gr (Apriluana & Fikawati, 2018).

UNICEF states that adolescents in Indonesia are faced with the triple burden of malnutrition (undernutrition, overnutrition, and micronutrient deficiency). Malnutrition has severe implications for the current health of young people and future generations. The nutritional status of young women will affect pregnancy outcomes and maternal and child health and survival (UNICEF Indonesia, 2021). Based on this information, stunting prevention efforts must indeed be carried out as early as possible by parents because parents (under normal circumstances) are the first adolescents environments who are responsible for their adolescents’ life.

There are some definitions of adolescent. UNICEF defines an adolescent as an individual between 10-19 years. (Younger adolescents are between 10-14 years, and older adolescents are between 15-19 years) (UNICEF, 2021). Furthermore, according to the Regulation of the Minister of Health of the Republic of Indonesia number 25 of 2014, adolescents are residents aged 10-18 years. Then, according to the Population and Family Planning Board (BKKBN), the age range is 10-24 years and with unmarried status. Its age categories are early adolescents (10-14 years), middle adolescents (between 15-19 years, and late adolescents (between 20-24 years) (Direktorat Bina Ketahanan Remaja, 2020; Kementerian Kesehatan RI, n.d.). Adolescence is a significant stage that marks the transition from childhood to adulthood. This period is a period of rapid growth and development, physically, psychologically, and intellectually. Adolescence is a critical window of a second chance to introduce positive development after infancy. So during this period, the positive environment and relationships can also increase positive outcomes in adolescents, while negative experiences experienced by adolescents will firmly imprint and affect adolescents in their adult lives (UNICEF, 2021). Therefore, Parents play an essential role in briefing their youth because adolescents need to be told what they can and cannot do, what should or should not be done, what they can or cannot do, and what are their strengths and limitations (Ismail & et.al, 2016).

Nedra et al. conducted research in seven high schools in East Jakarta. They found that in terms of physical readiness and knowledge of adolescents as mothers-to-be in fostering the growth and development of toddlers, as many as 263 adolescents stated that they were not ready to become mothers-to-be. As many as 120 adolescents were ready (Nedra et al., 2006). The results of this study can reflect that there are still many teenagers who are not ready to become mothers to foster the toddlers’ growth and development. Meanwhile, young women’s physical readiness and knowledge are essential to prevent stunting.

For all those reasons, parents are responsible for their teenage daughter’s life in the future. Parents have a crucial role in shaping their teenage daughters to become future mothers who can be the stunting agents of prevention to avoid stunting in children. Therefore, this study aims to examine the crucial role of parents in preventing stunting early in teenage daughters.

 

  1. Methods

this study used a qualitative approach that applies the library research method. This study used various literature as objects of this study. The source of data in this study was collected from books, reports, journal articles, and news articles. Then, the data obtained are analyzed descriptively to answer parents’ crucial role in preventing the early stunting of teenage girls by understanding and studying the concepts and various literature found.

 

  1. Finding and Discussion

Young women who are ready to prevent stunting must be healthy. The Head of BKKBN RI, Hasto Wardoyono, said that young women need to be educated in preventing stunting, and their nutritional intake must be maintained. Their health condition is good, not anemia or any other diseases. It is important because young women are mothers-to-be. Their nutritional intake must be sufficient to avoid the risk of giving birth to malnourished children (bkkbn, 2021b). Therefore, the crucial role of parents in preventing early stunting in teenage daughters is to give nutritional and health interventions.

