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ORCID ID

Charissa Otniel Sukamto: 0009-0008-0335-7845

Siti Nur Fatimah: 0000-0002-4491-2875

Noormarina Indraswari: 0000-0002-2801-5410

Abstract

Background: Stunting remains a major issue in Indonesia. Maternal factors during pregnancy are one of the key determinants in preventing stunting. This study aimed to analyze the association between maternal history during pregnancy (age, height, parity, and inter-pregnancy interval) and stunting, with a comparison between urban and rural areas.

Methods: This analytical cross-sectional study used data from 3,639 children aged 1-5 years old from the household survey of Indonesia Family Life Survey 5, conducted between late October 2014 and August 2015 within 13 provinces in Indonesia. Data was analyzed using chi-square and binary logistic regression methods.

Results: The toddlers were predominantly boys (51.9%), with a mean age of 3 years (1–5). Around 37% were stunted. Stunting was associated with adolescent mothers, short maternal stature, high parity, and rural residence. In both urban and rural areas, these maternal factors were significantly associated with stunting.

Conclusions: Younger maternal age, lower maternal height, and high parity were significant predictors of stunting, including in both urban and rural areas. Stunting management strategies should prioritize reducing early pregnancy, improving maternal nutrition, and limiting high parity with equitable implementation across rural areas to address existing disparities in Indonesia.

