Vol.
No.
March 2025: 30-46 OURNAL of Social Growth and Development Studies Health Quality in Brebes District.
Central Java: Stunting Prevalence in the Light of Galtung's Violence Triangle Ambika Putri Swakartika Sari 1* *1National Resilience Study Programme.
Universitas Gadjah Mada.
Bulaksumur.
Kecamatan Depok.
Kabupaten Sleman 55281.
Daerah Istimewa Yogyakarta.
Indonesia e-mail: ambikaputriswakartikasari@mail.
Submitted: 25/01/2025.
Fixed: 01/02/2025.
Approved: 01/03/2025 Abstract The dynamics of development in one of the regencies in Central Java Province, namely Brebes Regency, is analogous to a Greek mythological Aupandora's boxAy as a metaphor for the Aumany problems and difficulties that exist within itAy.
The AuPandora's BoxAy referred to in the context of development in Brebes District is the low quality of health services characterized by the high prevalence of stunting .
tunted childre.
The research question formulated is why the prevalence of stunting in Brebes Regency.
Central Java continues to occur and what factors are at the root of the problem from the perspective of Galtung's Violence Triangle concept.
The findings of this research are that the high prevalence of stunting is due to the intersection/interconnection between Galtung's three forms of violence.
Direct violence occurs verbally, which hits the psyches of families with stunted children in the form of social stigma and physically in the form of domestic violence, both of which are allowed to become a culture of silence in society.
Structural violence occurs in unfair social structures and systems that further exacerbate poverty and inequality, inadequate access to health facilities and services, low community literacy, especially pre-marital provision knowledge, and unequal access to clean water, environmental sanitation and the absence of local food At the same time, cultural violence also works to strengthen and legitimize the direct and structural violence that occurs, such as the existence of the key.
Key Word: Stunting.
Galtung Triangle.
Violence.
Health This work is licensed under a Creative Commons Attribution-Share Alike 4.
INTRODUCTION
The dynamics of development in Brebes Regency.
Central Java is analogous to the Greek mythological "pandora's box" as a metaphor for the "many problems and difficulties Departing from the "pandora's box" phenomenon, this research tries to explore the phenomenon of stunting as the main focus and topic related to human development as a reflection of health quality elaborated with Johan Galtung's concept of the Triangle of Violence.
Galtung's conception of violence becomes an analytical knife in understanding the dynamics of the various manifestations of factors that cause stunting .
tunted childre.
in Stunting is a national strategic issue as an integral part of malnutrition and acute malnutrition in children.
It is a condition where a child's growth is stunted due to chronic malnutrition from the womb and/or early in life.
The causes of stunting are diverse and have serious long-term impacts on individual children that will accumulate communally in This is a real threat to the growth of children not only in Brebes Regency.
Central Java but nationally in Indonesia which will be a challenge in achieving the Golden Indonesia The health dimension is one of the components to improve the quality of human life, which is organised into the HDI, where the better the human health aspects, the better the quality of human life aspects (Brebes Dalam Data, 2.
Cases of stunting and the various accompanying problems described above are a form of direct, structural and cultural violence in Brebes District.
Central Java.
Galtung formulated the meaning of violence as a barrier that can actually be removed so that violence can also be avoided (Eriyanti, 2.
These barriers can be in the form of murder, racism, poverty, war, which clearly bring down human dignity, due to the loss of freedom for potential realisation and actualisation.
The Health Quality in Brebes District.
Central Java: Stunting Prevalence in the Light of Galtung's Violence Triangle (Ambika Putri Swakartika Sar.
root cause is not only concrete acts of violence that can be directly seen and felt, but the existence of repressive, exploitative and unjust structures.
Windhu .
contributes to understanding the concept of violence expressed by Galtung that violence does not make much difference between someone dying quickly with a bullet, dying of hunger due to ongoing military attacks, or dying slowly due to lack of food as a result of vertical and asymmetrical structures that cause inequality and injustice.
Figure 1: Galtung's Violence Triangle Trilogy Teeth Source: Sari.
et al.
, 2020.
Galtung expands the meaning of violence that is always related to the temporal dimension: direct violence is an event.
structural violence is a process.
and cultural violence is permanently attached to both .
In this research, the concept of the three is narrated and illustrated as the gears of a machine that move together in relation to each other.
In line with previous research, inequality and injustice are the result of "power" giving birth to "violence".
Galtung argues that direct and structural violence is "justified" or "legitimised" through the cultural violence rooted in both violence (Indonesian Journal of Global Discourse (IJGD), 2.
Galtung argues that peace is not only no violence or nonviolence, but when injustice and inequality still occur in the community of Brebes Regency.
Central Java, which in this case is a case study of the prevalence of stunting as part of the violence itself, it ultimately distances this area from peace and prosperity.
It is important to remember that stunting is a problem that can be prevented through collegial collective efforts with strategic and comprehensive steps involving multi-actors, so as to create a healthy, smart and productive future generation.
Based on the description of the problem above, the research question was formulated, namely why the prevalence of stunting in Brebes Regency.
Central Java continues to occur and what factors are at the root of the problem from the perspective of Galtung's Violence Triangle concept.
This research aims to analyse the factors that influence the prevalence of stunting in Brebes Regency from the perspective of Galtung's Violence Triangle concept.
This concept sees violence as a multidimensional phenomenon consisting of direct violence, structural violence and cultural The complexity of the issue of stunting prevalence in Brebes Regency is seen to be explored and understood further through Galtung's three types of violence.
This research has a dependent variable, namely the prevalence of stunting, and an independent variable in the form of Galtung's triangle of violence.
The hypothesis or framework is based on the use of concepts or theories that are sharpened by literature review, so this research can temporarily suspect that stunting is caused by the manifestation of the interconnection cycle between Galtung's three violence: direct violence .
erbal and physical violence received by children and families with stunted children deaths of mothers, infants, toddlers caused by stuntin.
, domestic violence, structural violence .
overty levels, limited access to health services and facilities, community literacy levels, quality of clean water and environmental sanitatio.
, cultural violence .
he existence of inappropriate parenting practices, mystical beliefs, cultural values and norms related to food, health, children and the existence of stigma that develops in the communit.
RESEARCH METHODS
The research design used in this study is qualitative with a case study approach.
This OURNAL of Social Growth and Development Studies Vol.
No.
March 2025: 30-46 design allows researchers to explore the quality of health in Brebes Regency.
Central Java, related to the prevalence of stunting from the perspective of Galtung's triangle of violence.
This research also applied triangulation of data sources by exploring the truth of certain information through various methods and sources of data acquisition (Creswell and Miller.