 

Nutritional and Health Interventions

Parents must ensure that their teenage daughters’ nutrition and health are sufficient to prevent early stunting. The implementation of the parents’ crucial roles by giving their teenage daughter nutritional and health interventions are as below:

 

1) Providing a nutritionally balanced diet 

Parents must be able to provide nutritious food and drink for their adolescents. It is beneficial to maintain their ideal weight. By providing a nutritionally balanced diet, adolescents will avoid health problems experienced by most adolescents in Indonesia, like undernutrition (thin, stunting, Chronic Energy Deficiency (KEK)), overnutrition (Overweight, Obesity), and Micronutrient Deficiencies (Anemia) (Indriasari, 2020). Therefore, according to Hastuti, several things need to do those health problems ; (1) maintain the consumption of nutritious and balanced foods; (2) avoid snacks or snacking too much; (3) avoid fatty foods but still consume protein and calcium foods considering that adolescents are still at the stage of physical development; (4) avoid consuming fatty foods from nuts excessively, especially to maintain the health of the facial skin; (5) increase the consumption of vitamins and minerals for skin health, and (6) consume adequate drinking water to maintain the body’s metabolism (Hastuti, 2015).

Parents must provide a nutritionally balanced diet for their teenage daughters. Parents need to understand the concept of balanced nutrition itself. In balanced nutrition, what needs to be balanced is the variety (type) and amount (portion) of food with the body’s needs. The variety of balanced foods includes:

(1) staple foods. It is the primary source of energy that contain many carbohydrates. The example of it are rice, corn, sago, sweet potatoes, and others;

(2) side dishes. It is the source of protein that acts as a building agent and substitute for damaged body tissues. The protein sources are from animal sources, e.g., fish, eggs, meat, shrimp, and vegetable sources from nuts and processed legumes, e.g., tempeh, tofu;

(3) vegetables and fruits. It is the source of regulatory substances. It contains vitamins and minerals, such as vitamin C, vitamin E, Folic Acid, vitamin B, carotene (Provitamin A), iron, calcium, and zinc. In addition, vegetables and fruits also contain many fiber and antioxidants, which are essential for the body. Where fiber is needed to maintain the health of the digestive tract and prevent Non-communicable Diseases such as heart disease and bowel cancer, while antioxidants are responsible for neutralizing free radicals that can cause Non-Communicable Diseases such as cancer and heart disease;

(4) Water. Consuming enough water will facilitate digestion to prevent constipation, regulate body temperature, remove toxins, regulate the body’s acid-base balance, and support the increase of blood volume. Water is essential for blood circulation to the brain. Lack of water in the body (dehydration) will make the brain work slowly. The total drinking water needed per day is 2 liters or about eight glasses (bkkbn, 2021a). So all the elements like staple foods, side dishes, vegetables, and fruit, must be provided for teenagers.

Next, to increase the teenage daughter’s appetite, parents must provide a variety of foods to eat, including the variations in food processing (not monotonous). Balanced nutrition is needed for young girls to optimize their nutritional status. It is essential for them to give birth to healthy children in the future because, in general, babies in the womb take nutrients from their mother’s deposits. Therefore, the mother’s nutritional status during life before pregnancy becomes very important to ensure the availability of nutrition that will be utilized by the baby (Kementerian Kesehatan RI, 2018). Thus, to prevent stunting, teenage daughters must consume balanced nutrition for their body’s readiness as an investment for the pregnancy period in the future to give birth to healthy children.

 

(2) Monitoring teenage girls’ nutrition and health (prevent Anemia)

In providing food for adolescents, parents need to know about their children’s nutrition needs, whether their children fall into malnutrition, overnutrition, or whether they are deficient in micronutrients. Therefore, parents need to monitor the nutritional condition of their children, which is detected from their Body Mass Index. In doing so, parents can control what food intake need to consume. That action reflects parents’ awareness of their children’s needs for food. A person’s fat or thinness is determined by the Body Mass Index (BMI), which is measured by calculating Body Weight (kg) / Height (m2). The BMI’s classifications are (1) very thin < 17.0; (2) thin 17 – < 18.5; (3) Normal, the range is at 18.5 – 25.0; (4) Fat  > 25.0 – 27.0; and (5) Obesity > 27.0 (Gayatri et al., 2022).

For example, when a teenager is obese, parents need to fix their teenager’s food consumption by controlling the carbohydrates and fats intake from being excessive and balancing it with eating fruits and vegetables. It is in line with the results of a study stating that the main risk factors that cause obesity are an unhealthy diet, insufficient fiber consumption (fruits and vegetables), and inactive physical activity (Dewi, 2015). Furthermore, a study also mentioned that adolescents are vulnerable to obesity because, at that age, adolescents experience a decrease in physical activity (Kurdanti et al., 2015). Therefore, parents also need to invite their children to engage in physical activity, like exercise, to maintain energy balance and prevent overnutrition.

