Yosef Pandai Lolan*1 and Ucu Wandi Somantri2
1Bachelor Programme Public Health, Bhakti Kencana University, Bandung, Indonesia
2Bachelor Programme Public Health, Mathla ul Anwar University, Banten, Indonesia
Yosef Pandai Lolan
Abstract: Background: The year 2019 in Kab. East Flores for toddlers aged 6-24 months with the number of children under five measured as many as 4869, the normal number 3561, the number of stunting being 1334 with a percentage of 27.25%. And for toddlers aged 6-24 months the number of stunting is 1456 with a percentage of 25.52% of the number of children under five measured 5689. The purpose of this study was to determine the socio-cultural relationship of patriarchy with the incidence of stunting. Aim: The population in this study were all fathers who had children aged 6-24 months. Method: The research method used is descriptive analytic qualitative with a cross sectional approach. The sample size obtained was 373 using the proportional random sampling formula, sampling in this study used the Accidental Sampling method. The analysis technique used is Chi square and multiple logistic regression. Results: The results showed that the variables related to the incidence of stunting were patriarchal culture (P value = 0.001; OR = 2.077), father's role (P value = 0.004; OR = 1.854), father's occupation (P value = 0.009; OR = 1.793), father's knowledge (P value = 0.006; OR = 1.831. Conclusion: The risk factors for stunting in toddlers 6 to 24 months in the East Flores community are patriarchal culture, father's role, father's occupation and father's knowledge. Factors most related to the incidence stunting in toddlers in this study is the role of the father with a P-value of 0.001.
Keywords: Stunting, Culture, Patriarchy.
The development of nutritional problems in Indonesia is currently increasingly complex. In addition to the problem of malnutrition and overnutrition, Indonesia is also experiencing chronic malnutrition. Chronic malnutrition is malnutrition in the long term that causes short events (stunting). In toddlers. Stunting can be detected by looking at the PB/U or TB/U index which is small from -2 SD. The problem of stunting is still a problem that must be handled seriously (Ministry of Health, 2011) (Global Nutrition Report, 2014). According to a UNICEF study, Indonesia has. various obstacles that cause the high incidence of stunting in Indonesia. Some of the factors that cause the high incidence of stunting include lack of knowledge and inadequate nutrition-related practices (Unicef Indonesia, 2012).
It is stated in the 2015-2019 RPJMN that the main target is to improve the health and nutritional status of mothers and children by reducing the prevalence stunting to 32% in 2014. The condition of failure to thrive in toddlers (infants under five years old) due to chronic malnutrition that makes children too short for their age is called stunting. Malnutrition occurs since the baby is in the womb and in the early days after the baby is born, however, stunting only appears after the baby is 2 years old. Until now stunting is still a public nutrition problem both at the national and international levels. Indonesia is included in the third country with the highest prevalence in the Southeast Asia / Southeast Asia (SEAR) region. The average prevalence of stunting under five in Indonesia in 2005-2017 was 36.4%. More than a third (37%) of children under five in Indonesia were stunted in 2013 and the prevalence exceeds 40% in 15 of 33 provinces. WHO's target is to reduce stunting in children less than 5 years old, namely 40% by 2025. 5 In 2018 it is East Nusa Tenggara 42.6%, West Sulawesi 42% and Aceh 35%. The prevalence of stunting in West Java is 29.2% or 2.7 million children under five stunting incidence based on the results of the 2018 RISKESDAS of 42.6% from 51.7% in 2013, but NTT is still the province with the highest prevalence of stunting when compared to other provinces in Indonesia ( 29.5%) (TNP2K, 2018). Based on the latest data from the NTT Provincial Health Office (Ministry of Health, 2018), cases of malnutrition/stunting still occur in all districts in NTT.
In 2019 in Kab. East Flores for toddlers aged 0-59 months with toddlers measuring 16,108, stunting rate as much as 4979 with a percentage of 30.91% and in toddlers aged 6-24 months with a number of toddlers being measured as much as 4869, normal number 3561, stunting number 1334 with a percentage of 27.25%. And in 2020 toddlers aged 0-59 months with a number of toddlers being measured at 17,573 the number of stunting was 5277 at a percentage of 30.03% and for toddlers aged 6-24 months the number of stunting was 1456 with a percentage of 25.52 of the number of toddlers measured 5689 (East Flores District Health Office, 2020).