This research was conducted in Brebes Regency.
Central Java Province.
This research used data collection techniques through observation, in-depth interviews, literature study and documentation.
The data analysis technique used in this research is qualitative analysis to process and analyse the collected data into systematic, regular, structured, and meaningful RESULTS AND DISCUSSION The Irony of Healthcare Quality: The Issue of Stunting Prevalence in Brebes Regency The dynamics of understanding violence have increased to include forms of violence that are less tangible but can also be destructive and perhaps even more difficult to overcome.
Society finds it difficult to distinguish between gun murders and killings due to lack of food and other basic necessities of life.
In each case, violence inflicts suffering on others.
This can be intentional or simply due to negligence in taking into account the needs of other people or communities (Fisher, 2.
In the book Roots of Violence in Indonesia:
Contemporary Violence in Historical Perspective, several conclusions about violence are presented, namely:
First, violence occurs because there is a "justification" created to legitimise violence.
For example, in the case of the 1965 tragedy, the justification was the "ghost" of In the case of the 1998 tragedy, the justification was stereotypes and prejudices against ethnic Chinese.
Secondly, violence occurs because the group that is the target of violence is believed by the perpetrator to be "not fellow human beings as equals" and therefore it is okay to be mistreated.
Third, violence occurs because of the weakness of the state .
aw or authorised apparatu.
as we see cases of violence where the apparatus, security forces, and local government have ignored the violence that occurred, instead of reducing and stopping it.
This research underlines that the prevalence of stunting in Brebes Regency as part of an act of violence is not only committed by individuals .
others/father.
as members of the community, but there is also a share of repressive and unfair structures that cause problems in efforts to increase development capability.
Policies produced by local government structures that tend to be repressive and unfair towards all communities in Brebes District are a reflection of the poor health dimension.
This has led to social and economic inequality, where the poor will become more entangled in the poverty chain and the rich will become In line with the Indonesia Economic Inequality Report 2024: Jet Planes for the Rich.
Bicycles for the Poor published by the Center of Economic and Law Studies (Celio.
in September 2024, most of the people at the bottom of the pyramid who depend on informal work do not have social protection guarantees amid the storm of layoffs, soaring prices of basic commodities and salaries limited to the minimum wage.
Ironically, while portraits of the lower classes in various countries show overt protests to the government.
Indonesians show remarkable calm and acceptance in the form of simplicity and hope (Askar et al, 2.
It is this culture of accepting Indonesian society that further emphasises the disparity of human development and certainly keeps people away from the meaning of healthy, smart, prosperous and prosperous.
Askar et al.
highlight that while extreme poverty is progressively fought with a target close to zero per cent, inequality is tolerated without significant intervention (Askar et al.
, 2.
This study found that there have been inequalities and injustices in obtaining basic health rights for the PBI (Penerima Bantuan Iura.
group in the participation of the BPJS Health National Health Insurance (JKN) programme in Brebes Regency.
The BPJS Kesehatan participants of the PBI group in Brebes Regency have had their payments deactivated by the Social Affairs Office due to limited budget factors to cover 58 thousand people since November 2023 until now .
etikJateng.
The reason for budget efficiency from the limited APBD of the Brebes Regency Government is a paradox in achieving the quality of basic health that has been mandated by the constitution.
Every citizen is entitled to free basic health services, especially the PBI Women by The Sea: Role Dynamics and Economic Transformation in Maringkik Island (Ikmal Maulana.
Restu Nirwana.
Ihfan Rahmawad.
group, the majority of which come from informal workers, the poor, orphans and abandoned Although the Brebes Health Office stated that BPJS PBI membership can be reactivated by applying for an SKTM or Certificate of Incapacity, since 2024 the service of making SKTM at the Village / Sub-district Apparatus and Brebes Social Affairs Office cannot be done anymore (Interview with Mr Topari as a Researcher and Observer of Public Policy in Brebes Regency on 9 January 2.
Unequal power relations between powerful parties in Brebes Regency, especially in terms of control of economic assets, have even penetrated to the level of practical politics.
The power structure dominated by elites, families or companies greatly influences political contestation in changing the leadership baton in Brebes Regency.
Central Java.
This is evident from the Brebes Regency Regent Election in the 2024 Simultaneous Regional Election held on 27 November 2024 won by 1 single candidate namely Paramitha Widya Kusuma.
who was accompanied by Wurja.
against an empty box.
The victory of this single candidate indicates the purchase of all 12 supporting political parties and has the potential to form policies that are not in favour of the people because there is no opposition party to balance the winning party.
The political system currently run by the Brebes Regency Government increasingly supports the inequality and injustice felt by people at the grassroots.
This is due to the absence of policy control in favour of the community, especially in improving the quality of This condition reflects the non-transparent use of APBD and PAD due to the political process of "buying and selling power" and a government structure that tends to be repressive and prioritises "cake sharing" as a reward for winning elections.
This indicates that there will be studies and policy outcomes that do not favour the welfare and prosperity of every individual in the wider community, especially to achieve basic health needs.
According to Neil Arya in the Handbook of Peace and Conflict Studies Part 4: Peace across the disciplines entitled "peace through health?", peace and health have similar definitions both negative and positive and of course health is a fundamental human right especially for children.
Poor health and illness can be linked to war and violence.
The WHO .
defines health holistically as a state of complete physical, mental and social wellbeing, rather than simply resting on a definition of the absence of disease or infirmity (Arya, in Webel & Galtung .
), 2.
Therefore, reducing the forms of Galtung's triangle of violence in this study is a reminder that it is the professional responsibility of all actors involved from upstream to downstream to improve the quality of health in Brebes District.
Central Java.
Figure 2: Prevalence of Malnutrition and Stunting in Brebes District 2018-2022 Source: Brebes Baperlitbangda Report on Strategies to Improve the Human Development Index (HDI) of Brebes Regency.
June 2023 The infographic above shows that the prevalence of malnutrition and stunting experienced by toddlers and children in Brebes District.
Central Java has increased compared to the other 4 regions in the Central Java region in 2022.
If you look at the other infographics presented above, then during the last 5 years from 2018 - 2022 there has been an increase in stunting cases or an indication of an escalation of cases from malnutrition to While the national target for stunting prevalence is at 20%, this is a paradox in the accelerated stunting prevention programme in Brebes District.
Central Java.
However, this is considered a booster or encouragement for stakeholders and policy makers in stunting prevention efforts in Brebes District to improve the quality of living standards of its people in the future.
OURNAL of Social Growth and Development Studies Vol.
