Maternal mortality Children’s health and nutrition out comes

101 the RISKESDAS 2010 data show that exclusive breastfeeding was more commonly practiced in rural areas than in urban ones, and fewer babies were exclusively breastfed in richer households than in the poorer ones see Figure 3.15. More women working outside the home and longer women’s working hours contributed to the lower prevalence of breastfeeding among the urban and richer households. As also shown in Figure 3.15, boys were more likely to be breastfed than girls. In North Jakarta, many infants aged 0–6 months were not exclusively breastfed and many babies aged over four months received solid foods due to tradition. Mothers believe that giving solid foods, such as bananas, to their children will make them less fussy and less likely to cry. In addition to giving solid food, formula milk was commonly given to complement breast milk. Work demands on mothers were also a reason for not breastfeeding. In fact, posyandu personnel advised mothers to exclusively breastfeed their children and explained how important breast milk is for child development. A low level of exclusive breastfeeding was also found in East Sumba. Vitamin A consumption among children aged 6–59 months is important because it prevents blindness, Vitamin A deficiency, other nutritional problems, and death. In the MoH Strategic Plan 2010–2014 the government set a target for 85 per cent of children aged 6–59 months to be taking Vitamin A capsules by 2014. Data from RISKESDAS 2007 indicated that 71.5 per cent of children aged 6–59 months received Vitamin A capsules, and this figure decreased in 2010 to 69.8 Table 3.18: Coverage of nutrition intervention by urbanrural location and household expenditure, 2007 and 2010 Indonesia Urban Rural Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5 Households having sufficient iodized salt consumption, 2007 62.3 70.4 56.3 56.7 59.3 61.8 64.1 70.0 Children aged 6–59 months received Vitamin A, 2010 69.8 74.0 65.3 63.8 69.4 73.1 72.3 73.3 Mothers received iron tablet distribution, 2010 18.0 20.3 15.6 12.8 16.2 18.7 21.0 25.1 Children aged 6–23 months with 3 IYCF practices, 2007 41.2 44.7 38.7 36.5 40.7 42.1 42.5 44.4 Source:฀RISKESDAS฀2007฀and฀2010;฀IDHS฀2007 Note:฀IYCF,฀infant฀and฀young฀child฀feeding per cent Figure 3.12. Children who live in urban areas and come from rich households consume more Vitamin A than those who live in rural areas and come from poor households. Between the two case study areas there were obvious differences in terms of nutrition, with cases of malnutrition being more common in East Sumba than in North Jakarta. Causes of malnutrition in both regions differed, but the basic cause was poverty – the prevalence rates of all nutritional problems were higher in poor families. In North Jakarta, household economic difficulties forced mothers to work. As a result, exclusive breastfeeding was not possible for babies and older children had to buy food outside the home, making them susceptible to illness since the purchased foods generally did not meet standards of good nutrition and hygiene. Usually such food consisted of tofu, tempe,฀perkedel, vegetables, salty fish, soy sauce and crackers. Insufficient food, since these children generally only eat once or twice a day, also contributes to child malnutrition. In East Sumba poverty also affected the food consumption patterns of children. The limited economic resources of families made it difficult to provide nutritious food. Children usually ate twice or three times a day but they rarely ate healthy food. A typical child’s breakfast consisted of rice mixed with salt commonly called plain rice, raw chili, and sometimes sweet tea or coffee, and lunch was rice and vegetables. 