Malnutrition during the Golden Period (0-2 years) will cause toddler ditches not to grow perfectly. This is because 80-90% of the number of brain cells formed from the time in the womb until the age of 2 years. Stunting is a complex issue as described by various conceptual frameworks, which focus on malnutrition in children, malnutrition in mothers, and food safety. Common causes of stunting in children in Indonesia are height and maternal education, premature birth and birth length, exclusive breast milk for 6 months, and household socioeconomic status (Sutriyawan et al., 2020). In a previous study (2020) it was stated that another factor in the occurrence of stunting in East Flores was poor father knowledge supported by a patriarchal culture where the habit of taking care of all housework was women or patriarchal views and various the form of gender stereotypes and decision makers in the home and social environment are still dominated by men. The injustice that befell women will give rise to the perception that women are born to do a much more limited number of jobs with lower job status and lower pay. Women's work so far is generally limited to the household sector (domestic sector), although now women are starting to touch jobs in the public sector, this type of work is also an extension of other jobs that require more manual skills.
This research is a qualitative descriptive analytic study with a cross sectional (Sutriyawan, 2021). The case population in this study were all fathers who had stunted toddlers aged 6-24 months. In this case, the researcher wants to know and see patriarchal culture with stunting. The population in this study were all fathers who had all children under five at the age of 6-24 months as measured from families living in the wilaya Kab. Flore Timur 5689. The sample in this study was a father who had a toddler of 373. Purposive sampling technique was a sampling technique with certain considerations.
Table 1. Respondents' Determinants
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The results shown in table 1 above illustrate that most of the respondents have a strong patriarchal culture of 242 with a percentage of 64.9% and fathers who do not play a role in taking care of toddlers by 233 with a percentage of 62.5%, there are positive attitudes of fathers towards toddlers by 231 with a percentage of 61.9%, fathers having poor knowledge about parenting patterns of toddlers by 228 with a percentage of 61.1%, the average occupation of fathers is non-office (farmers, fishermen and traders), while the nutritional status of children under five in respondents with stunting nutritional status was 237 with a percentage of 63.5%.
Table 2. Factors Affecting Stunting Incidence in Toddlers 6-24 Months
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From table 2 above, it is explained that there is still a patriarchal culture in the Lamaholot community in the incidence of stunting with a proportion value of 70.0%, while there is no patriarchal culture in the Lamaholot community with the nutritional status of toddlers Normal with the proportion 47.1%. The P-value of 0.001 proves that there is a significant relationship between patriarchal culture in the Lamaholo community and the incidence of stunting in East Flores with an OR value of 2.077, the presence of patriarchal culture has a chance of between 0.9 and 2.1 times more often affects the incidence of stunting in toddler.
The proportion of positive fathers towards stunting in East Flores was 66.7 while the proportion of fathers was negative in normal children with a proportion of 41.5%.0.109 P-value means that there is no relationship between father's attitude and the incidence of stunting.
Fathers do not have a role in stunting under five with a proportion value of 66.2%, while fathers who play a role in toddlers with normal nutritional status have a proportion of 48.6%. P-value 0.004 which means that there is a significant relationship between the role of fathers on the incidence of stunting in the people of East Flores with an OR value of 1.854, fathers who do not have a role in the incidence of stunting have the opportunity between 1.2 to 2.8 times more often to affect the incidence of stunting. Fathers who work non-office (farmers, fishermen and traders) in stunting toddlers with a proportion value of 88.1%, while fathers who work in offices in normal toddlers 45.6%. P-value 0.009 which means that there is a significant relationship between father's occupation and the incidence of stunting in the East Flores community with an OR value of 1.793, non-office father work (farmers, fishermen and traders) has a chance of between 1.1 to 2.7 times more frequent against stunting.
The proportion of bad father knowledge on stunting incidence is 69.0% while good knowledge with stunting incidence is 54.9%. P-value 0.006 means that there is a significant relationship between father's knowledge and the incidence of stunting in children under five in the East Flores community with an OR value of 1.831. Fathers who have poor knowledge are 1.2-2.8 times more likely to have an effect on stunting.
The Relationship of Patriarchal Culture with Stunting Incidents in Toddlers 6-24 Months
In the frequency distribution of the questionnaire above, it can be seen that the distribution based on patriarchal culture can be said to be cultural. patriarchy in the Lamahalot community which has an impact on the incidence of stunting in toddlers. This is because men have a role as the main control in the household and society, while women have little influence or can be said to have no rights in general areas in society, both economically, socially, politically and psychologically, even including the institution of marriage. Every decision that is in the male household has a dominant role to decide until the decision to provide food intake to toddlers. Since the past, the culture of the people in Lamaholot (the race in East Flores) has placed men at the top of the hierarchy, while women have become the number two class. This can be seen in the practice of the Lamaholot community where women have to accompany their husbands/follow their husbands and take care of children, women are responsible for household work while men are responsible for subsistence work.