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March 2025: 30-46 Figure 3: Data on Prevalence of Stunting in Brebes Regency 2020 - 2024 Source: Annual Report of Acceleration of Stunting Reduction in Brebes District Semester 1 Developmental efforts in handling stunting by the Brebes Regional Government in Central Java in preventing stunting are still a challenge for the 2045 Golden Indonesian The difference in field data as illustrated in the graph above comes from first, the simultaneous weighing carried out by the Brebes Health Office every year in February and August with the attraction of providing Vitamin A for mothers and babies brought to the nearest Posyandu or Puskesmas and second.
SSGI and SKI conducted by enumerators from the Indonesian Ministry of Health with and without assistance from the Brebes Health Office.
The prevalence of stunting in Brebes District is far below the national target of 20% (Interview with Mrs Nurul Aeny as the Family Nutrition and Health Unit of Brebes Health Office on 8 October 2.
Figure 4: Data on Prevalence of Stunting in Brebes Regency in 2018 - 2023 Source: Brebes District Convergence Action to Accelerate Stunting Reduction in 2023 Developmental efforts in handling stunting by the Brebes Regional Government in Central Java in preventing stunting are still a challenge for the 2045 Golden Indonesian The difference in field data as illustrated in the graph above comes from first, the simultaneous weighing carried out by the Brebes Health Office every year in February and August with the attraction of providing Vitamin A for mothers and babies brought to the nearest Posyandu or Puskesmas and second.
SSGI and SKI conducted by enumerators from the Indonesian Ministry of Health with and without assistance from the Brebes Health Office.
The prevalence of stunting in Brebes District is far below the national target of 20% (Interview with Mrs Nurul Aeny as the Family Nutrition and Health Unit of Brebes Health Office on 8 October 2.
Despite these differences in data trends, the Brebes Regency Government continues to optimise the Stunting Reduction Acceleration Team (TPPS).
All of the Brebes district government's DPOs are responsible for conducting an accelerated stunting reduction programme with a sub-district model that includes sub-districts or villages (Interview with Mrs Harnie.
Head of Pemsosbud Baperlitbangda Brebes on 13 September 2.
However, in accordance with the findings of Nurva & Maharani .
, the Brebes Regional Government, which has implemented a policy to accelerate the handling of stunting, still faces challenges and requires a revision of the policy strategy.
Funding sources for the accelerated stunting management programme in Brebes come from various sources ranging from DAK.
APBD.
Women by The Sea: Role Dynamics and Economic Transformation in Maringkik Island (Ikmal Maulana.
Restu Nirwana.
Ihfan Rahmawad.
APBN, and CSR.
Decision-making for stunting is handled by DP3KB in continuous coordination with Brebes Health Office and Baperlitbangda Brebes.
However, the author found that there are sectoral egos between the three OPD agencies, especially the informant from DP3KB as the Head of Population Control who has a tendency to be reluctant or object to additional tasks related to the TPPS.
The author also obtained information from Ibu Sri Ayati, a cadre from Pebatan Village, that there are actually many children in the stunting category, but she stated that reporting in the field is only according to the usual data.
If there is a significant difference, the village midwife will be scolded for affecting the performance of the village government as well as the fact of the iceberg phenomenon due to the culture of silence and allowing stunting to continue (Interview with Ibu Sri Ayati as Posyandu Cadre.
TPK Cadre.
PKM Cadre in Pebatan Village.
Wanasari Subdistrict.
Brebes District on 9 January 2.
Direct Violence Identification Direct violence is an act of aggression or physical assault by individual actors (Galtung, 1.
The source of direct violence comes from the aspect of control .
accompanied by strength .
as a privilege possessed by a dominant person or group.
For example, one-on-one violence between men and women occurs massively at all social levels, from the family .
n the private/domestic spher.
to society .
n the public spher.
This is in line with Eriyanti's .
mapping, which elaborates between Galtung's concept of violence and the manifestations of gender injustice experienced by women.
In addition to the classic forms of direct violence that physically harm a person that are common on the battlefield such as murder, torture, rape and sexual violence.
Galtung recognises other forms of direct verbal violence such as insults (Eriyanti, 2.
Direct violence in this paper refers to verbal violence that affects the psychology of a child and family members who have stunted children, where this form of violence intersects with cultural violence as part of labelling, stereotyping and social stigma that develops in society.
Direct violence is considered a violation of basic human needs and widely recognises other forms of direct verbal violence such as insults (Eriyanti, 2.
Galtung asserts that when a person, a group or a state engages in ways of physical violence that have no direct impact, there is an indirect threat that limits human action in the form of mental violence that can be characterised as some form of psychological violence (Galtung, 1.
In line with Galtung.
Salmi.
argues that indirect violence that endangers and threatens human life is due to passive neglect and mediated violence as a result of intervention in the lives of other human beings.
Direct forms of violence intersect with cultural violence as part of the labelling, stereotyping and social stigma that develops in Brebes Regency society.
Cultural violence is an invisible driving force that has an impact on the continuation of direct and structural According to the interviewees of this research, namely Ibu Saminih.
Ibu Sumiyati and Ibu Astuti as TPPS activists as well as Posyandu cadres.
TPK cadres.
PKM cadres in Pesantunan Village.
Wanasari Sub-district.
Brebes District, there is no "mockery" or ridicule of families, especially mothers who have children who fall into the stunting category.
Furthermore, mothers "hang out" at the Posyandu to confide in each other or share stories about how to make their children stunting-free with Posyandu cadres, as well as checking their children and taking nutritious food rations from the Pesantunan Village Healthy Kitchen or Dasyat.
However, when the author tried to ask the informant Mrs NK, who has a stunted child, stated that the neighbours and the environment around her house, which is dominated by family and close relatives, every time she is pregnant and gives birth, she gets jokes or jokes "how come the child is small, the mother is big?" .
hy is the child small but the mother is big?).
This condition has been experienced by Mrs NK from the first child to the third child that the author met.
All three of her children experienced BB and TB deficiencies, but over time and education from Posyandu cadres, her two children have been free of stunting and the third child who is 2 years old is in the process of improving his nutritional status.
This was also found when the author visited Mrs SL who has 3 children and all three were born with very low BW and TB and fell into the stunting category even though the children were healthy and quite active in interacting.
Her first and second children have been freed from stunting and currently her third child is being monitored regularly so that her nutritional status can improve.
Seeing from the lack of understanding why her three children OURNAL of Social Growth and Development Studies Vol.
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March 2025: 30-46 are in the stunting category even though they have been given nutritious food and the condition of their children is healthy, it can indicate improper parenting patterns since pregnancy began.
Another condition was found in Mrs R who had a 4-year-old stunted child who could not yet walk and had prolonged diarrhoea.