In particular, teenage daughters should be monitored for their iron condition. Adolescents who lack iron are at risk for Anemia. Anemia is a condition of the body where the level of hemoglobin (Hb) in red blood cells is lower than the standard it should be. Young women’s Hb, if they get Anemia, is < 12 gr/dl. Whereas this hemoglobin is beneficial for binding oxygen and delivering it to all body tissues, including muscles and the brain, to perform their functions. Therefore, individuals who get Anemia will be tired and weak (Kementerian Kesehatan RI, 2020).

Alfi et al.’s. research stated that the problem of Anemia in young women occurs due to some factors:

  1. Lack of knowledge about nutrition
  2. Low intake of iron tablets (Fe)
  3. Consume too many plant foods which contain low iron.

In addition, many young women still have irregular eating habits, not eating breakfast, consuming unhealthy food, an uncontrolled diet that impacts nutritional status, unbalanced nutrition, and Anemia  (Alfi et al., 2021).

Mothers should provide balance iron foods and supervise their teenage daughters’ diet. There are two sources of iron food, animal and plants. From animal sources, e.g., beef, chicken, and fish, and vegetable sources (plants) like dark green vegetables, e.g., spinach and beans, e.g., tempeh, tofu, red beans) (Kementerian Kesehatan RI, 2018). In addition, to avoid Anemia for teenage girls, mothers need to remind adolescents to consume blood-added tablets (TTD) obtained at school or health centers. If there is none, Mom should provide her daughter with blood-added tablets (TTD) at home that can be gotten from the pharmacy (must pay attention to its composition of 60 mg of elemental iron and 400 mcg of folic acid). Adolescents should consume TTD regularly, one tablet per week, 52 tablets for a year.

Parents play an essential role in encouraging teenage girls to consume TTD regularly. In educating them, parents must explain why teenagers have to consume TTD. For example, avoiding (1) infectious diseases and (2) decreased fitness and dexterity of thinking due to lack of oxygen to muscle cells and brains and decreased learning achievement. Teenagers’ better understanding of iron consumption is essential because they will become pregnant women. Anemia in pregnant women can increase the risk of childbirth, maternal and infant mortality, and infection with diseases. Moreover, in educating the teenage daughter about the importance of consuming TTD, it is also necessary to inform them about ways to consume TTD properly and correctly. Adolescents need to know that the TTD will work effectively in the body if:

  1. Accompanied by a balanced nutritional intake, sufficient protein, and rich in iron
  2. Drinking TTD with plain water (do not drink with tea, coffee, or milk because it inhibits the absorption of iron)
  3. Eating fruits that contain vitamin C to increase the absorption of TTD more effectively (Kementerian Kesehatan RI, 2020).

At puberty, adolescents are at risk of iron nutrition anemia since much iron is lost during menstruation, and it will be aggravated if the young girl lacks iron intake. Iron in young women is needed for their growth and development. If the young girl gets Anemia during adolescence, she will likely experience Anemia during pregnancy. The negative impact of Anemia during pregnancy will affect the growth and development of the fetus in the womb and has the potential to cause complications of pregnancy and childbirth, even the death of mother and child. In addition, it’s stated that young girls who suffer from Anemia when pregnant are at risk of giving birth to Low Birth Weight (BBLR) and Stunting

(Kementerian Kesehatan Republik Indonesia, 2018). Widyaningrum and Dhiyah’s research showed a significant relationship between the history of Anemia during pregnancy and the incidence of stunting in toddlers in Ketandan Dagangan Madiun Village. Pregnant women who suffer from Anemia can increase the risk of stunting by four times compared to mothers who do not suffer from Anemia (Widyaningrum & Dhiyah A. Romadhoni, 2018). Therefore, parents need to control their teenage daughters’ nutrition and health to avoid Anemia, which puts the next generation at risk of stunting.

