The head of Indonesia's effort to curb the rate of stunting, or impeded growth, among its youngest children says the Covid-19 pandemic is likely to trigger a resurgence of the scourge that can lead to dire physical and developmental consequences later in life.
Falling household incomes, rising food prices and disrupted government programmes aimed at improving living conditions, particularly those of poor pregnant women in more remote rural areas, are undermining the health of Indonesia's youngsters, said lead programme director Iing Mursali of the Acceleration of Stunting Prevention Team under the secretariat of the vice-president.
Before the pandemic upended everything, the team was achieving results, with rates of stunting dropping from 37 per cent in 2013 to 31 per cent in 2018. Now, Mr Iing's office is girding itself for its first uptick in seven years.
To be sure, until he and his team can get out into the field and start measuring, Mr Iing's worries about stunting stem from statistical modelling and circumstantial evidence.
For example, visits to the country's 200,000 or so village-level clinics or posyandu for pregnant women and young mothers, where they can get nutritional advice and support, plummeted 40 per cent in May and June last year.
"We're very worried about Covid-19," Mr Iing (pronounced Ee-ing) told The Straits Times. "We had great progress but then the pandemic hit and we can't reach mothers and collect data."
A statistical determination comparing height and age, stunting is a hot button issue in Indonesia. The country ranks on a par with Laos when it comes to stunting, while in Thailand, only a tenth of youngsters are considered stunted, according to World Bank data.
Stunting loomed large as a topic at the 2019 presidential election when President Joko Widodo successfully sought a second five-year term.
The median height for an Indonesian two-year-old is 88cm. Any toddler just shy of 82cm is deemed stunted, according to government data. Causes of stunting vary, owing not only to poor nutrition but also inadequate sanitation, education or opportunities to play.
Indonesia's likely reversal of fortune comes despite government efforts. Since 2018, its anti-stunting campaign has been run under the office of the vice-president, giving the effort the political heft needed to coordinate the country's bureaucracy and local governments.
The central government is earmarking 39 trillion rupiah (S$3.6 billion) this year for clinics, supplements as well as food staples such as rice, fruit and eggs for pregnant women and young families.
By last year, Mr Iing's team was intervening in 360 out of Indonesia's 514 districts to coordinate outreach programmes as well as sanitation and poverty relief with the aim of improving living standards and nutrition for newborns and children.
But Mr Sirojuddin Arif, an analyst at the Jakarta-based public policy think-tank SMERU Research Institute, said the government bore some responsibility for the regression, owing to its slow response to the pandemic.
"From the beginning, the government was wrong about the pandemic," Mr Sirojuddin said. "It will impact on the progress the government has made on stunting and make it tough to adapt."
Even before the first coronavirus infections emerged in early March last year, outreach workers were facing obstacles in ensuring poor families had access to good food, Mr Sirojuddin said.
Indonesia's poorest households spend nearly two-thirds of their income on food while the price of rice, a staple, is the highest in the region, said a World Bank report last month.
Ms Eva Murni, 44, said her son Muhammad Rahman Naldi - the youngest of six children - is stunted because her attention is spread too thinly among other needs. During a visit to the midwife for a check-up in November, it was found that three-year-old Muhammad was 79cm tall and weighed 10.2kg.
Life is even tougher now for the family who live more than an hour's drive north of Padang in West Sumatra. Their rice-husking business is shuttered owing to the pandemic. Ms Eva's husband sells dishes and glasses and other kitchen wares.
The government offers 1.45 million rupiah in cash transfers every three months. There are also monthly deliveries of necessities such as rice, oil and fruit. It helps but is not enough, Ms Eva said.
"I'm so worried that our shop is closed," she said in a phone interview, while holding little Muhammad on her lap. "I wish the pandemic would end."