Exclusive, Hasto Wardoyo: The Need To Maintain The First 1,000 Days To Prevent Stunting

The first thousand days of postnatal life are crucial. Because in this period the formation of brain cells and other vital organs occurs. When a baby is stunted (chronic malnutrition), further growth and development will not be optimal. Therefore, said the Head of the Central BKKBN, Dr. (HC) dr. Hasto Wardoyo, Sp.OG(K) during the first 1,000 days must be fully paid attention so that stunting does not occur. To the VOI team, he shared ideas about stunting prevention.

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Don't take stunting for granted, which occurs in the first thousand days of a baby's life. Because after that time the situation is already difficult to fix. Head of the National Population and Family Planning Agency (BKKBN) Dr. (HC) dr. Hasto Wardoyo, Sp.OG(K) received a special task from President Jokowi to reduce editing problems in Indonesia. Especially now that there is a COVID-19 pandemic that doesn't know when it will end.

However, he said, the former regent of Kulonprogo, the Special Region of Yogyakarta, despite difficult circumstances, should not give up. He has already prepared an action agenda, when the proposal he submitted to the government received approval from the relevant agencies above the BKKBN, it immediately moved. “I have prepared a national action plan for handling stunting, namely family assistance. We will escort people who want to get married and people who want to get pregnant. Through the PKK program and the deployment of midwives who partner with extension workers and PKK cadres. All this is done to prevent stunting," he said.

The problem of stunting is closely related to the quality of our human resources in the future. So far, according to the data presented by Hasto, the problem of stunting accounts for 27.7 percent, then mental disorder 9.8 percent, then 4 percent with disabilities-autism and finally the problem of lust 5.1 percent. This is the focus of BKKBN in the future, how to make the quality of human resources superior in the future.

Stunting is important because after the first 1,000 days it cannot be corrected. “This program will be carried out within the first 1,000 days of life. This is where the stunting can be corrected. After that, we give up. Because the baby's brain development occurs at the age of the first two years. After that it can develop but not optimally. Likewise with physical growth, it is also determined at the age of the first 1,000, "he explained.

There is still a strong correlation with the stunting problem, the BKKBN is now closer to millennials. Therefore, the programs that they promote are also targeting millennials who will become potential couples of childbearing age next. The program that used to be successful with the slogan "two children is enough" is still being maintained by modifying it to become two healthier children. How does the BKKBN run a stunting program in the midst of the COVID-19 pandemic and also a tactic to target millennials? To Iqbal Irsyad, Edy Suherli, Savic Rabos, and Irfan Meidianto who met Hasto Wardoyo at the Central BKKBN office, in the Halim area, East Jakarta, not long ago. Here is an excerpt of the interview.

As an institution in charge of controlling population growth, what are the BKKBN's targets, both short and long term, in stopping the rate of population growth in Indonesia?

The BKKBN must truly appreciate that the success story of reducing the number of children or the fertility rate was achieved, in this case, it used to be 5.6 and 5.7 in the 80s and now it is 2.4. This means that we are quantitatively aware that the “two children is enough” campaign is a success.

When we have realized that, now we must be fully aware that quantity is not enough, but quality is much more important. In the short term, the BKKBN must have programs for campaigns because the BKKBN is an expert in demand creation, so how can the public be aware of the campaign for quality. Don't just have children, the important target is 2 or 3 children but the quality is not clear. That's why if the President assigns the BKKBN to an important business, it's actually appropriate because we have to think about quality.

For the long and medium term, we really have to anticipate the demographic bonus from 2030 to 2035. That's right, the demographic bonus is a bit advanced, so the dependency ratio between those who work and those who don't work, we thought that in 2025 it would only reach every year. 100 productive people accommodate 46 years. But it turns out that in 2020, on average, every 100 people in Indonesia will only bear 44. What we are worried about is that the window of opportunity will advance. Finally, the aging population has advanced too. If it progresses, the blame for its welfare will also advance or narrow. The opportunity for prosperity will soon be over. Maybe not until 2035.

So this has to be thought about. Are we ready or not now with a cool demographic bonus, the number of people who work a lot and those who don't work a little. Who are we if the bonus is lost, where our parents have many parents who have low education, there are old people who will fill the years 2030-2040 whose education is still relatively 7 or 8 years old. Are we ready for something like this?

