BKKBN Counseling Method for Pregnant Women in Preventing Babies with Stunting

. Fulfillment of balanced nutrition at 1000 HPK is very important for children. Inadequate nutrition will have an impact on the growth and development of children. This is often referred to as stunting. Especially in the current era, the government gives responsibility to BKKBN in reducing the number of stunting at birth that occurs in Indonesia. The purpose of this study was to find out the methods of stunting counseling carried out by BKKBN for pregnant women in preventing babies with stunting. This research was conducted using a descriptive qualitative method. Respondents in this study were BKKBN extension workers in Tanjung Pura District. The research results obtained were counseling methods carried out by the BKKBN for pregnant women in preventing babies with stunting, namely using the discussion method. This method is effective in providing understanding to pregnant women about stunting and its prevention. However, prevention cannot be done only through counseling, it must be adjusted again to the conditions and situation of pregnant women.


Introduction
Pregnancy is the most awaited thing by married couples. It is not surprising that during pregnancy, a mother's health is very closely guarded. Starting from physical health and eating patterns are arranged as best as possible. Unhealthy eating patterns not only have an impact on the mother, but also on the growth and development of the fetus in her womb. Stunted growth and development of the fetus will result in the baby growing abnormally. The baby's body length and brain development will be hampered due to lack of adequate nutritional intake during pregnancy. This causes babies to be born with stunting (Saadah et al., 2021).
Stunting is a chronic malnutrition that causes growth failure in a child due to insufficient nutritional intake (Sarman & Darmin, 2021). WHO says that stunting is not achieving growth potential due to suboptimal nutrition (Prawirohartono, 2021). The Ministry of Health of the Republic of Indonesia said that stunting can occur during pregnancy and will be seen when the child is 2 years old. Therefore, stunting needs to be prevented since the fetus is in the womb, especially in the first 1000 days of life (Rahayu et al., 2022).
In preventing stunting, the government appoints BKBBN to implement stunting reduction (BKKBN, 2021). BKKBN (National Population and Family Planning Agency) is an institution in charge of managing population control. In this case, the BKKBN is tasked with preventing and reducing stunting. This is also one of the government's goals so that children who are born stunted or grow up to be stunted can be minimized so that they can form a healthy generation.
However, knowledge about pregnant nutrition and stunting is not owned by everyone. Many married couples do not know the importance of the health of pregnant women in the growth and development of the fetus. In fact, most of the nutritional intake consumed by pregnant women is still lacking in providing nutrition to the fetus in the womb. Not only nutritional intake, the physical and mental health of pregnant women also plays a role in the development of the fetus. Pregnant women who are exhausted and do not get enough 4311 support during pregnancy will result in obstructed fetal development.
The lack of knowledge and education regarding the importance of nutrition and health for pregnant women is one of the factors for babies suffering from stunting. Based on research conducted by Nurfatimah et al. (2021) that stunting prevention behavior by pregnant women is still low, only accounting for 53.10%. This means that the implementation of 1000 HPK is still lacking. Prevention of stunting during pregnancy is still lacking. Based on these problems, the BKKBN conducts outreach to the public, especially pregnant women, to provide information about stunting. This counseling is one of the program activities of the BKKBN in reducing stunting rates so that pregnant women can take precautions so that their babies do not suffer from stunting.
It is different from the research that has been done before regarding research on stunting prevention which is taken from the perspective of nutritional health, the health of pregnant women, knowledge about stunting for mothers under two years old, and counseling by health workers. However, no one has conducted research on BKKBN counseling methods for pregnant women in preventing babies with stunting. Therefore this research focuses on counseling methods conducted by BKKBN for pregnant women so that the incidence of stunting in babies born can be prevented.
The purpose of this study was to find out the methods of counseling on stunting carried out by the BKKBN for pregnant women in preventing babies with stunting. Another goal of this research is that knowledge about stunting can be known by prospective parents and can minimize the occurrence of babies born with stunting.