 

(3) Conducting education about Balanced Nutrition

Conducting education about balanced nutrition can be interpreted as parental support to their teenage daughters to understand their body’s balanced nutrition. In educating their teenage girl using verbal communication, parents can use educational media like books, flyers, or  videos that stimulate their teenage daughters’ cognitive improvement of

In addition, education about balanced nutrition can also be transferred to the teenage daughter by involving them in the process of nutritional interventions. The optimization of the nutritional intervention process requires the interaction of both parties, both parents and their teenage daughter. So it is not one-way only. The parents and their teenage daughter must engage in the process. Therefore, teenage daughters’ involvement is needed to achieve the goal of the nutritional interventions, which is to create a healthy teenage girl who has sufficient nutrition. For this reason, adolescents need to be given an understanding of a balanced nutritional diet through direct practice.

In nutritional intervention, adolescents must be involved in every process and introduced to every action taken in terms of nutritional intervention. Parents can involve them in the cooking process, choosing menus, choosing ingredients, processing food, and serving the food.

Another example, in making eating patterns, parents must be able to explain the aims of the eating pattern to their teenage daughters. Education about balanced nutrition is essential to improve teenage daughters’ attitudes and motivation to meet their own nutritional needs and make a balanced nutritional diet part of their lifestyle.

Education about balanced nutrition is also related to health problems if the body does not meet its nutritional needs. Before heading to the role of parents in nutrition education for their teenage daughters, the important thing that parents need to do is first to educate themselves. Parents need to increase their knowledge about nutrition and health problems that their teenage daughter can suffer. They also need to know the solutions to cure those health problems, for example, Anemia. In dealing with Anemia, parents need to know the cause of Anemia. One of the factors popular in Indonesia is because of iron deficiency. So in the treatment to deal with Anemia, parents must meet the iron needs of their teenage daughters. It is in line with a study that stated that a Lack of parental knowledge could impact the child’s health status. Research by Apriningsih et al. mentioned that the Lack of parental knowledge about Anemia causes most parents to assume that their daughters have no problems with Anemia, which causes parents not to supervise their daughters to take TTD at home (Apriningsih et al., 2019). Therefore, mothers need to educate themselves to know what kind of nutritional education role should be taught to their children.

Besides educating teenagers on overcoming nutritional problems, education about balanced nutrition is also related to what is consumed (food variations) and how to process the food before it is consumed. As a mother-to-be, a young girl must understand how to process food correctly and adequately because they will practice it when they have a family and become a mother. The nutritional knowledge possessed by adolescents will play an essential role in stunting prevention care, especially in the first 1000 days of life; they will practice that in the future.

Several studies have shown that parenting is related to cases of stunting. Rohmawati & Antika, in their research, it is mentioned that parenting has a relationship with the incidence of stunting, where toddler who gets poor parenting are at risk of suffering more significant stunting than well-nurtured children (Rohmawati & Antika, 2021). Correspondingly, Utami et al.’s study concludes that Poor parenting behavior can increase the chance of stunting. In contrast, good parenting can decrease stunting occurrence—parents’ nutritional parenting and stunting in toddlers are significantly related (Utami et al., 2019). One of the supporting factors for stunting in Indonesia is low parenting, which causes the poor nutritional status of children under five years old. Poor parenting in this regard to feeding practice (Achmad et al., 2020). Teenage daughters as mothers-to-be must have a good knowledge of healthy parenting. Research shows that parents’ Lack of knowledge and information often leads to poor feeding practices, including parents’ inability to provide a diverse diet. So, well-informed parents are more likely to engage in positive parenting practices.

In contrast, parents with less knowledge tend to engage in negative parenting behavior. Thus, parents must have good nutritional knowledge to prevent children from stunting (Putri & Rong, 2021). Therefore, as mothers-to-be, teenage girls need to be well-informed about nutrition from their parents.