In the past, BKKBN was famous for its campaign for two children is enough, now what changes?

The campaign for 'two children is enough' has succeeded in bringing the total fertility rate between 2 and 2.4. Next we will shift to quality, so actually now it seems that two children should be healthier. This is a strategic campaign because if we say 'two children are enough', now the issue of reproductive rights has moved. The issue of reproductive health must be respected, whether people want to have children or not, whether they want to marry or not to marry must be respected.

How does a person have the autonomy to determine whether he wants to have children or not. Now if we talk about two children, it's also still being debated. But if you say two children are healthier, this is indeed evidence-based. Many studies in the world have published that examine the number of children two compared to three or five with multiparity or grande multiparity. This is clearly significant in the sense that it is evidence-based that maternal mortality is low and infant mortality is also low.

In the last National Family Day commemoration, what was the theme?

For this National Family Day we took the theme “Planning is cool and preventing stunting is important.” There are two things that mean here, cool and stunting. Why we brought this up because cool is also an abbreviation of family planning, but cool is also a term that is very close to the hearts of young people. It turns out that the cool sentence for young people is better than family planning. Now the population of young people is much larger, there are 64 million. We must approach the youth, the BKKBN must be a friend of the youth. We must be able to down-grade ourselves close to teenagers, otherwise we fail. Because it is youth who determine the future of this nation in the future. Those who will later become new life partners where there is a new partner of childbearing age. For those who are 35 years old, they have no plans to have children. So when we talk, we have to talk to the young. That is the reason BKKBN must be a friend of teenagers.

Then about stunting, the quality of our human resources that is the most disturbing is stunting; 27.7 percent, then mental disorders 9.8 percent, the third only 4 percent of people with disabilities-autism. But beyond that there is the problem of nafza 5.1 percent. This is our focus, how to make the quality of human resources superior.

What is the current data on stunting in Indonesia?

During this pandemic, experts predict an increase in infant mortality, experts suspect that this wasting (thin) baby will also increase, with predictions like this the stunting rate can also increase. The data can continue to increase. This is what we must watch out for.

During this corona pandemic, what are the stunting cases like?

When a pandemic occurs, stunting will also increase because morbidity increases. There are two sources of stunting; sub-optimal nutrition and sub-optimal health. When poverty rises and unemployment rises there is bound to be a sub-optimal nutritional threat. When many people are afraid to go to the hospital for health services too late, sub-optimal health will occur. This is our record. In Indonesia now there are approximately 23 million children under five, 2 million children under five in wasting will be thin. When two million become emaciated, if 2 and 3 months will hinder development, they will become stunted.

Before marriage, which is no less important to prevent stunting is the health examination of the prospective father and mother. Check his blood, check his HB, check his folic acid, and so on. If this is resolved it can be cool. Everyone who wants to get married must train for three months. If this can be done, it can prevent stunting. Expensive ones, such as pre-wedding, are carried out in the tens of millions, while relatively cheap health checks are ignored. This is what we need to pay attention to to improve the quality of future generations.

In this pandemic period where the piscal space is narrowing, we must make savings. The government with its policy of making savings, as well as us in small families, must be able to change focus. The important things are prioritized, no need for secondary and luxury styles and needs.

During this pandemic, the government is still focusing on prevention efforts such as vaccination, what about the stunting program, is this constrained by this situation?

I have prepared a national action plan for the handling of stunting, namely family assistance. Controlling people who want to get married and people who want to get pregnant. Through the PKK program and the deployment of midwives who partner with extension workers and PKK cadres. All this is done to prevent stunting. That's what the program will do. This can also provide assistance such as complementary foods, and complementary feeding. This program will be carried out in the first 1,000 days of life. This is where the stunting can be corrected. After that, we give up. Because the baby's brain development occurs at the age of the first two years. After that it can develop but not optimally.

Physical growth is also the same, a baby's minimum length at birth is 48 cm. If the baby is given good food intake in the first 1,000 days he will be able to grow to a maximum of about 174 cm in adulthood. However, due to stunting, his height as an adult can be less than that, for example 160 cm.