The mother and child earn a living by begging in the Batang Market area around Brebes Square because her husband is a coolie who only works when he gets a call.
The extreme poverty experienced by the family is coupled with the experience of domestic violence experienced by Mrs R who claimed to have been kicked, hit, and knocked down by her husband but she chose to remain silent and accept these The author found that there is still a belief or belief that develops in the Pesantunan Village community that children who are born small and fall into the category prone to stunting are caused by parents .
others and father.
who are also small or thin.
This is in line with research conducted by Siti Novianti .
who found that there is a stigma related to stunting which is considered to be related to short parental heredity, even though health workers and cadres .
have provided education about stunting and acute There are variations in mothers' understanding, knowledge and behaviour related to stunting as well as policy aspects regarding stunting, both the budgeting process and the implementation of activities in the field at the village level.
Pesantunan Village became a pilot village for stunting eradication in Brebes District because it was proactive in its efforts as the Village Level TPPS.
Identification of Structural Violence Galtung .
emphasises another form of violence that does not directly harm or kill, but rather the social structures that cause poverty, economic inequality or socio-political injustice in a society.
Susan .
draws from Galtung's structural violence by looking at the injustice created in a system so that individuals are powerless to meet their basic needs, which can be felt by feelings of insecurity towards repressive institutions whose actions are legalised by political policies, for example the state.
This violence is difficult to find a "mastermind" because it is inherent in the structure itself and is created unequally, causing people and social groups to be oppressed, making it difficult to live.
The context of structural violence in this study is the existence of injustice, inequality and unequal access to basic health services.
Even the extreme poverty faced by certain community groups in Brebes Regency also proves that structural violence is real, but not realised by most Brebes people.
Galtung's thinking can be used to understand that inequality or in other diction, unequal power relations between individuals and between certain groups of people cause marginalisation.
Of course, if the Brebes Regional Government does not fix the prevalence of stunting that occurs by comprehensively exploring the root of the problem, it will have an impact on the continuation of direct violence, namely children growing up with malnutrition, malnutrition and at the highest level of stunting.
Galtung explained that structural violence forms negative situations and conditions in life such as inequality of resources, income, education and other injustices.
Extreme cases of structural violence can be very repressive and cause psychological paralysis for victims, even unwittingly causing victims to be unable to carry out their vision of life because they are in a miserable position and do not have the comfort of life (Susan, 1.
Galtung's explanation is in line with research related to the issue of stunting prevalence in Brebes Regency.
Central Java, which the author found below:
Poverty and Inequality The chain of improvement in health .
, education .
and employment .
as illustrated to get to Advanced Indonesia needs to be done by paying attention to the main factors that are the key to success in improving the quality of life standards of the Indonesian people, namely health, education, employment.
The premise is that when people are healthy, they will be able to study well, when the results of learning are useful knowledge, they will have a job with a decent wage or salary as a reward for the work done, so they will be able to invest in health and education.
Adequate health will affect the quality of Human Resources (HR) which in turn builds the welfare of the community itself (Raymond Chin, 2.
The cycle above is a form of implementation of HDI measurement, namely healthy as the health dimension, smart as the education dimension and prosperous as the economic dimension.
Women by The Sea: Role Dynamics and Economic Transformation in Maringkik Island (Ikmal Maulana.
Restu Nirwana.
Ihfan Rahmawad.
Research findings from Smeru Research Institute .
on poverty in Indonesia from 1993 - 2014 state that 40% of children born into poor families will remain poor as adults.
There is an 87% income penalty suffered by children born into poor families than children who do not grow up in poor families.
Thus, structural poverty is indicated to exist in the lives of Indonesians.
Structural poverty is the phenomenon of poverty whose conditions are isolated from social and environmental structures that prevent the poor from getting out of A person living in poverty must have limited access to quality education.
When growing up in a poor family, they are often burdened to help the family economy, so they drop out of school and find it difficult to lift the family economy.
This then has an impact on the tendency of difficult access to adequate resources, coupled with the absence of government efforts to seriously deal with poverty.
The gaps and inequalities experienced by the poor are even more costly than those experienced by the middle class and above, such as buying clean and consumable water.
Ironically, while extreme poverty is progressively fought with a target of close to zero per cent, inequality is tolerated without significant intervention.
Economic inequality in Indonesia is commonly measured through Indonesia's Gini Index based on World Bank estimates or the Gini Ratio (Askar et al.
, 2.
The Centre of Economic and Law Studies (Chelio.
study titled "Indonesia's Economic Inequality Report 2024: Jet Planes for the Rich.
Bicycles for the Poor" published in September 2024 shows that the number of poor people in Indonesia is actually higher than that detected by BPS Indonesia because it uses household consumption as the basis for its calculations, not income (Askar et al.
, 2.
The super-rich tend to save and invest their income, while their daily consumption is not equal to their wealth.
Drawing on the above description of structural poverty and inequality, the poor in Kabupaten Brebes.
Central Java are finding it increasingly difficult to access adequate health and education services.
The impact is on the increase in stunting cases, which is a chronic malnutrition problem in toddlers and children who are short in stature, tend to be vulnerable to disease, below average intelligence and low productivity.
According to the WHO, an area is said to be chronically stunted if the prevalence of stunting is above 20%.
According to the Indonesian Ministry of Health, 1 in 3 toddlers in Indonesia suffers from stunting .
For this reason, the Indonesian government in the era of President Joko Widodo intensified the strategic issue of accelerating the reduction of stunting, and this issue even became the idea of launching a free nutritious lunch programme for Indonesian children by the president-elect for the 2024-2029 period during the Simultaneous Elections on 14 February 2024, namely Prabowo Subianto.
This is contained in an 88-page document that contains "Joint Vision of Advanced Indonesia Towards Golden Indonesia 2045, 8 Missions (Asta Cit.
, 8 Quick Best Results Programmes (PHTC), 17 Priority Programmes and Work Programmes" for the 2024 Presidential Election process.
In order to achieve these big goals, problems such as pregnant parents experiencing a lack of nutritious intake and eventually giving birth to children with low IQ and the issue of hunger in the community and efforts for national food selfsufficiency (Raymond Chin, 2.
became the number one Best Quick Results Programme (PHTC) through the provision of free lunches and milk in schools and Islamic boarding schools balanced with nutritional assistance for children under five and pregnant women.
Stunting is a priority for the government to ensure the achievement of good quality human resources and quality of life.
The programme targets more than 80 million beneficiaries with 100% coverage by 2029 (Koalisi Indonesia Maju, 2.
Sadly.
