Contextual Determinants of Stunting in Indonesia: A Systematic Review of Nutritional Interventions and Antenatal Care
DOI:
https://doi.org/10.6000/1929-4247.2025.14.03.1Keywords:
Stunting, Nutritional interventions, Antenatal care, Contextual factors, IndonesiaAbstract
Background: Stunting is a significant global health issue, especially in Indonesia, where long-term malnutrition adversely affects children's growth and development, with prevalence rates still exceeding the WHO's recommended threshold. This study examines the contextual factors that influence the effectiveness of nutritional interventions and antenatal care (ANC) in combating stunting in Indonesia.
Methods: A systematic review was conducted by the PRISMA guidelines. A comprehensive search across five major academic databases (Google Scholar, PubMed, ScienceDirect, Embase, and ProQuest) identified 3,690 articles. After a rigorous screening process, 13 studies published between 2019 and 2023 were included in the analysis, focusing on key contextual factors that impact stunting interventions in Indonesia. The quality appraisal utilized Joanna Briggs Institute checklists for analytical cross-sectional studies, cohort studies, quasi-experimental studies, qualitative research, systematic reviews, case reports, and text and opinion papers, each matched to the respective study design.
Findings: The review identified four critical contextual factors shaping stunting interventions: (1) socioeconomic status, particularly household income and education, which significantly influence access to healthcare and nutrition; (2) cultural beliefs, including food taboos and misconceptions, which hinder optimal nutritional practices; (3) geographical disparities, with rural populations experiencing higher stunting rates due to limited access to healthcare and resources; and (4) government policies, highlighting the importance of strong political commitment, multisectoral collaboration, and localized programs.
Conclusion: Nutritional interventions and ANC are more effective in reducing stunting among Indonesian children when tailored to local socioeconomic, cultural, and geographical contexts. These findings highlight the need for targeted, context-specific strategies to improve child growth outcomes in vulnerable populations.
References
World Health Organization. Global nutrition targets 2025: stunting policy brief [Internet] 2014 [cited 2024 Oct 21]. Available from: https://www.who.int/publications/i/item/WHO-NMH-NHD-14.3
World Health Organization. Levels and trends in child malnutrition: UNICEF/WHO/The World Bank Group joint child malnutrition estimates: key findings of the 2021 edition [Internet] 2021 [cited 2024 Oct 21]. Available from: https://www.who.int/publications/i/item/9789240025257
Mulyaningsih T, Mohanty I, Widyaningsih V, Gebremedhin TA, Miranti R, Wiyono VH. Beyond personal factors: multilevel determinants of childhood stunting in Indonesia. PLoS One [Internet] 2021 Nov 1 [cited 2025 May 28]; 16(11): e0260265. Available from: https://journals.plos.org/plosone/ article?id=10.1371/journal.pone.0260265 DOI: https://doi.org/10.1371/journal.pone.0260265
Cabinet Secretariat of the Republic of Indonesia. Address of the president on the state budget for fiscal year 2025 [Internet] 2024 [cited 2024 Nov 28]. Available from: https://setkab.go.id/en/address-of-the-president-of-the-republic-of-indonesia-on-the-presentation-of-the-government-statement-on-the-bill-on-the-state-budget-for-the-2025-fiscal-year-and-its-financial-note-before-the-plenary/
UNICEF, WHO, World Bank 2018 Joint Child Malnutrition Estimates (JME) [Internet] 2018 [cited 2024 Sep 11]. Available from: https://data.unicef.org/resources/levels-and-trends-in-child-malnutrition-2018/
Ministry of National Development Planning Republic of Indonesia. National Medium Term Development Plan 2015-2019 [Internet] 2015 [cited 2024 Sep 28]. Available from: https://lpr.adb.org/resource/national-medium-term-development-plan-2015-2019-indonesia
Ministry of National Development Planning Republic of Indonesia. Indonesia Medium Development Goals 2020-2024 [Internet] 2020 [cited 2025 May 28]. Available from: https://peraturan.bpk.go.id/Details/131386/perpres-no-18-tahun-2020
Islam MS, Zafar Ullah AN, Mainali S, Imam MA, Hasan MI. Determinants of stunting during the first 1,000 days of life in Bangladesh: a review. Food Sci Nutr [Internet] 2020 Sep 1 [cited 2025 May 28]; 8(9): 4685-95. DOI: https://doi.org/10.1002/fsn3.1795
Pandey P, Bajpai P, Jain S, Sharma A. Maternal empowerment holds the key to reducing stunting during first 1000 days of life: evidence from a case-controlled study. Ann Trop Med Public Health 2017; 10(3).