 

(4) Conducting education about Reproductive Health

According to WHO, Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity in all matters relating to the reproductive system and its functions and processes (Prijatni & Sri Rahayu, 2016). Parents must educate the reproductive health of their teenage daughter, for parents are the first and foremost educators for children. Anwar & Rikha’s research explains that mother and child have a very close relationship in the family. The child’s attachment relationship to the mother lasts until the child reaches adolescence. For teenage daughters, mothers have a more significant role, especially in their readiness to face the first menstruation (menarche).

For this reason, mothers can share knowledge about the natural menstruation process and its hygiene during menstruation and give emotional and psychological support (Anwar & Rikha, 2017). In teenage daughters’ puberty, parents need to explain the pregnancy process to avoid it.

The lack of even the absence of adolescents’ knowledge about reproductive health will be perilous for the future of adolescents because talking about reproductive health knowledge also talks about sexuality knowledge. One study found a relationship between adolescent knowledge and adolescent premarital sexual behavior attitudes. Adolescents who know about reproductive health will be positive in rejecting premarital sexual relations. In contrast, adolescents who lack knowledge will easily fall into the wrong attitude about sex–impacting free sex behavior / premarital sex (Halu & Nur Dafiq, 2021). Premarital sex that leads to premarital sexual exploration will be at risk of diseases related to sexually transmitted infections (IMS) and HIV/AIDS (Prijatni & Sri Rahayu, 2016).

Furthermore, adolescents who have had an early marriage have had premarital sex

(Wijayanti Urip Tri & Putu Y. A. Nurpratama, n.d.). Roswensi &Rodiah’s research stated that many adolescents who have premarital sexual behavior marry at an early age, between 16-19 years, due to having too-free dating styles (Roswendi & Rodiah, 2020).

Premarital sex tends to usher adolescents into early marriage. Whereas early marriage puts them at risk of pregnancy, even children are at risk of stunting because of babies’ low birth weight (BBLR). Siantar et al. stated that many pregnancy cases in adolescents cause BBLR condition. The mother’s age <20 years is a predisposing factor for the birth of a baby with BBLR conditions (Siantar et al., 2021). Rahayu’s research et al. found that BBLR is the most dominant risk factor associated with stunting conditions. Children with BBLR are more likely to be in stunting conditions than those without BBLR (Rahayu et al., 2015).

 

(5) Implementing The Clean and Healthy Living Behaviors (PHBS)

 Healthy teenagers are teenagers who are ready to prevent stunting in the future. Adolescents must implement clean and healthy living behaviors (PHBS) to maintain their health to achieve the expected health. As the primary caregivers, parents need to be the role models for this. Where in parenting practice, parents must show the PHBS to their children. Healthy parenting is one of the parental duties that need to be instilled early. Parents have a responsibility to provide health care to their children so that children are always healthy and free from disease to do their activities properly. For this reason, parents must form a healthy lifestyle such as bathing, shampooing hair, brushing teeth, washing hands before eating, and so on (Hastuti, 2015).

Teenage girls need to make clean and healthy living behaviors a part of their lifestyle so that wherever they are, they will practice this PHBS even when they become mothers to their children. Further, the child will model the mother’s PHBS behavior.

Parents need to educate their teenagers about the PHBS as it is said that a person’s behavior is influenced by their knowledge and attitudes (Republic of Indonesia’s Ministry of Health, 2011). In PHBS education, teenage daughters are taught how to live a clean and healthy life; they also need to be informed of the health consequences if they do not practice PHBS. An example of a health problem is diarrhea. A study showed that factors that cause diarrhea are (1) not using clean water; (2) not using healthy latrines; (3) they do not throw garbage in its place (Irawan, 2013).

