Is agriculture connected with stunting in Indonesian children living in a rice surplus area? A case study in Demak regency, central Java

Central Java province plays the main role in the production of food for national stocks in Indonesia, in which Demak is one of the 35 Regencies. Demak Regency had the sixth highest rice productivity in 2013, but at the same time, the seventh highest percentage of child malnutrition. This paradox between high rice productivity and low nutritional status of children triggered an interest in analyzing the correlations between agricultural production of households in the Demak Regency and the prevalence of stunting of children under-five. In December 2014 to February 2015, a cross-sectional survey was carried out in three sub-districts in Demak (Karanganyar, Dempet and Gajah) having the highest rice production and at the same time poor nutritional status of under-five children. The oldest under-five children from farmer family backgrounds were selected. Data on general characteristics, anthropometry of the children, as well as household socio-economics, including agricultural characteristics were obtained. Of the 335 children, 31.9% of them were stunted. A higher proportion of households that grew rice solely or mainly for own consumption (62.4%) and had significantly smaller sized rice-fields (p = 0.041) had stunted rather than non-stunted children. In total, rice production, farm income and agriculture diversity of families with non-stunted children were not significantly different from those of stunted children. However, yearly expenditure for improving family health and environmental conditions were significantly higher among non-stunted than stunted children (p = 0.044). Family decisions about what to spend money on also seemed to influence the nutritional status of the children, rather than nutritional diversity or revenue from agriculture itself. Therefore, improvement of agricultural production and diversity should be accompanied by education on household expenditure.