From silence to salience: The politics of building stunting reduction agenda in Indonesia

Child undernutrition remains a profound global health problem, and if prevented, approximately 45% of global child deaths would not occur (Black et al. 2013). One form of chronic undernutrition, stunting (low height for age), affects approximately 21.3% (144 million) of children under five years globally with the highest levels of stunting prevalence concentrated in South and Southeast Asia and sub-Saharan Africa (Vaivada et al. 2020). Yet, generating a priority for stunting reduction is difficult. The invisible nature of stunting as an issue makes it a less promising win for politicians. When producing public policy, the government is usually driven to get re-elected; and/or to fulfill a public-oriented policy that will be effective in tackling widely acknowledged problems (Schneider and Ingram 1993). The multisectoral nature of stunting makes the issue open to various interpretations with each context requiring its own framing. It can be seen as a health, food security, economic growth, intergenerational rights, or humanitarian issue (Gillespie et al. 2013). Further, nutrition practitioners and researchers are “more interested in the science of nutrition than in the messy business of shaping, promoting, and implementing nutrition policy” (Balarajan and Reich 2016, 3). There are several reasons to believe generating a priority for stunting would be difficult, but Indonesia managed to make stunting a policy priority. Between 2010-2013, Indonesia had the fourth-highest number of stunted children under five years old (almost 9 million) and was among the 34 countries contributing to 90% of the global burden of stunting (Bhutta et al. 2013). For Indonesia, stunting is estimated to cost 2-3% of its GDP per year (World Bank 2015). However, stunting remained a silent emergency for five years until 2018 when the Vice President himself launched a multisectoral stunting reduction policy. In my paper, I aim to analyze the political economy of this policy change by answering the research question: How and why did stunting become a policy priority in Indonesia as demonstrated by the adoption of the National Strategy to Accelerate Stunting Reduction in 2018? To answer the research question, I used a qualitative research design with process tracing as the analytical tool. Data were collected through 26 semi-structured elite interviews in Indonesia between December 2023 – April 2024 and a summative content analysis of Indonesia’s policy and program documents. Understanding that interests, ideas, ideology, interests, and institutions (the four I’s) commonly influence policy outcomes (Fox and Reich 2015), I attempt to uncover the most contributing factors in a way that is not trapped in an “everything matters” perspective (Sil and Katzenstein 2010). In this study, I argue that the salience of stunting in Indonesia’s policy priority was driven in large part by ideas through norm entrepreneurship and policy-oriented learning, rather than by political actors’ self-regarding interests. Connecting political science and global health, my research offers insight into how and why neglected issues emerge on national policy agendas and eventually come to receive attention and resources.