Method
This research uses a descriptive qualitative research type. Descriptive qualitative research is used to propose problem solving based on data from facts obtained in the field (Zellatifanny & Mudjiyanto, 2018). Data collection techniques in this study through interviews, observation and documentation. Interviews were conducted with BKKBN extension workers in Tanjung Pura District. The observations made were non-participant observations, meaning that the research was carried out by observing activities without participating in these activities. Observations were made by observing counseling activities carried out to pregnant women. Documentation was obtained through reading material and counseling procedures carried out by the BKKBN in overcoming stunting.
Sources of data in this study come from primary data sources and secondary data. Primary data or main data were obtained from the results of interviews conducted with BKKBN extension workers. Secondary data was obtained from reading results in the form of articles, books, and the BKKBN website. The data obtained were analyzed using interactive data analysis techniques. This data analysis technique proposed by Miles and Huberman consists of three components, namely: data reduction; presentation of data; and drawing conclusions (Nugrahani, 2014). The steps of this research are: first, the researcher arranges questions for interviews according to the variables. After the data is obtained, the researcher chooses which data is in accordance with the variables that the researcher will discuss and does not run away from the context. In this stage the researcher carried out data reduction assisted by the results of observations and documentation; second, after the data is collected then the data is presented in the form of narrative text; third, after the data is presented, summaries are drawn from the results of the data into new sentences.