BPS data shows that the poverty line in Brebes Regency shows an increasing trend every year from 2016 to 2023.
However, the rupiah income per capita per month obtained by the people of Brebes Regency, which is at IDR 513,339, is still far below the standard set by BPS RI, which is IDR 535,547 per month.
This is reinforced by the Brebes Health Office regarding the factors that cause stunting in Brebes District, namely extreme poverty due to low family income, family education, environmental sanitation and access to clean water.
One of the portraits of poverty that hits the northern coastal areas such as in the fishing villages in Pasarbatang Village.
Brebes Subdistrict.
Tanjung Village.
Tanjung Subdistrict and Kluwut Village and Grinting Village.
Bulakamba Subdistrict.
Brebes Regency, where the majority of people depend on the sea for their livelihood, preferring to sell all the fish they catch that day to buy rice, instant noodles, or packaged snacks whose nutritional value is far below the consumption of sea fish.
OURNAL of Social Growth and Development Studies Vol.
No.
March 2025: 30-46 Access to Health Facilities Inadequate access to health facilities .
edical personnel and infrastructur.
disproportionate to the population is a manifestation of structural violence that contributes to the prevalence of stunting in Brebes District.
Central Java.
The health system is not optimal, especially in the immunisation phase for toddlers and incomplete children, which can increase the risk of children getting infectious diseases that exacerbate stunting.
Limited access to transport due to distance to health facilities is an obstacle to obtaining basic health services, education and education related to balanced nutrition information.
Newborn babies need to receive basic health facilities such as immunisation to avoid an increased risk of infectious diseases.
In addition, the number of basic immunisation coverage in Indonesia has not reached the national standard coverage.
This is based on research by Deviana, et al .
who analysed the coverage of complete basic immunisation of infants in high-risk areas in Brebes Regency in 2019 with the target of mothers who have children aged <2 years.
The findings show that there are still many infants who have not received complete basic immunisation and the accuracy of basic immunisation for infants is still low due to mothers' knowledge, perceptions, attitudes, and beliefs (Deviana, 2.
The coverage of the ratio of medical personnel or health workers in the form of doctors, nurses, midwives to the ratio of health facilities in the form of hospitals and health centres in Brebes Regency is shown in the data below.
Based on the data reported by Baperlitbangda Brebes, only 1 out of 5 health facility coverage meets WHO standards or criteria, namely the availability of at least 1 Puskesmas in each sub-district.
The availability of 38 Puskesmas in Brebes Regency successfully covers the needs of 17 sub-districts, 5 villages, and 292 villages.
Inequality in access to health services, health facilities and infrastructure, the ratio of health/medical personnel exacerbates stunting conditions in toddlers and children, leading to direct violence in the form of maternal and infant deaths.
This makes it difficult for the community to obtain information and knowledge related to Clean and Healthy Lifestyle (PHBS), patterns of child development and care from the womb until the child is born and raised, sourced from midwives at the Puskesmas or Posyandu cadres.
The contour of Brebes Regency, which is very wide ranging from coastal to mountainous areas with the characteristics of a very dynamic community cultural background, is a challenge for medical personnel and the Brebes Regency Government to be able to alleviate stunting.
Stunting is the number 1 contributor to the infant mortality rate (IMR) in Brebes District according to the Nutrition and Family Health Unit of Brebes Health Office.
The problem of maternal and infant mortality in Brebes Regency is related to the unequal access to health facilities throughout the region.
Mothers and babies experience delays during the handling process by health workers, decision-making in determining where to give birth, coupled with the vulnerability factors possessed by high-risk pregnant women.
Although MMR and IMR experienced a downward trend from 2018 to 2022, the IMR until the third quarter of 2022 was the highest in Central Java.
The data from BPS Brebes District in Figures Year 2024 (Quarter I) shows that in 2023 there were 1 in 23 babies born malnourished, this has not been added to low birth weight babies, which if the two issues above are not seriously prevented, will increase to stunting.
The number of babies born throughout 2023 in 17 sub-districts in Brebes Regency.
Central Java was 27,412.
Of these, 1,525 babies with low birth weight (BBLR) were immediately referred, but sadly as many as 1,200 babies were malnourished.
According to Topari .
, service coverage for children under five in the age range of 12-59 months who receive growth and development monitoring services every month and at least 8x a year and then recorded in the KIA/KMS Book.
Therefore, the effort promoted by the Brebes Health Office team is to conduct simultaneous weighing every February and August each year with free Vitamin A as an attraction so that people want to bring their babies and toddlers to the nearest Posyandu or Puskesmas.
Low Education and Knowledge of Premarital Provisions The portrait of education problems in Brebes District.
Central Java is intertwined with the decreasing number of students at each level of education during the 9-year compulsory education programme.
There has been a decrease in the percentage of students attending school at each level of education, from primary school, junior high school to senior high Women by The Sea: Role Dynamics and Economic Transformation in Maringkik Island (Ikmal Maulana.
Restu Nirwana.
Ihfan Rahmawad.
school, indicating that there are children who have dropped out of school and are not continuing their education.
This is one of the factors triggering the high rate of early marriage among the people of Brebes District.
Apart from formal education at school, another factor is the absence of adequate pre-marital provision obtained by prospective bride and groom .
usband and wif.
so that it affects knowledge related to Clean and Healthy Lifestyle (PHBS), development patterns and childcare from the womb until the child is born and raised.
In the end, it will strengthen the factors that cause stunting children due to the lack of information filtering from various literacy or misinformation obtained by the Improvements in education will greatly affect the quality of the population who are well educated and correct.
Education is an integral part of development as an indicator of progress through improving the quality of human resources so that they can manage the natural resources owned by an area in an appropriate and targeted manner (Brebes Dalam Angka 2024 Quarter 1, 2.
In line with the explanation of the Head of Nutrition and Family Health of Brebes Health Office regarding the causal factors of the growth of stunted toddlers and children in Brebes Regency, one of them is the low level of family education.
Early marriage or marriage that is carried out at a young age, the majority > 18 years and < 25 years, if equipped with careful preparation, such as financial readiness, emotional stability, knowledge about the process of pregnancy, childbirth, breastfeeding and the right parenting process, will not be a problem in the future.
However, a paradox arises when linking marriage and divorce in Brebes District.
Central Java.
The high rate of early marriage is also quite in line with the high divorce rate with the majority of the causes being economic factors.
Data from Brebes Dalam Angka 2014 (Quarter I) shows that the number of divorces by factor as well as by sub-district in Brebes District throughout 2023 was highest due to economic factors, with 3,546 cases out of a total of 4,586 divorces.
