Only 40 percent of prospective brides and grooms' health is recorded at Elsimil

Health checks before marriage are not considered important even though they prevent many health problems, including stunting

KOMPAS/BAHANA PATRIA GUPTA

The wedding couple along with their marriage guardian are seen during a mass marriage registration session at Empire Palace, Surabaya City, East Java, on Tuesday (30/8). A total of 120 couples participated in the event held by the Surabaya City Government in collaboration with the Religious Court.

Preparing the physical health of the prospective bride and groom is still not seen as important. Some prospective brides and grooms are more busy preparing for the wedding reception, feel they are in good health, or consider it private. Health checks are important to prevent health problems arising from marriage, including the risk of stunting in children.

Of the 1,544,373 marriages registered in the Ministry of Religion's Marriage Management Information System (Simkah) in 2023, only 613,113 prospective bride and groom couples or 39.7 percent filled out the Ready for Marriage and Pregnancy Electronic System (Elsimil< /a>) National Population and Family Planning Agency (BKKBN).

Elsimil is an application created by BKKBN to detect the risk of stunted children in prospective newlyweds. This application can also connect prospective newlyweds with accompanying officers in their areas, as well as a means of education about marriage and pregnancy, especially as related to stunting.

Based on data received by Elsimil, it is recorded that 23 percent of female prospective brides suffer from chronic energy deficiency, characterized by a too small upper arm circumference. In addition, 14 percent of prospective brides are too thin or have a low body mass index, while 21 percent actually have excess weight. This means that 35 percent of prospective brides have an unhealthy body weight.

Not only that, around 20 percent of female bridal candidates have mild, moderate, or severe anemia, while 11 percent of brides did not have their hemoglobin levels checked. Twelve percent of bridal candidates are under 20 years old and six percent are over 35 years old.

"The attention given to preconception or preparation before pregnancy by prospective brides and grooms is still low," said Head of BKKBN Hasto Wardoyo during the National Work Meeting on Family Development, Population, Family Planning, and Accelerated Stunting Reduction Program in Jakarta on Thursday (25/4/2024).

The lack of attention to the health of the prospective bride and groom is worrying considering that 80 percent of brides and grooms will become pregnant when they reach one year of marriage. Chronic energy deficiency in expectant mothers is triggered by minimal energy intake from macro and micro nutrients in women of childbearing age continuously from adolescence, preconception, until pregnancy.

Chronic energy deficiency is characterized by an upper arm circumference of less than 23.5 centimeters and a body mass index during pregnancy of less than 18.5 kilograms per square meter, specifically in the first 12 weeks or first trimester.

Some prospective newlyweds consider health checks to be unimportant, thinking that their health is fine, getting caught up in cost issues, or fearing that their wedding will be cancelled if they are found to have certain diseases.

Chronic malnutrition can disrupt the formation and growth process of the fetus that a mother carries, starting from stunting, cognitive and motor development disorders, as well as disruptions to a child's immune system. As adults, they are more vulnerable to various degenerative diseases such as heart disease, stroke, diabetes, and cancer, reducing their productivity.

On the contrary, being overweight during pregnancy will increase complications. Mothers can potentially experience gestational diabetes, life-threatening preeclampsia for both the fetus and mother, premature birth, miscarriage, and birth defects. Therefore, encouraging weight gain during pregnancy is important, but excessive gain should be avoided.

Infants born to mothers with anemia are at risk of low birth weight, congenital defects, easy infections, low levels of intelligence, fetal distress, and even death. Meanwhile, for pregnant women, anemia can trigger miscarriage, premature delivery, and hinder the fetal growth and development in the womb.

Therefore, continued Hasto, if the health conditions of prospective brides and grooms can be screened from the start, then efforts to prevent stunting can be carried out earlier, while the problem is still upstream. If from Elsimil's data it is found that prospective brides and grooms are at risk of giving birth to stunted children, then the family support team can accompany them so they are ready to get pregnant.

Nevertheless, in a different occasion, Hasto often emphasizes that it is not only the female bride-to-be who needs to prepare her health condition to support conception, but also the male groom-to-be. From 75 days before the wedding, the male groom-to-be is asked to stop smoking, drinking alcohol, and not soaking in hot water in order to have quality sperm.

However, according to the data from Elsimil, building awareness about the importance of knowing the health status of prospective newlyweds is not easy. While waiting for an increase in awareness of prospective newlyweds to use Elsimil, the government is also trying to solve other issues, especially related to infrastructure, which also triggers stunting.

"The significant decrease of households with slum conditions and lacking clean water and standard toilets is expected to accelerate the reduction of stunting," he said. The latest data from the Indonesia Nutritional Status Study (SSGI) in 2022 shows that the prevalence of stunting in Indonesia has reached 21.6 percent, far from the government's target of 14 percent by 2024.

Also read: Elsimil Application Results: Erina Gudono Ready to Become a Mother

KOMPAS/PRIYOMBODO (PRI)

A total of 633 bridal couples took part in a mass wedding event on New Year's Eve at DKI Jakarta City Hall, Tuesday (31/12/2019).

Field challenges

Pre-marital health check-ups are indeed a major issue in Indonesia. The action that should be taken by male and female bride-to-be, 3-6 months before marriage, has not been done by all bride-to-be.

Although the Ministry of Religion requires Elsimil certification as one of the prerequisites for marriage registration at the Office of Religious Affairs (KUA), in many cases, couples are still married without Elsimil for various reasons. Usually, this is due to the limited knowledge of the community and the tight schedule between the reporting and the actual wedding ceremony.

Some prospective brides and grooms consider health checks unimportant, thinking that their health is perfectly fine, or they are worried about the cost involved or fear that their wedding will be cancelled if a certain illness is discovered. Even some brides worry that the examination could be a kind of virginity test that could embarrass them.

Separately, a health sociology researcher who is also a lecturer in the Postgraduate Program of Public Health at Sebelas Maret University Solo, Argyo Demartoto, stated that the majority of Generation Z, who are now entering the age of marriage, actually have information and awareness related to their health, including reproductive health.

Through gadgets and the internet in their hands, they can access health information, learn from other people's experiences, and consult directly about their health. They generally do all this independently. As a risk society (risk society), they are very reflective, have initiative, and are ready to face any conditions, including matters of reproductive health.

If they neglect these conditions, they generally realize that it will backfire on them. If they make a mistake, the risk is their health. Therefore, Argyo thinks that the government program that asks prospective brides and grooms to independently report their health through Elsimil is not suitable for the character of the generation and the current conditions.

"They are more concerned about privacy issues if their health condition is known by others, especially outside of healthcare professionals in healthcare facilities," he said. When facing problems, they will consult their condition with professionals, family, or close acquaintances that they know.

Therefore, according to Argyo, the efforts that the government can make to ensure the risk of stunting in prospective brides and grooms is detected is through increasing reproductive health education from an early age. Thus, even though they do not yet have an Elsimil certificate, they can still maintain their health independently.

The dissemination of information about Elsimil also needs to be expanded. Although this program has been running for several years, not all prospective couples are aware of its benefits. As a program from the central government, not all local government officials are aware of the importance of this program. As a result, they are implementing the program only as an obligation from the central government or other institutions.

Also read: Nutritional Status Recording Application to Prevent Malignancy

The introduction of Elsimil needs to be done collaboratively, not only with the district office or health and population department, but also with the education department. However, building a sense of ownership over a program takes time and requires active community involvement, not just as objects but as subjects who realize the importance of pre-marital health checks for prospective brides and grooms.