Social Determinants of Stunting and Implications for Public Health Programs in Indonesian Coastal Fishing Communities: A Qualitative Evidence Synthesis
Keywords:
coastal public health, fishing households, food security, qualitative evidence synthesis, social determinants of health, stunting preventionAbstract
Children in Indonesian coastal and fishing communities experience stunting despite living close to abundant marine food. This qualitative evidence synthesis aimed to identify the social determinants of stunting from caregivers’ experiences of child feeding and household food security, and their implications for public health programs. Following the ENTREQ statement, qualitative and mixed-methods studies published from 2015 to 2026 were identified through Google Scholar, Garuda, and journal websites. Study quality was appraised with the CASP checklist, findings were analyzed using thematic synthesis, and confidence was assessed with GRADE-CERQual. Seven studies from six provinces were included. Five themes were developed: (1) abundant sea, narrow plate, as fish was sold or seasonal and cheap snacks filled the gap; (2) inherited beliefs and household hierarchy, including taboos on fish and eggs and the prioritization of fathers at meals; (3) mothers caught between knowing and doing; (4) coping with an uncertain livelihood through debt, cheaper foods, and reduced portions; and (5) support that reaches unevenly. Child diets in coastal Indonesia are constrained less by the absence of fish than by livelihood insecurity, food beliefs, household food allocation, and uneven support. Interventions should combine culturally tailored feeding counselling that involves the wider family with livelihood and food-access support for fishing households.
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