Permatasari TAE, Rizqiya F, Kusumaningati W, Suryaalamsah II, Hermiwahyoeni Z. Effect of nutrition and reproductive health education for pregnant women in Indonesia: a quasi-experimental study. BMC Pregnancy Childbirth [Internet] 2021 Dec 1 [cited 2025 May 28]; 21(1): 1-15. Available from: https://bmcpregnancychildbirth. biomedcentral.com/articles/10.1186/s12884-021-03676-x DOI: https://doi.org/10.1186/s12884-021-03676-x
Oh C, Keats EC, Bhutta ZA. Vitamin and mineral supplementation during pregnancy on maternal, birth, child health and development outcomes in low- and middle-income countries: a systematic review and meta-analysis. Nutrients [Internet] 2020 Feb 14 [cited 2025 May 28]; 12(2): 491. DOI: https://doi.org/10.3390/nu12020491
Saleh A, Syahrul S, Hadju V, Andriani I, Restika I. Role of maternal factors in preventing stunting: a systematic review. Gac Sanit [Internet] 2021 Jan 1 [cited 2025 May 28]; 35: S576-82. DOI: https://doi.org/10.1016/j.gaceta.2021.10.087
Mehta K, Mukherjee SG, Bhattacharjee I, Fate K, Kachwaha S, Kant A, et al. Systems strengthening during antenatal care improves maternal nutrition and reduces childhood stunting in West Bengal, India. medRxiv [Internet] 2022 Oct 17 [cited 2025 May 28]; 2022.10.14.22281107.
Upadhyay AK, Srivastava S. Effect of pregnancy intention, postnatal depressive symptoms and social support on early childhood stunting in India. BMC Pregnancy Childbirth 2016; 16(1). DOI: https://doi.org/10.1186/s12884-016-0909-9
Mehta K, Mukherjee SG, Bhattacharjee I, Fate K, Kachwaha S, Kant A, et al. Systems strengthening approach during antenatal care improves maternal nutrition and reduces childhood stunting in West Bengal, India. medRxiv [Internet] 2022 Oct 17 [cited 2025 May 28]; 2022.10.14.22281107. DOI: https://doi.org/10.1101/2022.10.14.22281107
Ernawati F, Syauqy A, Arifin AY, Soekatri MYE, Sandjaja S. Micronutrient deficiencies and stunting were associated with socioeconomic status in Indonesian children aged 6-59 months. Nutrients [Internet] 2021 May 26 [cited 2025 May 28]; 13(6): 1802. DOI: https://doi.org/10.3390/nu13061802
Nuzuliana R, Wijhati ER. Social economic status and stunting in toddler 2021 Jan 27 [cited 2025 May 28]; 222-4. DOI: https://doi.org/10.2991/ahsr.k.210127.050
Yuningsih Y, Sari AI, Handayani Y. Hubungan status sosial ekonomi dengan kejadian stunting pada balita usia 12-60 bulan di Puskesmas Kaliwates. ARTERI J Ilmu Kesehatan [Internet] 2023 Aug 11 [cited 2025 May 28]; 4(4): 215-21. DOI: https://doi.org/10.37148/arteri.v4i4.288
Alfianti KZ, Yunitasari E, Armini NKA. Cultural perspectives of stunting prevention: a systematic review. Pediomaternal Nurs J [Internet] 2023 Mar 16 [cited 2025 May 28]; 9(1): 36-41. DOI: https://doi.org/10.20473/pmnj.v9i1.37242
Musasizi B, Kiracho EE, Kamukama S, Babughirana G. Assessment of public health units’ capacity to manage under-five malnutrition: a case study of Kamuli District, Uganda. Int J Stud Nurs [Internet] 2018 Jul 30 [cited 2025 May 29]; 3(3): 100. DOI: https://doi.org/10.20849/ijsn.v3i3.511