References

  1. de Onis M, Branca F. Childhood stunting: a global perspective. Matern Child Nutr. 2016;12 Suppl 1:12–26.
  2. United Nations Children’s Fund, World Health Organization, International Bank for Reconstruction and Development, The World Bank. Levels and trends in child malnutrition: Joint UNICEF/WHO/World Bank Group Child Malnutrition Estimates: Key Findings of the 2025 Edition. Geneva: World Health Organization; 2025.
  3. World Health Organization, United Nations Children’s Fund. Extension of the 2025 Maternal, Infant, and Young Child Nutrition Targets to 2030: WHO/UNICEF Discussion paper. Geneva: World Health Organization, United Nations Children’s Fund; 2019.
  4. Kementerian Kesehatan RI. Survei Status Gizi Indonesia (SSGI) 2024 dalam Angka. Jakarta: Kementerian Kesehatan RI; 2025.
  5. Presiden Republik Indonesia. Peraturan Presiden Republik Indonesia Nomor 72 Tahun 2021 Tentang Percepatan Penurunan Stunting. Jakarta: Presiden Republik Indonesia; 2021.
  6. Kementerian Perencanaan Pembangunan Nasional. Ringkasan Rencana Pembangunan Jangka Menengah Nasional Tahun 2025–2029. Jakarta: Kementerian Perencanaan Pembangunan Nasional; 2025.
  7. World Health Organization. Global Nutrition Targets 2025: Stunting Policy Brief Geneva. Switzerland: World Health Organization; 2014.
  8. Sari DT. Government health expenditure and stunting prevalence reduction in Indonesia. Jurnal Perencanaan Pembangunan. 2023;7:192–208.
  9. World Health Organization, United Nations Children’s Fund. Global nutrition targets 2030: stunting brief. Geneva: World Health Organization; 2025.
  10. Vaivada T, Akseer N, Akseer S, Somaskandan A, Stefopulos M, Bhutta ZA. Stunting in childhood: an overview of global burden, trends, determinants, and drivers of decline. Am J Clin Nutr. 2020;112:777S–91S.
  11. Myrskylä M, Fenelon A. Maternal age and offspring adult health: Evidence from the health and retirement study. Demography. 2012;49:1231–57.
  12. Amaha ND, Woldeamanuel BT. Maternal factors associated with moderate and severe stunting in Ethiopian children: analysis of some environmental factors based on 2016 demographic health survey. Nutr J. 2021;20:18.
  13. Palino IL, Majid R, Ainurafiq. Determinan kejadian stunting pada balita usia 12–59 bulan di wilayah kerja Puskesmas Puuwatu Kota Kendari tahun 2016. Jurnal Ilmiah Mahasiswa Kesehatan Masyarakat. 2017;2:1–12.
  14. Santosa A, Novanda Arif E, Abdul Ghoni D. Effect of maternal and child factors on stunting: Partial least squares structural equation modeling. Clin Exp Pediatr. 2022;65:90–7.
  15. Andarusukma Y, Adiba R, Sari MGK. Exploring the influence of maternal and birth history on stunting in children under 5 years in Indonesia: Evidence from the Indonesia Family Life Survey. Paediatr Indones. 2025;65:207–15.
  16. Wardani IMK, Nurrochmah S, Mawarni D. Faktor maternal sebagai determinan stunting di kawasan Timur Indonesia: Analisis data Indonesian family life survey 5. Jurnal Penelitian Kesehatan Suara Forikes. 2022;13:229–33.
  17. Rafi’i A, Sari AS, Ririnsahawaitun. The relationship between maternal characteristics and socioeconomic factors and the incidence of stunting among children under five in Palembik village. Omni Nurs J. 2025;2:30–9.
  18. Anggraeni LD, Utami TA, Wihardja H. Factors contributed toward stunting in children in Indonesia. Jurnal Mutiara Ners. 2025;8:1–11.
  19. Pakpahan L, Manurung K, Sitorus ME, Ketaren O, Lina Tarigan F. Factors influencing the incidence of stunting at the Lumban Sinaga Community Health Center, Pangaribuan District, North Tapanuli Regency in 2023. J Pharm Sci. 2025;8:536–49.
  20. Syah J, Wahab A, Kandarina BJI. Teenage pregnancy as a risk factor of stunting and wasting among children aged 6-23 months in Indonesia (IFLS 5 analysis study). Jurnal Kesehatan Masyarakat. 2020;16:216–24.
  21. Fajariyah RN, Hidajah AC. Correlation between immunization status and mother’s height, and stunting in children 2–5 years in Indonesia. Jurnal Berkala Epidemiologi. 2020;8:89.
  22. Utami MMH, Kustiyah L, Dwiriani CM. Risk factors of stunting, iron deficiency anemia, and their coexistence among children aged 6-9 years in Indonesia: results from the Indonesian family life survey-5 (IFLS-5) in 2014-2015. Amerta Nutr. 2023;7:120–30.
  23. Siramaneerat I, Astutik E, Agushybana F, Bhumkittipich P, Lamprom W. Examining determinants of stunting in Urban and Rural Indonesian: a multilevel analysis using the population-based Indonesian family life survey (IFLS). BMC Public Health. 2024;24:1371.
  24. Senbanjo IO, Olayiwola IO, Afolabi WA, Senbanjo OC. Maternal and child under-nutrition in rural and urban communities of Lagos state, Nigeria: the relationship and risk factors. BMC Res Notes. 2013;6:286.
  25. Widyaningsih V, Mulyaningsih T, Rahmawati FN, Adhitya D. Determinants of socioeconomic and rural-urban disparities in stunting: evidence from Indonesia. Rural Remote Health. 2022;22:7082.
  26. Ayuandini S, Habito M, Ellis S, Kennedy E, Akiyama M, Binder G, et al. Contemporary pathways to adolescent pregnancy in Indonesia: A qualitative investigation with adolescent girls in West Java and Central Sulawesi. PLOS Glob Public Health. 2023;3:e0001700.
  27. Badan Kependudukan dan Keluarga Berencana Nasional. Laporan Kependudukan Indonesia 2024. Jakarta: Badan Kependudukan dan Keluarga Berencana Nasional; 2024.