Patriarchal culture can be associated with the dominant role of a husband as a father in the household. The dominance of the father in providing positive input in the form of encouragement for his family members can be seen in the practice of giving food intake patterns to toddlers. Through support and reinforcement in influencing the growth and development of toddlers, which are based on patrilinealistic ties. This research is in line with research conducted by Prasetya (2019) which states that, a father can provide positive support to improve breastfeeding practices, and maintain full support for his wife in breastfeeding until the baby is 6 months old to achieve exclusive breastfeeding. husbands can help their wives finish homework while their wives are breastfeeding, husbands can burp their babies after breastfeeding, help mothers breastfeed in public by removing nursing cloths, husbands can accompany their wives to come to lactation classes, provide adequate nutrition to mothers To facilitate breastfeeding, remind the wife to always give only breast milk until the baby is 6 months old.
The Relationship between Father's Attitude and Stunting Incidence in Toddlers 6-24 Months
In this study, attitude is the attitude of the father in the form of an assessment of the incidence of stunting in toddlers, where the father's behavior towards stunting toddlers in feeding children under five. It is known that in this study the father's attitude was positive towards the incidence of stunting. This illustrates that the behavior of fathers in affection for toddlers is quite good even though fathers rarely take care of their toddlers because fathers are busy at work.
The role of the father is no less important than the role of a mother who cares for and takes care of children at home because the role of the father is also important in shaping the growth and development of children such as emotional development in children. If a father gives full love to the child, the child will feel happy and comfortable when close to his father and it is better if a father does not give attention and affection to his child, the child will feel sad and uncomfortable when with his father. The attitude of the father that does not affect the nutritional status of toddlers is due to the most important factor affecting the nutritional status of toddlers, namely food with good nutrition. Foods with various nutrients are needed by toddlers for growth and development. Toddlers will grow optimally if their food intake is sufficient, nutritious, and balanced (Aini et al, 2013).
The father's positive attitude towards the incidence of stunting in toddlers is caused by the father feeling that the growth and development of toddlers is also his responsibility. That is, the potential for attitude reactions that have been formed in the individual will appear in the form of actual behavior as a reflection of the actual attitude towards something. Conversely, if the individual experiences or feels obstacles that can interfere with his freedom in expressing his true attitude or if the individual feels a physical threat or mental threat that can occur to him as a result of the attitude statement to be expressed, what is expressed by the individual as verbal behavior or action is very important. may not be in line with the attitude of his conscience, can even be very contrary to what he holds as a belief. The more complex the situation and the more factors that are considered in acting, the more difficult it is to predict behavior and the more difficult it is to interpret it as an indicator (Azwar, 2007).
The Relationship of Father's Role with Stunting Incidence in Toddlers 6-24 Months
This research shows that there is a problem between the father's role and the incidence of stunting. This is because all affairs in nurturing, maintaining and providing food intake for toddlers are the responsibility of the woman/wife. This is a patriarchal view inherent in the Lamaholot community where the division of labor between men and women can be seen in the physical activities carried out. Where women in Lamaholot are responsible for household work while men tend to do nafka work. Fathers do not have a role in the incidence of stunting in toddlers, also because the father is often outside the house because of his father's occupation who is a fisherman and farmer. Domestic work is not valued as a job for purely economic reasons (work that makes money). The role of the father in the family not only affects changes in the socioeconomic status of the family but is also closely related to the involvement of the father in parenting.
Father involvement in parenting includes aspects of time, interaction, and attention to children. The involvement of fathers in parenting is not just a greater quantity of time for the child, but the quality of the interaction that is built is also fundamental. The role of a father in toddlers is no less important than a mother in fulfilling nutrition. Fathers work together to organize and control the family's expenses. Father involvement in parenting is father's continuous participation in child care which contains aspects of frequency, initiative and personal empowerment in the physical, emotional, social, intellectual and moral dimensions. This research is in line with research conducted by Aritonang (2020) which states that the test results show that father's involvement in parenting has a significant positive effect on the cognitive development of children aged 2-3 years in stunting prevalence areas.