 Teenagers who make the PHBS their lifestyle will bring it into their adulthood when they play the role of a mother in parenting. Childcare that prioritizes PHBS will prevent children from stunting. Parents who do not practice PHBS will put their children at risk of stunting. Uliyanti’s research stated that PHBS affects the incidence of stunting indirectly through a history of infectious diseases (Uliyanti et al., 2017). Furthermore, Astari research et al. show that food sanitation practices and environmental sanitation practices affect children’s insecurity to infectious diseases. The food sanitation towards diarrheal diseases and the environmental sanitation toward diarrheal diseases and Acute Respiratory Infections (ISPA) (Astari et al., 2005). Nasikhah and Ani M. research stated that the history of acute diarrhea is a risk factor for stunting. Where toddlers who often have acute diarrhea are at 2.3 times greater risk of growing up to be stunted because, during diarrhea, there is malabsorption of nutrients, dehydration, and loss of nutrients. Next, if the condition is not treated and balanced with adequate food intake, hence severe dehydration, malnutrition, and failure will arise (Nasikhah & Ani Margawati, 2012).

 The character of adolescents who practice PHBS should be formed from an early age. The behavior will then be fostered as they get older within parental supervision. In addition to parental supervision, parents as role models are crucial. Wulandari and Wiwik, in their research, stated that parents should give examples of clean and healthy living behaviors to their children. This example is significant because the children have an easy nature and are interested in following and imitating what they often see. Unfortunately, many parents do not play a role in determining their children’s PHBS. The results of his research showed a relationship between the role of parents and the child’s PHBS. Students whose parents play a minor role are at 4,471 times greater risk of misbehaving in implementing PHBS than students whose parents play an excellent role.

 Furthermore, they said that parents play a crucial role in the children’s PHBS because the parents are the closest people to the children, and the children consistently model their behavior. Therefore, parents must be able to provide real examples in daily life at home by providing an understanding of the benefits and impacts of clean and healthy living behaviors (Wulandari & Wiwik E.Pertiwi, 2018). Because if parents do not teach or care about PHBS, then children will not care about their health and environment (Rexmawati & Apri U.P Santi, 2021) Therefore, the lifestyle of teenage girls who practice the PHBS must be formed by parents in their daily lives, starting from an early age, so PHBS practices can be embedded in parenting practices and can be part of solutions to prevent stunting in the future.

Discussing stunting prevention from an early age by parents is inseparable from discussing parenting patterns with children. According to Hastuti, parenting is a long process in a child’s life. It starts from prenatal to adulthood, where parents generally carry out the parenting because parents are the main actors that can influence the child and have a role as the leading resource for the child’s life. Child care aims to achieve children’s competencies (physical competence, nutrition, child health, intellectual competence, emotions, social, morals, and self-confidence) optimally (Hastuti, 2015). According to UNICEF, parenting is interactions, behaviors, emotions, knowledge, beliefs, attitudes, and practices associated with providing nurturing care, which refers to introducing and supporting children’s development and socialization. Hence, the parent’s role is critical for children’s development, protection, empowerment, adjustment, and lifelong success (UNICEF Indonesia, 2021).

The effective way to implement nutrition and health interventions for young girls to prevent stunting can only be done if parents practice an authoritative parenting style. A number of studies have suggested that authoritative parenting is the most effective and beneficial parenting practiced among families related to adolescent outcomes, in contrast to authoritarian parenting (parents use their power rigidly), permissive parenting (parents fail to exercise their power, allow or fulfill all their children’s wishes), neglectful parenting (parents neglect their responsibilities to their children) (Hastuti, 2015).

Authoritative or democratic parenting is a parenting style that underlies the relationship with the child in a warm relationship and gives affection and love to the children. Parents with this act as rule determinators regarding children’s discipline to make children independent and responsible. In applying the rules, parents will always provide explanations and information to the existing rules, and parents provide opportunities for children to give their comments. If there is a difference between the opinions of parents and children, then parents will give a rational explanation of the matter discussed. So parents uphold discussions with the children and pay attention to the children’s needs, although the parents do not necessarily agree with the children. The authoritative parents try to direct the children rationally.

In addition, parents with this care are also empathetic to the children, flexible and responsive to the children’s needs, and encourage the verbal expression of giving and receiving each other. This parenting style will also give appreciation and rewards for the children’s good behavior and provide punishment for wrong behavior. (So, this parenting style applies a balance between discipline and nurturing behavior). A number of studies have found that adolescents with authoritative care have Positive Outcomes, such as the lowest level of depression, the highest level of school (the higher academic achievement of children), and higher well-being (such as higher self-esteem and life satisfaction (Hastuti, 2015; Hoskins, 2014; Mensah & Kuranchie, 2013; Susanto & Ari Andriyanti, 2019).

