Attending to Mother and Child Nutrition

KOMPAS/SONYA HELLEN SINOMBOR

Several mothers in RW 001, Kalibaru Sub-District, Cilincing District, North Jakarta, Wednesday (22/2/2017) queued milk for their children which were distributed directly by Foodbank of Indonesia (FOI) volunteers and health cadres at the local RW.

The statistical data on COVID-19 victims around the globe shows that more men have died from the disease than women. In fact, according to The New York Times (07/4/2020), the number of COVID-19 deaths among men is twice that among women in New York City.Experts have been unable to provide a clear reason for this discrepancy. Prof. Philip Guilder, an immunologist at Oxford University, explained that women’s immune systems were twice as strong as men’s in terms of genetics. This is also due to behavioral factors: men smoke more than women. Smokers generally develop heart and lung problems, so they are more susceptible to COVID-19 infection. However, Guilder cannot ascertain whether the two factors apply independently or concurrently.

In the first place, the impact of the pandemic on poverty threatens the health of families and people everywhere by reducing their nutritional intake from food.

The data does not guarantee that women will be healthier and free of the risks of COVID-19 and other health problems. In the first place, the impact of the pandemic on poverty threatens the health of families and people everywhere by reducing their nutritional intake from food. The World Bank has reminded the G-20 at a recent meeting in Saudi Arabia that the pandemic was a threat to the food security of poor countries. The Indonesian Agriculture Minister, who also attended the meeting, said that the pandemic could potentially disrupt Indonesia\'s food system.

Also read: Fear of Impoverishment amid COVID-19

Hidden hunger

The food system disruptions that affect the people are at the end or the downstream industry, namely food scarcity, rising prices and increased demand, especially daily staples. For the poor, the basic foods come pre-packaged like rice, eggs, (sometimes chicken or canned fish), sugar, cooking oil, salt, and biscuits. For poor households, a price increase in staple foods means that a family must adjust its eating pattern.

KOMPAS/FRANSISKUS PATI HERIN

A child eats white rice in a former East Timor refugee housing complex in Oebelo, Kupang Regency, East Nusa Tenggara on Friday (14/2/2020). Living below the poverty line causes children\'s nutrition to not be fulfilled.

Before the pandemic, they may still have a wide variety of foods to choose from, according to the guidelines for balanced nutrition. During the pandemic, their nutritional intake has declined because eggs, fish, vegetables and fruit may disappear from the menu due to the decline in purchasing power. Their diet changes to prioritize foods that are filling yet still tasty and affordable, typically rice with side dishes of noodles, tempeh, or salted fish, fish crackers, and sambal (chili paste), with fried cassava, fried sweet potatoes, and other fried foods, accompanied with coffee, sweet tea, or other sweet drinks purchased from a nearby warung (food stall).

Their originally diverse diet changes to focus more on getting their calories from carbohydrates (rice, flour, sugar) and fat (cooking oil). This diet is universally common among poor families, not only in Indonesia.

Derek Headey and Marie Ruel, who authored "The COVID 19 Nutrition Crisis: What to expect and how to protect" on the IFPRI Blog (23/4), refers to the food sources of calories among the poor as “cheap calories” because they come from relatively cheap carbohydrates and fats, but contain little to no proteins, vitamins or minerals. Prof. Marion Nestle of Cornell University calls it “empty calories” in Why Calories Count: From Science to Politics (2012).

Also read: Strengthening Family Resilience

Some international media are concerned that the pandemic could cause famine, especially in Africa. The NYT published the frightening article (22/4) , "’Instead of Coronavirus, the Hunger Will Kill Us.’ A Global Food Crisis Looms." Several nutritional studies on the impacts of the 1998 economic crisis in Indonesia found no hunger. If there was any hunger, it occurred in remote areas in eastern Indonesia as the result of a long dry season that coincided with the economic crisis. However, the studies found increased rates of malnutrition among pregnant women and toddlers in conjunction with increased poverty.

"Macro shocks and micro outcomes: Child nutrition during Indonesia’s crisis” by Peter Timmer et al, a joint report from the National Development Planning Agency (Bappenas) and USAid, mentions what they call "micronutrients crisis": a lack of vitamins and minerals that develops into anemia (lack of iron), as well as lack of vitamin A and other micronutrients as reported by other studies.