  28. Badan Penelitian dan Pengembangan Kesehatan. Laporan Nasional Riskesdas 2018. Jakarta: Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan; 2019.
  29. National Population and Family Planning Board, Statistics Indonesia, Ministry of Health. Indonesia–Demographic and Health Survey 2017. Jakarta: BKKBN, BPS, and Kemenkes; 2019.
  30. World Health Organization. Report of a World Health Organization Technical Consultation on Birth Spacing. Geneva: World Health Organization; 2007.
  31. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371:340–57.
  32. Lestari E, Siregar A, Hidayat AK, Yusuf AA. Stunting and its association with education and cognitive outcomes in adulthood: A longitudinal study in Indonesia. PLoS One. 2024;19:e0295380.
  33. Strauss J, Witoelar F, Sikoki B. The fifth wave of the Indonesia family life survey (IFLS5): overview and field report, Journal of the Indonesian Society of Public Health. California: RAND Corporation; 2016.
  34. Strauss J, Witoelar F, Sikoki B. Household Survey Questionnaire for the Indonesia Family Life Survey, Wave 5. California: RAND Corporation; 2016.
  35. Trihono T, Atmarita A, Tjandrarini DH, Irawati A, Handayani N, Tejayanti T, et al. Pendek (Stunting) di Indonesia, Masalah dan Solusinya. Indonesia Jakarta: Badan Penelitian dan Pengembangan Kesehatan; 2015.
  36. Gaillard R, Rurangirwa AA, Williams MA, Hofman A, Mackenbach JP, Franco OH, et al. Maternal parity, fetal and childhood growth, and cardiometabolic risk factors. Hypertension. 2014;64:266–74.
  37. Das M, Jana A, Muhammad T. Understanding the associations between maternal high-risk fertility behaviour and child nutrition levels in India: evidence from the National Family Health Survey 2015–2016. Sci Rep. 2022;12:17742.
  38. Thoma ME, Copen CE, Kirmeyer SE. Short interpregnancy intervals in 2014: Differences by maternal demographic characteristics. NCHS Data Brief. 2016;(240):1–8.
  39. World Health Organization. Reducing stunting in children: Equity considerations for achieving the Global Nutrition Targets 2025. Geneva, Switzerland: World Health Organization; 2018.
  40. Zhang Z. Model building strategy for logistic regression: Purposeful selection. Ann Transl Med. 2016;4:111.
  41. Zhang G, Bacelis J, Lengyel C, Teramo K, Hallman M, Helgeland Ø, et al. Assessing the causal relationship of maternal height on birth size and gestational age at birth: A mendelian randomization analysis. PLoS Med. 2015;12:e1001865.
  42. Addo OY, Stein AD, Fall CH, Gigante DP, Guntupalli AM, Horta BL, et al. Maternal height and child growth patterns. J Pediatr. 2013;163:549–54.
  43. Fall CH, Sachdev HS, Osmond C, Restrepo-Mendez MC, Victora C, Martorell R, et al. Association between maternal age at childbirth and child and adult outcomes in the offspring: A prospective study in five low-income and middle-income countries (COHORTS collaboration). Lancet Glob Health. 2015;3:e366–77.
  44. Badan Pusat Statistik. Child Marriage in Indonesia in 2013 and 2015. Jakarta: Badan Pusat Statistik; 2016.
  45. UNICEF Indonesia, Ministry of National Development Planning/Bappenas. Formative Evaluation of the National Strategy to Accelerate Prevention of Stunting. Jakarta: UNICEF Indonesia; 2024.
  46. Yiga P. Child growth and determining factors: A case study of Burundi. België: Universiteit Gent; 2016.
  47. Kurniawati A, Sujiyatini, Saputro NT. Association of maternal age during pregnancy with stunting in children age 2–3 years. Informasi dan Promosi Kesehatan. 2022;1:46–53.
  48. Podungge Y, Yulianingsih E, Porouw HS, Saraswati E, et al. Factors determining stunting in children under five. Open Access Maced J Med Sci. 2021;9:1717–26.
  49. Lutfiah U, Besral B, Herdayati M. Individual and regional factors that affect fertility rates in five provinces of Indonesia. Makara J Health Res. 2017;21:6–12.
  50. Fadilah TF, Eliafiana R. Relationship between mothers birth spacing and incidence of stunting in children 24-59 months. Jurnal Biomedika dan Kesehatan. 2022;5:42–9.
  51. Saaka M, Aggrey B. Effect of birth interval on foetal and postnatal child growth. Scientifica. 2021;2021:6624184.
  52. Fanny Dewi TIA, Wirawan NN, Muslihah N. Determinants of stunting in urban and rural areas of Indonesia: A systematic review. AcTion. 2025;10:860–74.
  53. Beal T, Tumilowicz A, Sutrisna A, Izwardy D, Neufeld LM. A review of child stunting determinants in Indonesia. Matern Child Nutr. 2018;14:e12617.
  54. Laksono AD, Wulandari RD, Amaliah N, Wisnuwardani RW. Stunting among children under two years in Indonesia: Does maternal education matter? PLoS One. 2022;17:e0271509.
  55. Hidayat R. Multidimensional analysis of risk factors for stunting in rural South Sumatra, Indonesia: A Community-Based Study. Sci J Pediatr. 2023;1:1–13.
  56. Sekretariat Wakil Presiden Republik Indonesia, Kementerian Koordinator Bidang Pembangunan Manusia dan Kebudayaan, Kementerian Dalam Negeri, Kementerian PPN/Bappenas, Tim Nasional Percepatan Penanggulangan Kemiskinan. Strategi Nasional Percepatan Pencegahan Anak Kerdil (Study) period 2018–2024. Jakarta: Sekretariat Wakil Presiden Republik Indonesia; 2019.
  57. UNICEF Indonesia, Kementerian Kesehatan Republik Indonesia. Toward a Future Without Child Undernutrition in Indonesia. Jakarta: UNICEF Indonesia, Kementerian Kesehatan Republik Indonesia; 2023.

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