Lifting the barriers to improve women and child health in Indonesia’s Komodo

Women drying small pelagic fish in Komodo, Indonesia. CIFOR/Emily Gibson

Small-scale coastal fishing in Indonesia can benefit women nutritionally and economically, but in some areas, despite plentiful fish stocks, undernutrition is prevalent, often due to a lack of financial resources and societal taboos surrounding its consumption.

Fish are a valuable source of fatty acids, micronutrients and minerals, providing a third of the global population with almost 20 percent of its animal protein. In coastal Indigenous communities, up to 90 percent of dietary animal protein comes from fish.

In Indonesia, the second largest producer of marine fish in the world, fish is estimated to provide up to 54 percent of dietary animal protein. Up to 95 percent is caught by small-scale fishers, roughly 2.6 million people operating at the household level with non-mechanical fishing gear in small boats.

However, despite the availability of fish, nutritional food insecurity is high in coastal communities throughout the 17,000-island archipelago, with more than 36 percent of children under age 5 stunted and 20 percent of adults overweight.

“We need to improve understanding of access to nutrient-dense food, especially in rural coastal communities, and how this food is distributed within households, especially to vulnerable household members,” said Emily Gibson, a Ph.D. candidate at the Research Institute for Environment and Livelihoods at Australia’s Charles Darwin University, who led research into dietary diversity and fish consumption in Indonesia, published in PLOS ONE online journal.

In addition to assessing the quality of diets of women and children, the research focused on three communities in Komodo, a district in Indonesia’s southmost province of East Nusa Tenggara.

Researchers learned that hidden hunger and stunting is prevalent by examining patterns of household consumption and the role of gender in local nutrition security.

Local fishing boats in Komodo, Indonesia.

“Just because fish are available or harvested doesn’t necessarily mean they’ll be consumed at the household-producer level, and there are a wide range of factors that determine how money earned from increased harvests will be spent, and that’s not necessarily on nutrient-dense foods,” said Gibson, who conducted the research working collaboratively with Terry Sunderland, a senior associate scientist with the Center for International Forestry Research (CIFOR) and a professor in the Faculty of Forestry at Canada’s University of British Columbia.

Consumption of a nutritious, diverse diet, including nutrient-dense fish, is especially important for women of reproductive age, young children and infants, because women have higher nutritional needs due to the demands of pregnancy and lactation, and children have high nutritional requirements in their first 1,000 days.

“Poor fetal growth is associated with stunting, lower academic ability and sets off intergenerational consequences,” Gibson said.

Researchers found that fish was the most frequently consumed animal-source food by mothers, with around 90 percent eating it daily. It was also the most frequently consumed animal-source food by children, with 58 percent eating it in the wet season and 80 percent eating it in the dry season.

However, they discovered that more than three quarters of infants from six to11 months old did not eat fish. Only 12.5 percent consumed it in the wet season and only 20 percent consumed it in the dry season.

INSIDE VIEW

It turned out that often mothers do not give infants and younger children fish because they are believed to cause allergies or stomach upsets.

While some women do not eat these species due to allergies or fears about the potential for mercury poisoning, for others it is considered taboo for breastfeeding women to consume parrotfish, rabbitfish, sea urchins and shellfish, in some cases because they are said to cause upset stomachs in breastfeeding children.

These taboos are passed down the generations, from mother to mother, in such a manner that a woman who eats these foods is said to be disobedient to her mother, Gibson said, explaining that mothers delay the introduction of taboo species until the child has ceased breastfeeding, eats un-mashed rice – the food staple in Indonesia – or is walking.

“We need to understand the socio-cultural reasons why nutrient-dense foods aren’t shared with everyone in a household, and especially introduced as complementary foods for young children when nutritious diets are crucial for growth and cognitive development,” Gibson said. “Time burdens on mothers may make it difficult for them to prepare bony fish, or they may not have access to equipment to process, dry and store fish safely.”

The rationale behind increasing nutrition and health knowledge among mothers and other important influencers in the community – like grandmothers and traditional healers – including sensitively tackling misconceptions and fears, is to increase overall dietary diversity, thereby reducing hidden hunger and ultimately make progress towards national and international food security targets established in the U.N. Sustainable Development Goals, she added.

Although researchers found that children who consume an adequately diverse diet have mothers who also consume an adequately diverse and nutritious diet, fewer than a quarter of the women in the area do. Often, diets are based around one or two staple foods and are at risk of micronutrient deficiency. Close to 50 percent of children had stunted growth.

Finances also play a significant role in curtailing dietary diversity. The inclusion of fish, meat, vegetables or sambal chili sauce is based on whether women, who bear responsibility for feeding the family, can afford to buy it. Often women reduce their own portions or send children to eat with relatives in lean times.

SEEKING SOLUTIONS

Through the National Movement to Accelerate Nutrition Improvement, the Indonesian government has committed to increasing nutrition outcomes, Gibson said.

“We recommend boosting support through programs to increase home or community gardening complemented by support for women’s groups to develop nutrient-dense food products from local foods for sale to mothers within their communities, Gibson said.

“A multi-level cross-sectoral response across the Indonesian food system, beginning with the delivery of clean water, sanitation and hygiene and social and livelihood support to households in rural coastal communities, would also undoubtedly benefit nutritional needs,” she added.

So far, programs in Komodo District have focused on marine conservation and creation of alternative livelihoods aimed at minimizing perceived fishing pressure.

“However, it would be good to build linkages and synergies across sectoral programs to achieve improved nutrition outcomes.”

This research was supported by USAID.