Divorces that occurred were dominated by people in transit areas to and from Brebes such as Ketanggungan.
Larangan.
Banjarharjo and sub-districts on the north coast of Java Island (Pantur.
such as Bulakamba.
Brebes.
Wanasari.
Losari.
Tanjung.
Although the community has low education or higher education, it cannot be denied that it will have implications for the increase in stunting cases in Brebes Regency.
This is allegedly due to the lack of adequate premarital education and provision for prospective husband and wife couples, which ultimately impacts on the wrong pattern of preparation for having children and parenting patterns during the 1000 HPK period.
Several cross-sectoral informants in 3 OPDs of Brebes district government, namely Baperlitbangda.
DHO, and DP3KB, confirmed this.
Starting from chronic malnutrition experienced by mothers since conceiving a baby who lack education related to balanced nutrition, the absence of support from the closest family, continues when the baby is born there is an inappropriate parenting This will be explained further in the section on cultural violence.
Unequal Access to Resources In line with the author's previous research, inequality and injustice are the result of "power" that gives birth to "violence" (Sari, 2.
The context is a significant difference in access to clean water, proper sanitation and a food diversification system to alleviate stunting that has not been maximised by the Brebes Regional Government.
Dependence on certain commodities and lack of food diversification causes vulnerability to fluctuations in food prices and availability.
Furthermore, less environmentally friendly agricultural practices can pollute soil and groundwater and impact the quality of local food.
This is in line with the explanation of the Nutrition and Family Health Unit of the Brebes Health Office related to the excessive use of chemical pesticides in the Pantura area, the majority of which are onion farmers who also have a high prevalence of children affected by stunting.
According to him, babies born there are malnourished or malnourished, which if it reaches the chronic stage, the status rises to stunting, which is found in pockets of areas with agricultural areas that use excessive pesticides so that clean water is polluted.
According to the Head of Social and Cultural Affairs of Baperlitbangda Brebes, the lack of access to clean and proper water is because PDAM (Regional Drinking Water Compan.
has not yet reached all villages in Brebes District.
In addition, there is a threat of drought that occurs in the hilly ridges in the central to southern areas of Brebes Regency.
Although there are several dams or artificial reservoirs in the southern region of Brebes Regency, it does not rule out the possibility of a drought OURNAL of Social Growth and Development Studies Vol.
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March 2025: 30-46 disaster when not well prepared by the community and local government.
Of course, the availability of clean water is one of the vital infrastructure factors for communities, whether in rural or urban areas.
The household health survey shows that many households in Brebes District, especially in rural coastal areas, have difficulty accessing clean water and proper sanitation, with the main source of drinking water still coming from polluted rivers or wells.
Lack of access to clean water can increase the risk of infectious diseases that can stunt growth and exacerbate stunting.
Furthermore, the food system is unsustainable with dependence on certain food commodities such as rice and the absence of healthy and nutritious food diversification, resulting in an uneven food distribution process and hampering the distribution of nutritious food and access to health facilities.
Research from UGM has made zinc fortified rice to improve nutrition consumed by the community in areas with high stunting rates in the Pantura region, namely Brebes District.
Wanasari and Bulakamba.
Identification of Cultural Violence Cultural violence presents itself as something that is right or at least seems not wrong when direct and structural violence occurs (Eriyanti, 2.
Galtung expressed his thoughts on cultural violence as something that has been cultivated in society as attitudes and beliefs that prevail and are taught since childhood in everyday life, but this should be resisted.
Cultural violence legitimises acts of direct violence and structural violence to make them seem right - or at least not wrong so that they can be accepted in society.
As such, cultural violence is not as directly visible as the operations of structural violence and is more lethal because it causes an escalation of direct violence.
Galtung provides a definition of the concept of cultural violence by referring to aspects of culture and symbolic environments such as religion, ideology, language and art, empirical science and formal science .
ogic, mathematic.
to justify or legitimise direct violence or structural violence (Galtung, 1.
What needs to be done to confront cultural violence is to identify and pinpoint the cultural elements that are used to legitimise direct or structural violence.
Thus, understanding the root of the problem is to show how cultural violence operates in both the acts and processes of cultural violence - which we initially fail to recognise - to become visible and recognisable (Gursozlu, 2.
Cultural violence is the driving force behind the continuation of structural and direct violence.
This is because cultural violence foregrounds aspects of culture such as ethnic differences, religion, ideology, religion, language and art that are used to justify the actions of the two previous violences (Susan, 2.
Galtung's cultural violence in this study focuses on the justification of values, norms and ideologies that legitimise injustice and violence itself such as gender discrimination, mystical beliefs about health, and stigma against stunted children.
Galtung sees that violence is the opposite of peace and anti-development because it hinders the process of personal realisation and growth.
Windhu .
states that Galtung understands the concept of power as a multi-faceted diamond and understands violence as a tart that is sliced and then reveals many dimensions.
If contextualised with the prevalence of stunting in Brebes Regency, then the justification for the prohibition of immunisation, inappropriate parenting patterns, stigmatisation of stunting sufferers and their families, and a patriarchal society reinforce a dilemmatic cycle of violence that has unwittingly occurred and institutionalised as norms and practices that encourage the ongoing cases of stunting in toddlers and children in Brebes Regency.
Central Java.
Immunisation Ban The beliefs of the Islamic community .
certain grou.
in the coastal area of the North Coast of Java (Pantur.
, precisely in Kluwut Village.
Bulakamba District.
Brebes Regency.
Central Java, are that the immunisation process for children and toddlers is haram.
The Islamic group believes that immunisation is an act of polytheism or associating partners with Allah SWT, the One True God.
They believe that man-made immunisation is considered to violate what has been destined, outlined and given by Allah SWT God Almighty.
So, the immunisation process for toddlers and children is often not allowed by the local community.
The Brebes Health Office even brought in Islamic religious leaders to preach in the Kluwut area about the importance of the immunisation process for the growth and development of Women by The Sea: Role Dynamics and Economic Transformation in Maringkik Island (Ikmal Maulana.
Restu Nirwana.
Ihfan Rahmawad.
This is reinforced by research conducted by Deviana, et al .
who argue that there are various reasons parents do not immunise their babies or immunise them but not according to the established schedule.
First, parents are busy working, parents who forget, children who are sick, the distance of the immunisation place, there is a fear of parents that when their children are immunised they will become sick, prohibitions from the family and community beliefs about immunisation are haram.
For this reason.
