| Abstract |
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The scope of maternal nutrition starts from preconception, ante and postpartum periods, and
throughout the reproductive period, as well as the next generations from fetal to adolescence. The
World Health Organization (WHO) has targeted different types of nutritional interventions for
adolescent girls, women of reproductive age, pregnant women and postpartum women. The root causes
of nutritional problems in menstruating women (women of reproductive age) include the lack of, or
excessive, consumption of macronutrients to micronutrient deficiencies due to imbalanced diet, limited
access to healthy food, and increased physiological demand for nutrition due to infections (i.e., malaria,
HIV, tuberculosis) or growth problems (malabsorption or altered metabolism). Underlying issues related
to social determinants of health such as poor socio-economic status, low educational levels, and
insufficient nutrition services, as well as inequality issues in accessing quality diet and health care also
play a role in maternal nutrition outcomes. From a wider policy perspective, national and local nutrition
policy and implementation of sustainable solutions to nutritional issues, provide the opportunity for
women to access a healthy diet and crucial nutrition programs.
Many maternal health programs have been implemented in Indonesia, including routine IFA and
postpartum vitamin A supplementation, supplementary feeding for undernourished pregnant women,
and nutrition education and counseling. It is important to review these programs from time to time, to
ensure alignment with the latest evidence and global recommendations, address barriers and
bottlenecks and adjust programming for maximum impact. Additionally, the COVID-19 pandemic has
worsened maternal nutrition outcomes, due to the effects on health care delivery systems, including
restrictions in accessing maternal health care services.
Given the high rates of maternal and neonatal mortality and high prevalence of maternal malnutrition in
Indonesia, this landscape analysis seeks to better understand the current situation of maternal nutrition
programs in Indonesia. It aims to provide a systematic identification of barriers, from the policy level to
program implementation, of maternal nutrition interventions in Indonesia, and their alignment with the
2016 WHO recommendation on antenatal care for a positive pregnancy experience (and the relevant
WHO nutrition recommendations for menstruating women and postpartum). Additionally, the analysis
also aims to understand the direct and indirect impact of the COVID-19 pandemic and the preparedness
of the health systems in dealing with uncertainties due to the pandemic.
The landscape analysis uses data collected from a desk review of existing literature, secondary data
analysis, as well as field observation in four districts of South Sulawesi (Makassar and Jeneponto) and
East Java (Surabaya and Jember). The desk review compiles findings from over 200 pieces of literature
and utilizes data from DHS 2007-2017 and other data repositories, such as Riskesdas, Ministry of Health
and World Bank. Six to seven community health centers (puskesmas) in each district were included in
the field observation, conducted in 2021. The four districts were selected to ensure a range of
characteristics, including urban/rural, development indicators, maternal nutrition indicators, and
staffing qualifications in the puskesmas. |