102 Figure 3.12: Coverage of micronutrient intervention, by province West Nusa Tenggara East Nusa Tenggara West Sulawesi Southeast Sulawesi Maluku East Java Bali Banten Aceh West Java Central Java South Sulawesi Central Sulawesi INDONESIA Jakarta Bengkulu South Kalimantan Lampung Yogyakarta Riau North Maluku East Kalimantan West Kalimantan Papua Central Kalimantan Riau Islands North Sulawesi North Sumatra Gorontalo West Sumatra West Papua South Sumatra Jambi Bangka Belitung Islands Households having sufficient iodized salt consumption 2007 0 50 100 150 200 250 Receive vitamin A 2010 Iron tablet distribution 2010 27.9 31.0 34.2 43.5 45.1 45.1 45.1 46.4 47.3 58.3 58.6 61.0 62.3 62.3 68.7 69.7 76.2 76.8 82.7 82.8 83.0 83.8 84.4 86.2 88.7 89.1 89.2 89.9 90.1 90.3 90.9 93.0 94.0 98.7 70.7 62.3 53.5 61.3 50.4 78.7 58.5 69.3 66.2 75.7 78.6 69.9 53.5 69.8 72.9 65.4 70.1 65.5 91.1 58.9 49.6 72.7 50.9 55.0 59.7 67.3 74.3 53.7 68.9 71.6 49.3 55.7 63.7 81.4 17.9 15.1 2.3 5.4 3.2 25.8 31.1 19.8 12.3 15.2 20.4 5.3 3.1 18.0 19.4 9.8 21.2 21.9 67.5 19.3 35.0 30.1 5.5 18.1 13.5 35.6 13.2 7.5 2.7 24.6 18.7 11.0 19.1 16.9 Source:฀RISKESDAS฀2007฀and฀2010;฀IDHS฀2007 Notes:฀-฀Iodized฀salt฀consumption:฀Numbers฀of฀households฀consuming฀iodized฀salt ฀ -฀Vitamin฀A:฀Children฀aged฀6–59฀months฀receiving฀vitamin฀A฀for฀the฀last฀6฀months ฀ -฀Iron฀tablets:฀Pregnant฀women฀receiving฀iron฀tablet฀distribution Sometimes lunch and dinner was just rice mixed with salt. To save money, sometimes rice was mixed with or replaced by corn. If they could not afford rice or the corn supplies had run out they called this ‘the hungry season’, they sought an alternative food from the surrounding forest called iwi – a kind of sweet tuber that needs to be prepared carefully to remove its poison by immersing it in a river for several days. Besides poverty, the culture in East Sumba also shapes the food consumption patterns. Most households own livestock such as pigs and chickens, but they rarely use these livestock for their own consumption. Rather, when there were ceremonies in the community, such as a funeral, they would offer their pigs to the bereaved family. The government has already established policies for improving nutrition, including both prevention and treatment approaches. Government activities in this area range from; monitoring children’s nutritional status and providing supplementary feeding, to treating cases of malnutrition, 103 Riau Islands Bali Gorontalo Jakarta Papua Banten Lampung Central Java Aceh Central Kalimantan North Sumatra West Papua Bangka Belitung Islands North Sulawesi West Kalimantan West Java INDONESIA North Maluku East Java Jambi South Kalimantan Riau Southeast Sulawesi Central Sulawesi West Nusa Tenggara East Kalimantan West Sumatra East Nusa Tenggara South Sumatra Yogyakarta Maluku Bengkulu South Sulawesi West Sulawesi 0.0 20.0 40.0 60.0 80.0 100.0 120.0 31.5 59.7 36.6 40.9 30.1 24.7 33.9 45.6 33.8 41.5 35.4 34.0 23.4 43.3 41.8 45.9 41.2 25.1 42.7 43.1 37.7 31.7 36.9 53.2 39.0 41.8 34.3 42.1 38.9 54.7 42.0 42.8 44.2 40.7 Exclusively Breastfeeding 2007 Complementary feeding 2007 13.0 13.3 15.1 16.4 22.7 24.4 24.4 24.7 24.8 25.6 25.8 26.1 28.1 28.8 31.5 32.2 32.4 33.1 33.3 34.5 34.8 35.2 38.9 43.5 43.7 43.8 44.0 44.9 47.0 49.3 54.9 55.2 59.8 62.5 Source:฀IDHS฀2007 Notes:฀Complementary฀feeding:฀Percentage฀of฀children฀aged฀6–23฀months฀with฀3฀IYCF฀practices฀ Figure 3.13: Coverage of macronutrient intervention, by province, 2007 providing counselling on feeding practices, and providing micronutrient supplements to children and pregnant women. Unfortunately the government has often focused on underweight children weight-for-age and has given inadequate attention to the problems of stunting height-for-age and wasting weight-for-height, as was evident from the nutritional targets set by the government. Furthermore, the prevalence of cases of overweight children is increasing, not only in rich households but also in the poor ones. Yet the government so far has only issued policies aimed at preventing an increase in the prevalence of overweight children, and has no policies aimed at reducing the prevalence of overweight children. A number of government nutrition improvement activities are already easily accessible in communities, since they are channelled through the posyandu and puskesmas system. However, these programmes and activities are not specifically intended for poor households but are aimed at the general community. The increasing prevalence of malnutrition occurring in poor households from 2007–2010 is evidence that the government’s nutrition interventions have been ineffective for poor households.