Sawadogo-Lewis T, King SE, Aung T, Roberton T. The potential contribution of the health system to reducing stunting in SUN countries. Food Nutr Bull [Internet] 2021 Jun 1 [cited 2025 May 28]; 42(2): 159-69. DOI: https://doi.org/10.1177/0379572121998127
Huicho L, Vidal-Cárdenas E, Akseer N, Brar S, Conway K, Islam M, et al. Drivers of stunting reduction in Peru: a country case study. Am J Clin Nutr [Internet] 2020 Sep 1 [cited 2025 May 28]; 112: 816S-829S. DOI: https://doi.org/10.1093/ajcn/nqaa164
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg [Internet] 2010 Jan 1 [cited 2025 May 28]; 8(5): 336-41. DOI: https://doi.org/10.1016/j.ijsu.2010.02.007
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics [Internet]. 1977 [cited 2025 May 28]; 33(1): 159-74. DOI: https://doi.org/10.2307/2529310
Titaley CR, Ariawan I, Hapsari D, Muasyaroh A, Dibley MJ. Determinants of the stunting of children under two years old in Indonesia: a multilevel analysis of the 2013 Indonesia Basic Health Survey. Nutrients [Internet] 2019 May 18 [cited 2025 May 28]; 11(5): 1106. DOI: https://doi.org/10.3390/nu11051106
Rizal MF, van Doorslaer E. Explaining the fall of socioeconomic inequality in childhood stunting in Indonesia. SSM Popul Health [Internet] 2019 Dec 1 [cited 2025 May 29]; 9: 100469. DOI: https://doi.org/10.1016/j.ssmph.2019.100469
Hasanalita. Analisis faktor intervensi prioritas dan faktor intervensi pendukung pada ibu hamil dalam penanganan stunting di Desa Sumpur Jaya Kecamatan Ketambe. J Sehat Mandiri [Internet] 2023 Dec 31 [cited 2025 May 29]; 18(2): 192-203. DOI: https://doi.org/10.33761/jsm.v18i1.1211
Wahyuningsih W, Bukhari A, Juliaty A, Erika KA, Pamungkas RA, Siokal B, et al. Stunting prevention and control program to reduce the prevalence of stunting: systematic review study. Open Access Maced J Med Sci [Internet] 2022 Mar 8 [cited 2025 May 28]; 10(F): 190-200. DOI: https://doi.org/10.3889/oamjms.2022.8562
Zaleha S, Idris H. Implementation of stunting program in Indonesia: a narrative review. Indones J Health Adm [Internet] 2022 Jun 30 [cited 2025 May 28]; 10(1): 143-51. DOI: https://doi.org/10.20473/jaki.v10i1.2022.143-151
Diana R, Rachmayanti RD, Khomsan A, Riyadi H. Influence of eating concept on eating behavior and stunting in Indonesian Madurese ethnic group. J Ethn Foods [Internet] 2022 Dec 1 [cited 2025 May 28]; 9(1): 1-11. DOI: https://doi.org/10.1186/s42779-022-00162-3
Arbie FY, Labatjo R. Examining the nutrition levels and stunting problem in Indonesian children. AcTion Aceh Nutr J [Internet] 2019 Dec 19 [cited 2025 May 28]; 4(2): 89-98. DOI: https://doi.org/10.30867/action.v4i2.126
Apulina Ginting J, Nurlaella Hadi E. Faktor sosial budaya yang mempengaruhi kejadian stunting pada anak: literature review. Media Publikasi Promosi Kesehatan Indones [Internet] 2023 Jan 13 [cited 2025 May 28]; 6(1): 43-50. DOI: https://doi.org/10.56338/mppki.v6i1.2911
Fristiwi P, Nugraheni SA, Kartini A. Effectiveness of stunting prevention programs in Indonesia: a systematic review. J Penelit Pendidikan IPA [Internet] 2023 Dec 20 [cited 2025 May 28]; 9(12): 1262-73.