So this is a crucial period that we must guard and save so that stunting does not occur. So we think more about those who want to be born so that they can be free from stunting.

The matter of premarital and during pregnancy is very important. Before marriage, prospective partners must check their health, during pregnancy, do not let the newborn be less than 48 cm long. The first six months he weighed at least two and a half kilograms. Then in the first 6 months it must be full of breast milk. And for two years the baby's age if possible the mother does not get pregnant first. This is a concrete effort that can be done to prevent stunting.

A balance between work and rest must be maintained. Otherwise it will affect the quality of life and life. Head of the National Population and Family Planning Agency (BKKBN) Dr. (HC) dr. Hasto Wardoyo, Sp.OG(K) has tips to avoid stress that often afflicts due to high work demands.

The most important thing according to the general practitioner who has won the Bhakti Husada Exemplary Badge award as an Exemplary Health Center Doctor, is calm. “When doing a job with a high load, you need calm. In addition, as a believer, he suggests praying to the Almighty. A special prayer and surrender to the Almighty can make you calm,” he said.

Another thing that needs to be considered according to the man who was born in Kulonprogo, July 30, 1964, is to reduce feelings of superiority. Especially for those who act as the backbone of the family. It could be a father, mother or someone who is a single parent. "There's an exaggerated feeling of superiority. For example, he is very burdened when he can no longer work. He was very depressed that he was no longer in this world. Though not necessarily the one left behind will suffer like his worries. It could be that they can be happier after we are gone,” he said as an example.

So what about during the current pandemic? For difficult times such as the COVID-19 pandemic, coupled with the implementation of Emergency PPKM and some areas have Micro PPKM, according to Hasto, health protocols are absolutely mandatory. If there is no urgent work, it is better to just stay at home. The key is to reduce the mobility of citizens who have the potential to spread the virus from one person to another.

As for food intake, he continued, it is no less important to increase the body's immunity. He recommends consuming lots of vitamin C sourced from local fruits that are affordable. "During a pandemic like now immunity is very important. Because it can help the body in dispelling the incoming virus, "he continued.

“During a health pandemic, that number can be achieved by exercising and consuming vitamin C and other vitamins that the body needs. That will prevent various diseases, if people who are aged 45 and over also prevent aging. No need to be expensive, local fruit juices such as tomato juice are cheap and contain antioxidants. Yes, it's bigger than wine, but the price is more expensive," he continued.

In terms of food, according to Hasto, try to reduce preserved foods or foods that use preservatives in their processing. "From now on, reduce foods that contain lots of preservatives if we want to last longer. I say this, I hope that the people in the village, these middle to lower families will not find it hard to live this life. The problem is that what we need can actually be obtained at an affordable price,” said the alumni of the UGM Faculty of Medicine and the alumnus of Obstetrics and Gynecology Specialist at FK UGM as well as a Doctorate in Technology and Vocational Community Empowerment from Yogyakarta State University (UNY).

The message from Doctor Hasto does not need to be grandiose to change the world if it is difficult to realize it. “We don't have to rush to change the world, because that is very difficult to do. What you need to focus on is changing yourself first. Because after we can change ourselves, the effect will have an effect on the family, the environment and even the nation and the possibility of this country and the world, "he explained.

During this pandemic, Hasto continued, let's live a more relaxed life. You don't feel like you're being chased by work. Then do not demand what is not our right. “For example, regarding social assistance, there is no need to be jealous if we do not receive assistance from the government. Because there are rules and regulations, who is entitled to receive assistance,” said Hasto, who was very concerned about interactions with his family even though he was separated from his family members.

One achievement that made Hasto very happy. Namely when gassing the idea of the Angguk gymnastics. This is a traditional dance that is deeply rooted in Kuloprogo. When he became Regent, the idea came up to make Angguk gymnastics. “I invited professors who are gymnastics and dance experts. I found them and the result is Angguk gymnastics. I am very happy to be able to help give birth to new ones that come from the noble traditions of the community," concluded Hasto Wardoyo.

“This program will be carried out within the first 1,000 days of life. This is where the stunting can be corrected. After that, we give up. Because the baby's brain development occurs at the age of the first two years. After that it can develop but not optimally. Likewise with his physical growth, also determined at the age of the first 1,000, "

Hasto Wardoyo