The cultural determinants of child health in Java, Indonesia

This study examines the relationship between culture and child health in Java, Indonesia by assessing whether cultural factors can explain why Sundanese children suffer from higher rates of morbidity and mortality than Javanese children. This question is explored through the combined use of quantitative and qualitative methods. Ethnographic research was conducted in Java by the author in 1996, and data from the Indonesia Demographic and Health Survey (DHS) 1994 form the basis of the quantitative analysis. Calculation of mortality rates for children under five years of age using DHS data shows that Sundanese children are approximately 45 percent more likely to die at all ages than Javanese children. Bivariate analysis demonstrates that Sundanese children are 128 percent more likely to suffer from diarrheal disease than Javanese children. After controlling for other background characteristics, Sundanese children are still approximately twice as likely to suffer from diarrhea. Multivariate analysis of the DHS data also suggests that Sundanese children are almost 150 percent more likely to have never been brought to a posyandu (baby-weighing and immunization station). Sundanese women are almost twice as likely to obtain water from an unhealthy source as compared to Javanese women, all other factors being equal. Analysis of the DHS data alone suggests that the relationships between various child-care practices, such as breast-feeding and immunization, and diarrheal morbidity are unclear. My ethnographic research illuminates the possibility of reverse causality between these child-care practices and diarrheal morbidity. Sick children may be more likely to come into contact with the health care system and subsequently receive immunizations. Additionally, older children who are still being breast-fed may be less robust than children who are weaned at younger ages. Evidence from my ethnographic fieldwork suggests that these large differentials in morbidity and mortality are due to ethnic variations in child-care practices. Sundanese mothers observe poorer hygiene practices and supervise their children less in comparison to Javanese mothers. Sundanese mothers in this study were also less diligent in bringing their children to posyandu. These contrasting child-care practices may be due to differences in opinion leaders and marital patterns. Ethnographic data demonstrate that Javanese mothers are more likely to bring their children to posyandu because the village head, a government employee, is the opinion leader in most Javanese villages. Widespread marital instability among the Sundanese may also negatively affect mothers' ability to take care of children relative to Javanese mothers.