This finding is in line with previous research which also found that father involvement in parenting has a significant effect on children's cognitive (Perales& Baxter,2018) fishermen and farmers, where father is always at work and has little time with his wife and children. Time spent with children is the most important factor in shaping a child's development and human capital (Becker, 1981). In the father's work in this study, the researcher did not discuss and look at the income generated, but the researcher wanted to highlight the time fathers with their children because the majority of respondents in this study were fishermen (dominantly) and farmers where they spent more time at sea and in the fields. In previous studies, it was found that there was no relationship between economic status and the incidence of stunting in the people of East Flores (2020). That is, how the time that fathers spend in forming children and differences in the use of time between fathers for child development greatly contribute to inequality in the quality of children in the future. Some views from the Lamaholot community if the father spends too much time for the child, the father will experience anopportunity cost. People often experience a dilemma whether the father chooses to use his time to work and make money or prefer to use his time to take care of the child where the father does not increase income, but on the other hand the future growth of their children is improving. In other words, when the father is with the child, it plays an important role in the child's growth because the wife can prepare and provide good complementary foods according to government recommendations. The high number of hours worked does have a positive impact on the Indonesian economy.
However, the effect of increasing the number of hours worked on children's development is still unknown. It is feared that the high number of working hours will reduce the interaction time between parents and children where the interaction of parents and children is an important input in building child development (Gemellia, 2021). Child development is closely related to the investment given by parents, including the time that parents give to their children. Ideally, the more time parents give to their children, the more stimulation they will get so that the child's development becomes optimal. Some studies have found that working hours have a positive impact on children's cognitive development, but there are also other studies that have found the opposite result (Gemellia, 2021). Based on several studies conducted by Williams & Radin (1993), Buehler et al., (2014), Hsin & Felfe (2014), Kunn-Nelen et al., (2015), and Baker (2016), found a positive impact of the number of hours worked on children's cognitive development. Williams & Radin (1993), Buehler et al., (2014).
The Relationship of Father's Knowledge with Stunting Incidence in Toddlers 6-24 Months
Father's knowledge is still low about parenting in toddlers resulting in the high incidence of stunting in East Flores. In research, father's knowledge greatly influences the incidence of stunting, fathers need to get good knowledge regarding parenting in toddlers because fathers also have responsibility for toddler development, not only mothers who get knowledge from health workers. With good knowledge, fathers will tend to care about child rearing patterns, according to the concept of L.Green's behavior, one of the things that affect one's health is one's knowledge and attitude. Knowledge certainly plays an important role, because by having good knowledge about parenting, fathers can decide what attitude can be done to overcome health problems in toddlers, especially reducing the risk of stunting in toddlers. Increased knowledge is not absolutely obtained from.
Formal education, but can also be obtained in non-formal education. Fathers can also get knowledge from cadres' mothers or health workers when accompanying or dropping their children to the Posyandu. A person's knowledge of an object also contains two aspects, namely positive and negative aspects. These two aspects will ultimately determine a person's attitude towards a particular object (Sutriyawan & Nadhira, 2020). The more positive aspects of the object are known, the more positive attitude will be towards the object. This level of knowledge will later shape a person's attitude towards something. Attitude is not yet an action or activity, but it is still a predisposition to the action of a behavior. A person's attitude will affect health behavior, a person's positive attitude will produce positive health behavior as well (Lolan & Sutriyawan, 2021). This research is in line with research conducted by Rahmawati (2019). Parental knowledge about stunting is still lacking, as shown from the results of this study, namely as many as 11 (55%) parents have less knowledge about stunting. Based on the bivariate test (table 6), it can be seen that the factors that are significantly related to knowledge about stunting.
The risk factors for stunting in children aged 6 to 24 months in the East Flores community are patriarchal culture, father's role, father's occupation and father's knowledge. The factor most related to the incidence of stunting in children under five in this study was the role of the father with a P-value of 0.001.
