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Looking back to look forward: Mother's nutrition and health in Indonesia
Indonesia’s history offers a profound lesson: neglecting maternal health is equivalent to compromising the nation’s future.
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by Ray Wagiu Basrowi, MD, PhD; founder of the Health Collaborative Center (HCC) and medical science director of Danone Indonesia
The health and nutrition of mothers are not merely personal or familial concerns, they are civilizational imperatives. A healthy mother nurtures a healthy child, and a generation of healthy children forms the bedrock of national progress. Conversely, when maternal health falters, the ripple effects are devastating: stunted children, diminished cognitive development and a labor force ill-equipped for the demands of the future.
Indonesia’s history offers a profound lesson: neglecting maternal health is equivalent to compromising the nation’s future. The colonial era showed us the dangers of systemic disregard, with the post-independence period demonstrating the potential of community-driven interventions. Prior to independence, motherhood was deeply intertwined with survival.
Women in agrarian societies such as Indonesia, bore children amid severe nutritional deficiencies, limited medical care and an oppressive colonial system that prioritized extraction over welfare. Malnutrition was rampant, as stated by a historical-based epidemiology study by Boomgaard in the early 1980’s. This study noted that the average caloric intake in Java during the late 19th century hovered around 1,800 calories per day, far below the recommended levels. Maternal mortality rates were staggering, with estimates suggesting as many as 2,500 deaths per 100,000 live births.
Yet, these mothers endured, guided by ancestral wisdom on herbal medicine and communal care. Their sacrifices laid the groundwork for Indonesia’s population growth and its eventual struggle for independence. However, the lack of formal health systems meant that motherhood often came at the cost of life itself, a tragic yet powerful reminder of the role maternal health plays in shaping a nation’s destiny.
After gaining independence in 1945, Indonesia embarked on a tumultuous journey to build a national identity and infrastructure. The 1950s and 1960s saw the introduction of basic healthcare services, yet access remained uneven, particularly in rural areas. The government’s Rencana Pembangunan Lima Tahun (five-year development plans) in the 1970s began addressing these disparities, with initiatives like family planning programs and maternal health campaigns.
The Posyandu system, integrated health posts based in villages, introduced in the 1980s, marked a significant milestone. These community-based centers became lifelines for mothers, providing immunization, nutritional counseling and antenatal care.
Research from the World Bank highlights the impact of these programs, showing a 20 percent reduction in infant and maternal mortality rates between 1980 and 1990. And the existence of the Posyandu is sustainable. A study by the Health Collaborative Center in 2022 showed evidence that the Posyandu is a reliable resource for pregnant women and moms with infants, and hence interconnected with the reduction of infant and maternal mortality rates.
Strengthening maternal nutrition
Today, Indonesia stands at a crossroads. Significant progress has been made in maternal health and nutrition, yet disparities persist. The maternal mortality rate, although reduced to 177 per 100,000 live births as of 2022, remains far from the Sustainable Development Goal (SDG) target of 70.
Malnutrition has evolved from a crisis of undernutrition to a dual burden, with around one-third of mothers overweight or obese while based on Basic Health Research 2018, nearly half of Indonesian mothers now suffer from iron deficiency anemia, contributing to high rates of low-birth-weight infants, which is a precursor to stunted growth.
Policies like the Kartu Indonesia Sehat (Healthy Indonesia Card) and the expansion of universal health care (BPJS) have improved access, but systemic issues, including limited health literacy and inadequate rural healthcare infrastructure, hinder progress. The COVID-19 pandemic exacerbated these challenges, with disruptions to maternal health services contributing to a resurgence of preventable complications.
Therefore, we must heed these lessons and act decisively. To ensure a healthier future for mothers and, by extension, the entire nation, governments and stakeholders must take deliberate, multi-faceted actions.
Strengthening the existing maternal nutrition programs in a strategic approach to address systemic gaps is critical, while leveraging historical lessons and current opportunities. Identified challenges such as high rates of anemia and the dual burden of malnutrition, undernutrition and obesity are a to-do list for the Red and White cabinet under the leadership of Prabowo Subianto.
Expanding fortified food programs and increasing the availability of fortified rice, flour and cooking oil to combat micronutrient deficiencies, are proven to be promising and evidence-based. Government policy to subsidize nutrient-dense foods to make them accessible to low-income families is a tangible step with short- to mid-term potential results. The roles and responsibilities of the National Nutrition Body (BGN) moving forward should be scaled-up to cover universal maternal nutrition intervention and promotion.
Midwives and Posyandu
Looking ahead, Indonesia faces both challenges and opportunities. Urbanization, climate change and shifting dietary patterns threaten maternal and child health. Persistent maternal mortality rates and limited access to skilled birth attendants in rural and remote areas, are an obvious challenge as well.
The Indonesian Midwives Association (IBI) plays a pivotal role in safeguarding maternal health and nutrition across the archipelago. They act as both an advocate and implementer of critical interventions. With over 300,000 members, the IBI is one of the largest professional organizations in Indonesia, uniquely positioned to address maternal health challenges, particularly in underserved rural and remote areas.
The government should strategically partner with the IBI by integrating midwives into national healthcare plans, funding their training and equipping them with modern resources. Engaging them in policymaking ensures maternal health programs are grounded in field expertise, while formal collaborations enhance service delivery, especially in rural areas. Protecting midwives through job security, fair compensation and mental health support, will strengthen their capacity to provide high-quality and sustainable care.
A state-of-the art showcase of integrated midwifery and Posyandu was displayed in the Ruang Tumbuh revitalization project, powered by Yayasan BUMN. Here, they utilized digital platforms to track pregnancies. Through a multifunctional approach, the project deployed to 50 posts in Greater Jakarta, and expanded the space-usage to childcare on top of the regular nutrition and anthropometric services. This can revolutionize maternal health care and is a worthy example to be scaled up nationwide!
Maternal mental health is often overlooked, leading to postpartum depression and stress-related complications. Community empowerment by revitalizing Posyandu with a focus on maternal mental health and nutrition education can bridge gaps in rural areas.
Another excellent example was set in motion by Wanita Indonesia Keren in 2022. In Bekasi, Manado, Yogyakarta and Central Java, they help villages to create a mental health-friendly Posyandu generated by its own cadres and supervised by midwives. They initiated an integrated mental health screening and introduced mandatory mental health assessments during ante- and post-natal visits, stimulating positive conversations and early mental illness diagnosis, in a sustainable way.
As a final reflection, the health of mothers in Indonesia transcends the boundaries of health systems, it reflects the nation’s commitment to equity, dignity and progress. Through the spirit of Asta Cita, government, stakeholders and citizens must collectively foster a holistic ecosystem where maternal health and nutrition are prioritized as civilizational imperatives.
We need to learn from history, weaving lessons from the past into actionable strategies, then Indonesia can transform its challenges into opportunities for a stronger, healthier and more resilient future. By investing in the health and nutrition of mothers, we honor their sacrifices and ensure that their legacy endures. In doing so, we not only uplift mothers but also secure the foundations of a prosperous, equitable and resilient Indonesia.
The health of a mother is the health of a nation, and the journey toward a brighter tomorrow begins with her. Let this be our pledge, not just on Mother’s Day, but every day.
Happy Mother’s Day 2024!
Source: Danone