Result and Discussion
Based on the results of interviews conducted with one of the BKKBN extension officers, the implementation of stunting counseling was carried out using the discussion method. The discussion method is a method used in a group to discuss a problem together (Supriyati, 2020).
Based on research conducted by Lubis et al. (2013) that the discussion method has a major influence in increasing the knowledge and attitudes of elementary school children about PHBS. In line with research Widiarsa (2020) that the discussion method increases student motivation because this method system which involves students directly can increase student enthusiasm in conducting discussions. This affects the memory and thinking power of students.
The discussion method in stunting counseling is carried out by BKKBN extension workers by providing material related to stunting, then conducting questions and answers to counseling participants. The counseling participants were pregnant women who still had little or no knowledge about stunting and its dangers.
The counseling material is about the definition of stunting, the causes of stunting, 1000 HPK, physical and mental health in pregnant women, as well as solutions to overcome stunting during pregnancy. The material is delivered not only orally but also in video form. This is Data Reduction Data Presentation Summary to make it easier for pregnant women to understand stunting counseling. Apart from being in the form of discussions, BKKBN extension workers said that another counseling method they carried out for pregnant women in preventing babies with stunting was the snakes and ladders game. This snakes and ladders game is a type of game that is used to help counseling participants to better understand and understand the causes of stunting.
Snakes and ladders game is carried out by forming a minimum of 4 participants per group with a maximum of 4 groups. Each group chooses one of them to be a pawn in a game of snakes and ladders. Snakes and ladders are played as usual by throwing the dice and then walking according to the number of numbers that come out on the dice. What differentiates it from the usual snakes and ladders game is the information on the snakes and ladders board which contains matters related to stunting and the health of mothers and children as well as question cards related to stunting.
Based on the results of the snakes and ladders activity, it is evident that this game can make it easier for mothers to understand stunting. This is in line with research conducted by (Kisman et al., 2020) entitled "The Effect of Providing Counseling Methods on Knowledge of Toddler Mothers About Stunting" that the simulation aspect of the snakes and ladders game can increase participants' interest in their cognitive development.
BKKBN extension workers said that this extension activity served to provide information about the nutritional health of mothers and children. Many people do not know about the importance of healthy nutrition in giving birth to children who are physically and psychologically healthy. Therefore, stunting counseling activities are often carried out so that pregnant women can consume adequate nutrition during pregnancy. Not only that, it is also important in maintaining emotional stability and mental health for pregnant women. BKKBN extension workers said that the role of the father can help the growth and development of the fetus. Pregnancy is not only passed by a mother, but also by a father.
The role that can be played by the father is to provide stimulation to the fetus, such as having small talk with the fetus, stroking the mother's stomach, and reciting verses from the Koran so that the baby can hear it in the womb. As written by Hapsari, the role of stimulation carried out by a father is important in the optimal development of the fetus (Aprilia, 2020;Hasanah et al., 2020).
It is generally known that stunting occurs due to poor nutritional balance by the fetus. However, based on the results of interviews conducted, there are several factors that trigger stunting in infants, namely: lack of knowledge about stunting, protein intake, emotional stability in mothers, and the economy. Information about stunting is a basic thing that mothers and fathers who are about to become parents need to know. Knowledge about stunting can be a prevention so that prospective mothers and fathers know about what should and should not be given and done at 1000 HPK.
Mother's knowledge about stunting can prevent babies born with stunting. The lack of knowledge about stunting is because mothers rarely carry out uterine controls and visit posyandu to get counseling about stunting. Mothers also rarely find out information about balanced nutrition needed by children (Purnama et al., 2021;Ramdhani et al., 2020).
Protein intake becomes important during the 1000 HPK period. Pregnant women also need to pay attention to what foods are consumed during pregnancy. Fetal nutrition depends entirely on the mother. Mothers who do not consume good nutrition during pregnancy will affect the growth and development of the fetus (Ekayanthi & Suryani, 2019).
Emotional stability in pregnant women can affect fetal development. Mothers who are physically and mentally healthy will give birth to smart children. If the mother is easily stressed and unhappy during pregnancy, it can affect the development of the fetus. O'leary said that welfare is important for pregnant women to give birth because welfare is closely related to the health of mothers and children. Mothers who are prosperous during pregnancy to delivery will give birth to healthy and intelligent babies. Conversely, if the mother does not feel well-being during pregnancy, it is possible to give birth to a stunted baby (BKKBN, 2018).
Economic factors are the most common triggers for stunting. This is because the mother cannot fulfill balanced nutrition due to insufficient economic factors. What's more, because of economic factors, mothers and fathers have to work hard to meet their daily needs, so the mother's health may decline. Even mothers do not get attention from their husbands during pregnancy because husbands are busy working to meet their needs. As stated by (Ulfah & Nugroho, 2020) that economic factors are a factor causing stunting. Low income is still insufficient to meet their daily needs, especially in terms of providing adequate nutrition for pregnant women.
Some of these factors are things that can trigger stunting. Not only that, there are many other causes for the birth of babies with stunting, namely: low energy intake, infectious diseases, age of pregnant women, nutritional status of pregnant women, education of fathers and mothers, and occupations of fathers and mothers (Ariati, 2019;Mugianti et al., 2018).
Stunting can be prevented since the baby is still in the womb or since 1000 HPK. In this case, the BKKBN addresses solutions in preventing stunting by providing education and information to pregnant women about what to do so that their children are not born stunted.
BKKBN extension workers said that to deal with the birth of babies with stunting it is important for pregnant women to consume food that has sufficient nutrition. In addition, the health and happiness of pregnant women also need to be considered so that the babies who are born later are in good health. Pregnant women should often check their womb to find out the development of their fetus.
Based on the results of the research conducted, after being given counseling about stunting, pregnant women in the Tanjung Pura sub-district understand more about the development of their pregnancy to give birth to children who are free of stunting. Knowledge about stunting is useful in preventing the birth of babies with stunting. However, the BKKBN extension staff emphasized that a child who is born not stunted does not mean that he will grow up free of stunting, but that he still needs to pay attention to the 1000 HPK for the child. This means that you must always pay attention to the growth and development of the child until he is 2 years old. Keep an eye on the nutrition that goes into his body. If the child consumes less nutrition after birth, it can cause the child to grow up with a stunted state.

Conclusion
Based on the results of the research conducted, the BKKBN counseling method for pregnant women in preventing babies with stunting takes the form of a discussion method. The discussion included material delivery activities by BKKBN extension workers, a game of snakes and ladders, and closing activities. The result of this activity is that there is an influence of BKKBN counseling in preventing babies with stunting accompanied by other supporting factors. Pregnant women also know more about and can anticipate the occurrence of babies born in a stunted state. However, babies born with stunting can still occur after being given counseling because many factors can influence the incidence of babies born with stunting, one of which is the economic factor that cannot be changed through this counseling. BKKBN extension workers can only provide education and information regarding the importance of physical and mental health for pregnant women, but in fulfilling nutrition it is returned to prospective mothers.