Almatsier, S. (2001). Prinsip dasar ilmu gizi. Jakarta: PT. Gramedia Pustaka Utama, 2001
Aritonang D dkk (2020). Pengasuhan Ibu, Keterlibatan Ayah Dalam Pengasuhan, Dan Perkembangan Kognitif Anak Usia 2-3 Tahun Di Wilayah Prevalensi Stunting, Jurnal Ilmu Keluarga dan Konsumen, Vol 3 No 1. https://jurnal.ipb.ac.id/
Becker, G. S. (1965). A theory of the allocation of time. The Economic Journal, 75(299), 493–517. doi: https://doi.org/10.1360/zd-2013-43-6-1064
Buehler, C., O’Brien, M., Swartout, K. M., & Zhou, N. (2014). Maternal employment and parenting through middle childhood: contextualizing factors. Journal of Marriage and Family,76(5), 1025–1046. doi: https://doi.org/10.1111/jomf.12130
Dinas Kesehatan Kab. Flores Timur, (2020). Laporan Pemantauan Status Gizi Anak Balita Kabupaten Flores Timur Tahun 2020
Gamellia, A.P. (2021). Pengaruh Jam Kerja Orang Tua terhadap Kognitif Anak di Indonesia, Jurnal Ekonomi dan Pembangunan Indinseia, Vol 21 N0 1. https://doi.org/10.21002/jepi.v21i1.1329
Lolan, Y. P., & Sutriyawan, A. (2021). Pengetahuan Gizi Dan Sikap Orang Tua Tentang Pola Asuh Makanan Bergizi Dengan Kejadian Stunting. Journal of Nursing and Public Health, 9(2), 116–124.
Monika dkk. (2021). Hubungan Pekerjaan Ibu Dan Praktik Asi Ekslusif Dengan Kejadian Stunting Pada Balita Di Kabupaten Timor Tengah Selatan, Jurnal Kesehatan Vol 8 No 2. https://doi.org/10.35913/jk.v8i2.200
Nurwijayanti, Suyadi, Djati, M.S., & Yanuwiadi, B. (2015). Strategies for improving nutritional status of children under five in communities. Journal of Applied Environmental and Biological Sciences. 6(2): 37-45, ISSN: 2090-4274,
Prasetya, dkk. (2019). Budaya Patriarki Dalam Praktik Pemberian ASI Eksklusif, Jurnal Keperawatan, Vol 3 No 1. https://stikesks-kendari.e-journal.id/
Puspita, dkk. (2019). Faktor-Faktor Resiko Penyebab Terjadinya Stunting Pada Balita Usia 23-59 Bulan, Jurnal Ilmia Kebidanan, Vol 6 No 1. https://doi.org/10.35316/oksitosin.v6i1.341
Rahmawati. (2019). Faktor yang Berhubungan dengan Pengetahuan Orang Tua tentang Stunting pada Balita, Jurnal Ners dan Kebidanan, Vol 6 No 3. http://jnk.phb.ac.id/index.php/jnk/
Rismwanti dan Yulizawati. (2012). Hubungan Sikap Ibu Balita Tentang Gizi terhadap Status Gizi Balita di Wilayah Kerja Puskesmas Pekan Heran Kecamatan Rengat Barat.
Sakina Irma, dkk. (2017). Menyoroti Budaya Patriarki DI Indonesia, SHARE: Social Work Jurnal, Vol 7 No 1, Hal 1-129. http://jurnal.unpad.ac.id/share/article/view/13820.
Sjaifudin, H. (1992). Gender Marginalisasi dan Pekerjaan di Pedesaan. Wanita Pengusaha, Tenaga Kerja Upahan dan Tenaga Kerja di Jawa Barat. Warta Studi Perempuan, No.2. Vol.III.
Sjaifudin, H. 1996. Sensitifitas Gender Dalam Perumusan Kebijakan Publik. Jurnal Analisis Sosial. Edisi 4, November 1996
Sutriyawan, A. (2021). Metodologi Penelitian Kedokteran dan Kesehatan: Dilengkapi Tuntunan Membuat Proposal Penelitian. Bandung: PT Refika Aditama.
Sutriyawan, A., Kurniawati, R. D., Rahayu, S., & Habibi, J. (2020). Hubungan status imunisasi dan riwayat penyakit infeksi dengan kejadian stunting pada balita: studi retrospektif. Journal Of Midwifery, 8(2), 1–9.
Sutriyawan, A., & Nadhira, C. C. (2020). Kejadian Stunting pada Balita di UPT Puskesmas Citarip Kota Bandung. Jurnal Kesmas (Kesehatan Masyarakat) Khatulistiwa, 7(2), 79–88. https://doi.org/http://dx.doi.org/10.29406/jkmk.v7i2.2072
WHO. Nutrition Landscape Information System. Nutrition Landacape Information System (WHO Document Production Services, 2010).
Williams, E., & Radin, N. (1993). Paternal involvement, maternal employment, and adolescents ‘academic achievement: An 11-year follow-up. American Journal of Orthopsychiatry, 63(2), 306-312. doi: https://doi.org/10.1037/h0079415