The authoritative parenting style is the most appropriate and effective way to boost positive outcomes regarding nutritional and health interventions to prevent early stunting in teenage daughters. It is in line with studies that stated that authoritative parenting was associated with a healthy BMI (Shloim et al., 2015) and healthier dietary intakes (Burnett et al., 2020). Research by Afifah et al. stated that children taken care of by authoritative parents have good nutrition. It is because parents always pay attention to the needs of the children, take time to pour out affection to the children, invite/involve children and guide children in worship, and maintain the child’s hygiene and food (Afifah & Galia W. Alvita, 2019).

Parents with authoritative parenting are parents who build communication with their children. One study found a relationship between parental parenting and adolescent risky sexual behavior. Adolescents who receive authoritative parenting from their parents tend not to have risky sexual behaviors (Ungsianik & Tri Yuliati, 2017). Therefore, parents need to continue fostering communication relationships to educate adolescents about various topics around reproductive health, including risks and premarital sexual behaviors, to prevent adolescents from falling into negative behavior.

Getting the outcomes for young women who can prevent stunting in the future requires a long process, which must be started early. What is meant by this process is a solid emotional bond (attachment) between parent and child, which is built from an early age. This emotional bond will be a strong base for applying nutritional and health interventions to the teenage daughter. Theoretically, emotional bonding or attachment is an initial process of bonding. Bonding is a connection (one-way relationship) between a mother and her child that can be formed before or after birth. So Bonding with children makes parents have an emotional attachment to their children (Hastuti, 2015). If the parents and children already have an attachment, the children will easily cooperate with the parents.

The implementation of adolescent nutrition and health interventions will be effectively implemented by practicing the authoritative parenting style. Parents have to form and maintain their emotional relationship with their children ( attachment capabilities) (Hastuti, 2015). It is necessary to nurture the teenage daughters, be intimate with them, and make them feel comfortable to always make their parents the primary resource in their life. Hence, they will engage and cooperate with their parents’ interventions.

According to Kuczynski, A strong Attachment can only be built when parents adopt an authoritative parenting style. Parents must create an association with their children by responding to their needs, like comfort, attention, and communication. Besides,  parents can become friends with the children while playing, talking, and spending time together. This kind of relationship has to be practiced from childhood. So when they get older, it will be easier for them to talk and share close feelings with their parents and create various things together, which will make children want to cooperate and obey their parents (Hastuti, 2015).

Thus,  it can be seen that attachment is an essential basis for applying the authoritative parenting style in conducting nutritional and health interventions for teenage girls. This basis is needed so that teenage girls can work together with their parents and accept and respond to nutritional and health interventions carried out by their parents to meet their nutritional needs and achieve optimal self-health to prevent stunting.

In addition, another approach in the authoritative parenting style used in discussing nutritional and health interventions for teenage girls is the nurturing parental behavior. Hoskins states three parenting behaviors related to adolescence outcomes: (1) Parental Warmth and Support. Parental warmth is how teenagers are loved and accepted by parents that goods cannot measure, like how often moms and dads spend time listening carefully to their child’s point of view and helping them with the essential things they have. Several studies have shown that children who get the warmth of their parents will make children behave positively, as associated with reduced alcohol use and substance use significantly.Meanwhile, parental support is about the presence of parents who have a close relationship, care and accept their teenagers. Some studies have exposed parental support with low juvenile delinquency, aggression, depressive symptoms, and irritability. Thus, parental support plays an essential role in adolescent well-being because it serves as a protective factor for adolescents; (2) Inductive Reasoning. Inductive reasoning is where the parent clarifies his expectations to the children, identifies the problem and possible consequences, and provides explanations and gives reasons by involving the children to convey his ideas. Furthermore, this parenting is an integral part of parenting practice because it provides essential knowledge education to children and must ensure children’s ability to evaluate situations they may experience in their lives. This approach makes adolescents more likely to internalize and apply the rules (along with reasons) taught by their parents in situations and environments outside the home. It is a process for teenagers to learn from the rules made by their parents and understand why they were made. Research shows that parents who do not apply this approach make adolescents have a sense of uncertainty and frustration, which can lead to the causes of depressive symptoms in adolescents;