Brebes Regency has launched the Joint Movement for Immunisation Care (Gabes Limu.
at the Brebes Indonesian Doctors Association (IDI) Building on 10 April 2019 stating that the immunisation programme is an effort to improve public health and has proven to be the most cost effective since it began in 1956 to prevent the transmission of several diseases such as tuberculosis, diphtheria, pertussis, measles, polio, tetanus, hepatitis B, and pneumonia .
Prevention of diseases that can be prevented by immunisation (PD3I) above can inhibit the severity of stunting cases experienced by under-fives and toddlers.
The aftermath of the COVID-19 pandemic has posed major challenges to routine immunisation activities in Indonesia, resulting in a large number of children not receiving or only partially receiving immunisations.
The result is that they may potentially suffer from PD3Is which can exacerbate the incidence of malnutrition to an acute level known as stunting (WHO Indonesia, 2.
Therefore, immunisation as a crucial process as protection for infants requires support from various parties, ranging from the government, community leaders to families to increase awareness of complete basic immunisation for infants (Deviana et al.
, 2.
Basic immunisation is important to increase the immunity of infants and toddlers in preventing the transmission of viruses and bacteria that can exacerbate the incidence of stunting.
Patriarchal Society Patriarchy is a system of social structure with male dominance, so it tends to oppress and exploit women (Walby, 1.
Patriarchy in a society legitimises male dominance that leads to structural violence against women, in the form of marginalisation, fragmentation, penetration and segmentation as part of exploitation (Eriyanti, 2.
Patriarchy forms beliefs that normalise and justify structural violence that is rooted in repressive and unjust structures that lead to direct violence that kills one's potential.
This culture is the main cause of continued violence in Galtung's conception of violence.
There is a mechanism to obscure the reality of violence, making it appear acceptable (Eriyanti, 2.
A clear portrait of the patriarchal scheme in Indonesian society in the issue of stunting prevalence that continues to occur is the absence of figures, roles or figures of husbands and fathers who collaborate with their wives since pregnancy, childbirth, breastfeeding, providing complementary foods until the baby or child born grows healthy with balanced nutrition.
The process of caring for, educating and understanding the growth and development of children is mostly imposed by the husband on the wife, whether the wife works in the domestic or public sphere.
This creates a double burden for wives and mothers of children who are born and becomes commonplace, normalised, justified in a patriarchal society.
Indonesia is the third highest fatherless state in the world (Kompas.
This problem has become an international problem, where most cases in Western countries are fatherless due to unmarried fathers and mothers.
The problem in Indonesia is that fathers and mothers are married, but the implementation of parenting duties is neglected or not fulfilled.
Many children have a physical father but at the same time have no psychological father (Ashari.
Therefore.
Galtung emphasised the need for gender equality to reduce violence against women by advocating parity rather than matriarchy as a solution to patriarchy.
Galtung believed that structural changes are needed to achieve gender equality between men and women can work together to eliminate various forms of violence through empathy and co-operation which is essential to fostering a peaceful society (Eriyanti, 2.
Drawing from the explanation above, the role of gender equality between husbands or fathers as men and wives or mothers as women greatly influences a peaceful non-violent life in the family.
A mutually beneficial relationship between the two can minimise the ultimate impact of nutritional deficiencies on toddlers and children, namely stunting as a form of violence.
Galtung argues that anything that can kill a person's potential is also violence, suffering from prolonged starvation is the same as suffering from death by bullet on the battlefield.
In line OURNAL of Social Growth and Development Studies Vol.
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March 2025: 30-46 with the explanation of the Head of Nutrition and Family Health of Brebes Health Office, stunting is the number one contributor to AKI in Brebes Regency.
When there is no gender inequality and injustice in the family, there is good cooperation between the husband or father as a man and the wife or mother as a woman in a mutually trying relationship.
This can be in the form of learning from each other to recognise the needs of the baby from the womb of the wife or the period of pregnancy, childbirth, breastfeeding, and especially the growth and development of the child in the 1000 HPK period.
According to Mrs Saminih, the village head of Pesantunan, who is the driving force behind the TPPS at the village level, she has tried to conduct intervention programmes to reduce the stunting rate in her area, such as holding classes for pregnant women, classes for toddlers and classes for fathers.
However, the father's class was first planned but could not be run again because "bapak-bapak laka sing teka" or men did not attend.
This condition reflects men's unwillingness to contribute to alleviating and preventing stunting children and putting the burden on women because it is considered that women are pregnant, give birth and care for children, while men focus on earning a living.
According to the village head of Pesantunan, there are some families who let the mother after giving birth, which is a critical period, not even prioritised and cared for.
In-laws or male parents usually let their daughtersin-law after giving birth do quite heavy housework or are allowed to continue working during the postpartum period.
Another condition is that the mother after giving birth is allowed to sleep too long and is not woken up by her husband or other family members to provide breast milk to her baby.
This is a dangerous condition that can threaten the mother's life, especially if the mother falls into the following categories.
The author met Ibu R who has a 4-year-old stunted child who cannot yet walk and has prolonged diarrhoea.
The mother and child earn a living by begging in the Batang Market area around Brebes Square because her husband is a coolie who only works when he gets a The extreme poverty experienced by the family is coupled with the experience of domestic violence experienced by Mrs R who claimed to have been kicked, hit, and knocked on the head by her husband but she chose to remain silent and accept the condition.
The culture of silence that continues to afflict women in Pesantunan Village ultimately adds to women's suffering and seems to justify what is usually done in a society with a patriarchal Parenting Patterns The majority of stunted toddlers and children in Brebes District.
Central Java are in the age range > 6-24 months and > 2 years .
bove the age of 2 year.
more cases occur.
that the 1000 HPK period of the baby experiences quite fluctuating growth.
When newborns are born and immediately receive exclusive breastfeeding from the mother, there is no problem of stunted growth or stunting.
However, problems begin to arise during the complementary feeding period above the age of 6 months.
The complementary feeding period is the growth period of the baby with the provision of complementary foods for breast Lack of knowledge about nutrition and the importance of exclusive breastfeeding among the community can lead to inappropriate parenting practices.
The parenting mistakes experienced by the people of Brebes District are based on traditional parenting practices such as the provision of complementary foods that are not nutritionally appropriate.
In addition, there are indications of parents' inability to learn and obtain information about good and correct nutrition for each period of their children's growth and development.
In a field survey conducted by the Brebes District Stunting Prevention Acceleration Team (TPPS), there are still many mothers who do not provide exclusive breastfeeding for their newborn babies for 6 months, replace exclusive breastfeeding with formula milk, give water and complementary foods before the age of 6 months, or exclusive breastfeeding is given continuously past the age of 6 months.
The implication is that infant growth and development are disrupted, which can increase the risk of stunting.
