It was a simple lunch: fried noodles, a piece of fried chicken and a banana. But for Safira, an elfin 11-year-old, this meal is a luxury. Provided free by her school, it’s also the first and only meal she will have for the rest of the day.

The daughter of a factory employee and a day labourer who travels hours each day to find work, there is little money to cook meals at home. Dinner is usually a banana or two. When the school does not provide lunch, Safira goes hungry.

“On days without school meals I don’t bring anything from home. Then, I don’t eat,” she said, picking delicately at the chicken with freshly washed hands. “When I’m very hungry, I can’t concentrate on what the teacher is saying. The food at school is delicious – I usually eat fried rice at home.”

Her small primary school in the city of Serang, some 60 km (37 miles) west of the Indonesian capital Jakarta, provides three out of six lunches every week.

The menu is a carefully considered mix of carbohydrates, proteins, fibre and vitamins. The ingredients are sourced from local farmers, and groups of mothers whose children study at the school take turns to prepare the meals.

The school meal programme, funded by the UN World Food Programme and global commodities trader Cargill Inc, is part of a larger effort by the Indonesian authorities and aid agencies to tackle widespread malnutrition that affects millions of children, stunting their growth and hobbling their potential.

In Indonesia, one in three children between the ages of six and 14 do not eat enough nutritious food, the World Food Programme says.

The situation is worst in eastern areas where the weather is drier, and there is chronic poverty and low development.

The problem has significant implications for the archipelago’s future economic growth and resilience, as well as its health needs, experts say.

“Economic losses due to stunting and malnutrition are estimated to be 2% to 3% of Indonesia’s GDP,” said Martha Bowen, deputy country director in Indonesia for the US government’s Millennium Challenge Corporation, which runs a $134 million project to reduce stunting in Indonesia.

According to government data, about 37% of all Indonesian children under five were stunted in 2013, up from 35.6% in 2010. This translates to over 9.5 million stunted children, the fifth-highest national figure globally, the World Food Programme says.

Stunting is caused by long-term under-nutrition, combined with sanitation and hygiene problems. It hinders children’s cognitive growth and economic potential, experts say.

Stunted children, who are shorter than average height, generally complete fewer years of schooling and earn less income as adults. The effects are largely irreversible.

Government research also found that more than a quarter of Indonesian children aged from five to 14 were anaemic in 2013. Usually caused by deficiencies of iron and vitamins in the diet, anaemia affects children’s cognitive and physical development.

A group of mothers whose children study at a small primary school in Serang, some 60 km outside Indonesia’s capital Jakarta, carry cooked meals from the small kitchen to the school, a short walk away, May 19, 2017. Photo credit: Thin Lei Win/Thomson Reuters Foundation

High food prices

A World Food Programme study comparing schools with the meal programme and those without revealed higher attendance rates at the former, said Anthea Webb, the agency’s director in Indonesia.

“Kids were skipping school a lot less, anaemia rates went down – which means the kids had more energy and were more focused – and their hygiene habits also improved because... we also teach them how to wash their hands and brush their teeth,” she said.

Yet for a long time, Indonesians did not realise malnutrition was a problem unless it led to severe wasting, when children are very underweight, experts say.

It was only in the 2009-2014 National Medium-Term Development Plan that the government identified stunting as an issue to be addressed, said the Millennium Challenge Corporation’s Bowen.

At that time, there was no word in the Bahasa Indonesia language for the phenomenon except “pendek (meaning simply “short”) used alongside the English term “stunting”, she told the Thomson Reuters Foundation.

An Millennium Challenge Corporation-funded campaign, in partnership with the health ministry, has been working to popularise a new Indonesian word – “stanting”.

Limited breastfeeding, a diet high in carbohydrates and low in proteins and vitamins, and increased consumption of processed foods contribute to the problem, experts say.

There are also worries climate change could make extreme weather more frequent, leading to more volatile food prices and putting nutritious food out of reach for poor households.

Indonesia already has some of the highest food prices in Southeast Asia due to trade restrictions on food imports and other government policies, another factor in its high rates of stunting, according to the World Bank.

More than 28 million Indonesians, just over a tenth of the population, live below the national poverty line of around $27 per month, while nearly 40% live just above it.

A doctor vaccinates a baby girl at a local health centre in Sengkol sub-district in central Lombok, east Indonesia, May 18, 2017. Photo credit: Thin Lei Win/Thomson Reuters Foundation

Double burden

Indonesia also faces a “double burden” of malnutrition, where under-nutrition and obesity co-exist.

A 2015 World Bank report warned that more and more Indonesians – both adults and young children, and across all income levels – are becoming overweight, and urged steps to mitigate related health risks such as non-communicable diseases.

As Southeast Asia’s largest economy and a member of the G20 nations, Indonesia is increasingly leading the drive to tackle these issues instead of relying on donors, aid agencies say.

The World Food Programme for example, no longer distributes food in Indonesia but provides technical help to the government instead.

It helped design, develop and monitor the school meals programme, which now covers 100,000 children across five provinces, in response to a government request in 2015.

The Millennium Challenge Corporation, meanwhile, supports health centres where pregnant women and children receive vaccinations, nutrition supplements and counselling.

Tackling stunting takes a generation, longer than most governments last, so it requires widespread buy-in, said the World Food Programme’s Webb.

“It’s a really good proxy for how your entire economy and society is developed,” she said. “Each centimetre grown is another few points of IQ and the strength and ability to work really hard and smart.”

This article first appeared on Thomson Reuters Foundation News.