(3) Parent-Child Communication. This approach relates to how often, in the past year, adolescents have communicated with their parents on various topics such as drugs, alcohol, sex, birth control, personal problems of adolescents, and others. Parents who have high-quality communication with their children tend to produce positive adolescent outcomes. Therefore, it is crucial to building an environment that can stimulate communication between parents and adolescents because it can act as a protective factor against adolescent behavior problems (Hoskins, 2014).

The Nutrition and Health Intervention in teenage daughters express parents’ warmth and supportive responses. Warm and supportive in providing nutritional intake and monitoring and educating their teenage daughter. In educating, parents apply the principle of inductive reasoning that clarifies their expectations of children, specifically in stunting prevention. Parents involve children in identifying adolescent problems and possible consequences that result in stunting in the future. Parents explain how children can meet their optimal nutritional needs and maintain their health by engaging the teenage daughter to deliver their responses. As previously explained, such as in teenage daughter’s nutritional and health education, reproductive health education, and PHBS education.

Parents and children need to consistently build communication so the progress of interventions can be bear day by day. Parents need to be sensitive to see the needs and conditions of nutrition, health, and development. For example, before and when young girls’ menarche, parents must be sensitive in seeing their daughter’s development by consistently communicating and educating their teenage daughter. If communication is continually built, then the attachment between parents and children, as previously described, will be more robust so that nutritional and health interventions for teenage daughters produce outcomes as expected to prevent early stunting.

The positive outcomes expected from the authoritative parenting approach through nutrition and health interventions by parents (current agents of change) to their teenage daughter  (future agents of change) for stunting prevention are (1) healthy teenage girls. If her nutritional needs are adequately met (not suffering any health problems),  she will be physically ready to be a healthy mother for her child in the future. Thus, it leads to a solid potential possibility for her to prevent early stunting; (2) the parenting experience that teenage daughters receive from their parents who practice authoritative parenting styles will affect their parenting style to prevent early stunting. As stated, the influence of parenting practice can extend across a generation (UNICEF, 2021). So it is assumed that young girls (future mothers) will also apply these authoritative parenting styles to their children in the future, Figure 1. parents’ crucial role in preventing early stunting in teenage girl .

(4) Conclusion

Parents play an essential role in shaping teenage girls’ readiness to prevent stunting in the future. Teenage girls’ readiness relates to their physical readiness and the knowledge and parenting experiences experienced with their parents. This readiness can be achieved through nutritional and health interventions from parents toward teenage daughters. The interventions are (1) providing a balanced nutritious diet, (2) monitoring teenage girls’ nutrition and health (prevent anemia); (3) Conducting education about Balanced Nutrition ; (4) Conducting education about Reproductive Health ; (5) Implementing the Clean and Healthy Living Behaviors (PHBS). The outcomes of Nutritional and health interventions for their teenage daughters are assumed to be achieved if parents apply the authoritative parenting style with an attachment and nurturing parenting behavior approaches. With this parenting style, adolescents will be involved, obedient, and cooperate with their parents’ nutritional and health interventions.

The teenage girl’s outcomes to prevent early stunting are (1) healthy teenage girls that will become healthy mothers for their children. (2) The parenting experience of authoritative parents will affect teenage girls parenting style. It is assumed that she will apply it to her children. It is in line that parents’ experience in the past has a very close relationship with parenting or parental attitudes to their children (Sutanto, 2019).

Thus, the study concludes that parents need to intervene in the nutrition and health of their teenage daughters, which is effectively implemented when parents adopt the authoritative parenting style, so the teenage daughter can produce positive outcomes to prevent stunting in the future.

 

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