This is the result of the author's in-depth discussions with several informants from the Health Office.
DP3KB and Baperlitbangda of Brebes District.
According to the Nutrition and Family Health Unit of the Brebes Health Office, in 2010 Brebes District had the third highest number of stunting cases in Indonesia.
A year later, in 2011.
UNICEF Indonesia intervened in Brebes District as the locus of stunting by providing the IYCF (Infant and Young Child Feedin.
Programme.
This programme provides education and training related to parenting patterns from newborns to the age of 5 years and Women by The Sea: Role Dynamics and Economic Transformation in Maringkik Island (Ikmal Maulana.
Restu Nirwana.
Ihfan Rahmawad.
began to run massively in 2015-present.
According to Ibu Saminih, the majority of stunted children in Pesantunan Village are caused by "ora telaten" or impatience, impatience, impatience, impatience, impatience and laziness to "ndulang" or feed their children, as well as the belief that "sing penting wareg" or what is important .
he chil.
eats full, but does not pay attention to nutrition.
Coupled with a weak economy with economic inequality between the ruler of the shallot farm "boss" and the shallot "mbutik" or onion cleaners after harvest.
An environment with poor sanitation, not having healthy toilets and building houses on the banks of the Pemali River.
Behaviour or habits in childcare patterns greatly impact the growth and development of children during the 1000 HPK period.
PKH assistance in Pesantunan Village to prevent maternal mortality after childbirth is carried out up to 42 days and to prevent infant mortality after birth up to 28 days.
Furthermore, immunisation, routine weighing and education from village midwives are carried out for families of under-fives and toddlers to prevent malnutrition that escalates into stunting.
However, changing community behaviour is a challenge for TPPS in Pesantunan Village as a pilot village for stunting eradication and a family planning village, which is now known as a Quality Family.
In line with the research findings of Deviana et al .
, there is a relationship between knowledge, perceptions, attitudes and beliefs of mothers as parents of infants with the completeness of basic immunisation.
The perception of respondents in the research conducted was that the benefits of immunisation were unknown, immunisation was not good so it should be rejected and haram.
This perception then forms an attitude that is motivated by many factors, such as personal experience, culture, myths, someone who is considered important, religious beliefs and public misconceptions about the side effects of Poor parental experience or belief in immunisation affects the completeness of infant immunisation.
Parents' low awareness of the importance of immunisation in infants makes children more vulnerable to illness.
Children will suffer from recurrent infectious diseases such as diarrhoea, worms, tuberculosis, high fever which are then allowed to heal by themselves, according to the Head of Population Control of DP3KB Brebes, which also has a major impact on stunting cases.
Furthermore, people prefer to prioritise buying tertiary goods such as gold or motorised vehicles when they have more income rather than improving the nutrition consumed by children and families.
Stigma associated with stunting According to KBBI, stigma is a negative characteristic or mark attached to individuals due to the influence of their environment.
This negative characteristic becomes a sign or marker in the social environment which is then believed to be true.
Families who have stunted children often experience social stigma which can cause them to be reluctant to seek help and tend to isolate themselves from the surrounding environment.
This becomes dangerous because over time it will become an iceberg phenomenon, this is a form of cultural violence that justifies structural violence and direct violence that occurs only appears a small part on the surface.
There are even some parents encountered in the field who do not want their children to be called stunted or malnourished.
So, the Brebes Health Office team at the Puskesmas and Posyandu cadres who are given assistance by the Puskesmas during periodic checks during daily services, will discuss other meanings related to stunting according to the real checks in the field.
For example, the mother's child weighs less by a kilogram, the height is less by another centimetre, or the daily menu that is usually served is asked and given direct education when encountering nutritional discrepancies.
In addition, stigmatisation occurs as part of the intersection with direct verbal violence as experienced by Mrs NK who has neighbours and the environment around the house getting jokes or joking "kok anake cilik, ibune gede si?" .
hy is the child small but the mother is big?).
This condition has been experienced by Mrs NK from her first child to her third child who is 2 years old.
A similar condition is also experienced by Mrs SL who has 3 children and all three of them were born with very low BW and TB and fall into the stunting category even though the children are healthy and quite active in interacting.
The stigma attached to the Pesantunan Village community as a belief or belief that children born small are due to parents .
other and fathe.
who are also equally small or thin.
Stigma related to stunting, which is considered to be related to the heredity of short parents.
OURNAL of Social Growth and Development Studies Vol.
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March 2025: 30-46 is eventually ignored or neglected due to the lack of understanding and shame of families who are labelled as having stunted children, even though intervention activities in the field at the village level through village midwives or village activist cadres have been carried out.
CONCLUSIONS AND RECOMMENDATIONS
CONCLUSIONS
Stunting in Brebes District can be understood through the lens of Galtung's Violence Triangle, which includes direct, structural and cultural violence.
Direct violence is experienced by families, especially mothers and stunted children, both in verbal forms such as social stigma and physical violence in the household.
Structural violence occurs due to economic inequality, limited access to health services, low literacy levels, and agricultural practices that pollute the environment and affect food quality.
Meanwhile, cultural violence legitimises these conditions through norms and practices that support stunting, such as the prohibition of immunisation, inappropriate parenting patterns, and gender discrimination in a patriarchal culture that burdens women with multiple responsibilities.
In addition to these violent factors, local government policies also contribute to this problem, especially related to the discrepancy in data on the number of stunting cases between simultaneous weighing by the Brebes Health Office and national data from the Indonesian Ministry of Health.
This data inaccuracy has an impact on the effectiveness of policy interventions.
Therefore, a more holistic understanding of the factors causing stunting in Brebes is essential to formulate more targeted and sustainable solutions.
RECOMMENDATIONS
To effectively address stunting in Brebes District, a comprehensive approach is needed by considering direct violence, structural and cultural aspects.
First, it is necessary to increase public awareness through health education that targets families, especially mothers, on the importance of balanced nutrition, proper parenting, and stunting prevention.
Intervention programmes such as father's classes should be strengthened with more inclusive strategies to increase the role of fathers in parenting.
In addition, protection of women and children from domestic violence should be strengthened with more effective complaint and assistance mechanisms.
On the structural side, local governments need to ensure more equitable access to health services, education, and basic infrastructure such as clean water and proper sanitation.
Policy reforms are needed to ensure more accurate and transparent stunting data so that interventions are well-targeted.
In addition, local-based economic empowerment programmes must be strengthened to overcome poverty, which is the root cause of stunting.
A community-based approach involving religious and cultural leaders is also needed to change norms and habits that hinder stunting prevention efforts, thus creating an environment that is more supportive of optimal child development.
REFERENCES