The mass media reported in April 2020 that a woman had died of starvation in Serang, Banten. Speculation arose that the pandemic would cause famine. It was later reported that the cause of the woman’s death was not starvation.

According to my experience as a public nutrition student practicing at the "center” of hunger (hunger edema) in Gunung Kidul and West Lombok in the 1950s-1960s, death due to famine or drought and poverty did not occur individually, but concurrently among several people, mostly older people.

In my opinion, there will be no hunger, but there will be an increase in hidden hunger from empty calories affecting mothers and children, especially from a lack of iodine (I), iron (Fe), zinc (Zn), folic acid, and vitamins A, B1, and B2.

With the government’s massive social assistance in the nine basic necessities and others as well as community initiatives for the poor or newly poor people and families, I do not believe that the pandemic will cause hunger in Indonesia, provided that the assistance reaches the targeted recipients and in a timely manner. Nobody is overlooked, or in the language of the sustainable development goals (SDGs), "no one left behind". In my opinion, there will be no hunger, but there will be an increase in hidden hunger from empty calories affecting mothers and children, especially from a lack of iodine (I), iron (Fe), zinc (Zn), folic acid, and vitamins A, B1, and B2. These are the vitamins and minerals that the World

Health Organization (WHO) has declared as a public health problem in poor and developing countries, including Indonesia.

If the problem occurs in pregnant women and infants below the age of 2, known as the “golden” first 1,000 days of life (1,000 HPK), it can have a long-term effect in children as developmental disorders and they can become stunted, which has been a concern in poor and developing countries since 2013.

Because of the above problems, we should be aware of the health and nutrition of mothers and children in the fight against COVID-19. In addition to frequent hand washing with soap and running water, maintaining physical distance, and so on, there is a need to meet the recommendation on balanced nutritional intake. Try to add at least some eggs, vegetables, and fruits to basic foods. It will be better if some staple foods are fortified so that the food source does not contain empty calories.

Fortified foods

Aya Hirata Kimura discusses the role of fortified foods to solve hidden hunger in Hidden Hunger: Gender and the Politics of Smarter Foods (Cornell University Press, 2018). The book uses “smarter foods” to refer to fortified foods. The 225-page book explores the emergence of “hidden hunger” as a term and the role of fortified food in several Asian countries in 2004, including Indonesia.

KOMPAS/P RADITYA MAHENDRA YASA

Officers weigh toddlers when Posyandu activities are routinely held in Dukusari Village, Ngampel District, Kendal Regency, Central Java, Thursday (20/6/2019). These activities play an important role in providing services and information on maternal and child health, family planning, and nutrition.

Kimura follows the history of Bogasari’s fortified flour, the role of the Fortification Coalition in Indonesia, the role of the government, private sector, and others. She noted the role of fortified foods during the 1998 Indonesian economic crisis. Besides the term “hidden hunger”, “lost generation” also emerged as a common term during the period due to an increase in malnourished children. The book includes a list of international organizations that helped provide food for children, including instant noodles, rice porridge, biscuits, and fortified soy milk. There were no food supplies at the time, so international organizations intervened.Food fortification in Indonesia was officially recognized with the issuance of Law No. 7/1996 on Food, which included an article on fortified foods. Thereafter, food fortification developed such as iodized salt (1994), wheat flour fortified with five vitamins and minerals (2001), palm cooking oil with vitamin A (2010), and more recently, rice fortified with five vitamins and minerals that the Agriculture Ministry and the State Logistics Agency (Bulog) developed in 2019.

This weapon can potentially be developed in Indonesia.

Several international organizations in Asia have voiced the importance of fortifying staple foods as a critical “weapon” against COVID-19. This weapon can potentially be developed in Indonesia. The four staple foods of rice, flour, cooking oil, and salt have been fortified. To ensure that staple foods do not contain empty calories, food fortification should be developed. Since fortification does not alter the taste and color of food, it should not lead to increased prices. In terms of funding, investment in food fortification is the most cost effective, according to World Bank economists.

Kompas

Prof Soekirman

Soekirman, Professor Emeritus, IPB University; guest professor, Faculty of Medicine, the Christian University of Indonesia (UKI), Jakarta