Wiliyanarti PF, Wulandari Y, Nasrullah D. Behavior in fulfilling nutritional needs for Indonesian children with stunting: rela-ted culture, family support, and mother’s knowledge. J Public Health Res [Internet] 2022 Oct 1 [cited 2025 May 28]; 11(4).
Rahmi FJ, Huljannah N, Rochmah TN. Program pencegahan stunting di Indonesia: a systematic review. Media Gizi Indones [Internet] 2022 Sep 30 [cited 2025 May 28]; 17(3): 281-92. DOI: https://doi.org/10.20473/mgi.v17i3.281-292
Rahmawati NF, Fajar NA, Idris H. Faktor sosial, ekonomi, dan pemanfaatan posyandu dengan kejadian stunting balita keluarga miskin penerima PKH di Palembang. J Gizi Klinik Indones [Internet] 2020 Jul 25 [cited 2025 May 28]; 17(1): 23.
Wiliyanarti PF, Wulandari Y, Nasrullah D. Behavior in fulfilling nutritional needs for Indonesian children with stunting: related culture, family support, and mother’s knowledge. J Public Health Res [Internet] 2022 Oct 1 [cited 2025 May 28]; 11(4). DOI: https://doi.org/10.1177/22799036221139938
Erlyn P, Hidayat B, Fatoni A, Saksono H. Nutritional interventions by local governments as an effort to accelerate stunting reduction. J Bina Praja [Internet] 2021 Dec 30 [cited 2025 May 28]; 13(3): 543-53.
Marmot M, Wilkinson R. Social determinants of health. Social Determinants of Health [Internet] 2005 Oct 13 [cited 2025 May 28]; 1-376. Available from: https://academic.oup.com/ book/9987
Erlyn P, Hidayat B, Fatoni A, Saksono H. Nutritional interventions by local governments as an effort to accelerate stunting reduction. J Bina Praja [Internet] 2021 Dec 30 [cited 2025 May 28]; 13(3): 543-53. DOI: https://doi.org/10.21787/jbp.13.2021.543-553
Helman CG. Culture, health and illness. 5th ed. Taylor and Francis; 2007 [cited 2025 May 28]. 1-630 p. Available from: https://www.taylorfrancis.com/books/mono/10.1201/b13281/culture-health-illness-fifth-edition-cecil-helman DOI: https://doi.org/10.1201/b13281
Field KS, Briggs DJ. Socio-economic and locational determinants of accessibility and utilization of primary health-care. Health Soc Care Community [Internet] 2001 Sep 1 [cited 2025 May 28]; 9(5): 294-308. DOI: https://doi.org/10.1046/j.0966-0410.2001.00303.x
Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet [Internet] 2013 Aug 3 [cited 2025 May 28]; 382(9890): 452-77. DOI: https://doi.org/10.1016/S0140-6736(13)60996-4
Fristiwi P, Nugraheni SA, Kartini A. The effectiveness of stunting prevention programs in Indonesia: a systematic review. J Penelit Pendidikan IPA [Internet] 2023 Dec 20 [cited 2025 May 28]; 9(12): 1262-73. DOI: https://doi.org/10.29303/jppipa.v9i12.5850
Rahmawati NF, Fajar NA, Idris H. Faktor sosial, ekonomi, dan pemanfaatan posyandu dengan kejadian stunting balita keluarga miskin penerima PKH di Palembang. J Gizi Klinik Indones [Internet] 2020 Jul 25 [cited 2025 May 28]; 17(1): 23-33. DOI: https://doi.org/10.22146/ijcn.49696
Downloads
Published
How to Cite
Issue
Section
License
Policy for Journals/Articles with Open Access
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
Policy for Journals / Manuscript with Paid Access
Authors who publish with this journal agree to the following terms:
- Publisher retain copyright .
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .
