Social Stratification and Coping-Resilience Strategies as Mechanisms of Stunting in Urban Areas
Abstract
Urban stunting is not just a manifestation of malnutrition, but a complex phenomenon formed by social stratification, food policy, stigma, and community coping and resilience strategies. This study is a systematic narrative review of 30 international and national articles relevant to the issues of stunting, urban vulnerability, food policy, and coping-resilience. The analysis is carried out through thematic synthesis to identify patterns and interconnections. As a result, positions in social structures (class, gender, maternal education, economic status, and ethnicity) were identified as the main determinants of a child's vulnerability to malnutrition. Dietary practices are strongly influenced by food policies such as nutrition labeling, sugar-sweetened beverage taxes, and advertising restrictions, but the impact on stunting still varies between social groups due to limited purchasing power and nutritional literacy. Social stigma exacerbates inequality by restricting poor families' access to formal services. Meanwhile, coping strategies and community resilience capacity show an important mediating role: adaptive coping (problem-solving, community solidarity, faith-based support) strengthens the resilience of urban poor families, while maladaptive coping (reduction of meal portions, substitution of low-nutritious cheap food, selling productive assets) actually deepens the cycle of vulnerability. In conclusion, urban stunting must be understood as a reflection of structural health injustices as well as the adaptive capacity of households and communities. This study proposes an integrated framework that links social stratification (class, gender, ethnicity), food policy, stigma, and coping-resilience, as a basis for interventions that are equitable, culturally sensitive, and oriented towards strengthening the resilience of urban communities.
References
Aronson, S. (2019). Cali's Food Systems : A Diagnostic Synthesis to Determine Priority Action Areas for Sustainable Food Systems. October.
Bristow, J. (2016). The sociology of generations: New directions and challenges. In The Sociology of Generations: New Directions and Challenges. https://doi.org/10.1057/978-1-137-60136-0
Copeland, S., Hinrichs-Krapels, S., Fecondo, F., Santizo, E. R., Bal, R., & Comes, T. (2023). A resilience view on health system resilience: a scoping review of empirical studies and reviews. BMC Health Services Research, 23(1), 1–19. https://doi.org/10.1186/s12913-023-10022-8
Duminy, J. (2023). Critical Commentary : Beyond growth and density : Recentring the demographic drivers of urban health and risk in the global south. 60(1), 1365–1376. https://doi.org/10.1177/00420980211014410
Earnshaw, V. A., & Karpyn, A. (2020). Understanding stigma and food inequity: A conceptual framework to inform research, intervention, and policy. Translational Behavioral Medicine, 10(6), 1350–1357. https://doi.org/10.1093/tbm/ibaa087
Fikru, M., & Doorslaer, E. Van. (2019). SSM - Population Health Explaining the fall of socioeconomic inequality in childhood stunting in Indonesia. SSM - Population Health, 9, 100469. https://doi.org/10.1016/j.ssmph.2019.100469
Foucault. (1978). T h e H i s t o r y of S e x u a l i t y Volume 1: An Introduction. Pantheon Books, 1, 161.
Frumkin, H., & Haines, A. (2019). Global Environmental Change and Noncommunicable Disease Risks. 261–282.
García, F. E., Barraza-peña, C. G., Wlodarczyk, A., Alvear-carrasco, M., & Reyes-reyes, A. (2018). Psychometric properties of the Brief-COPE for the evaluation of coping strategies in the Chilean population.
Gona, J. K., Newton, C. R., Rimba, K. K., Mapenzi, R., Kihara, M., Vijver, F. V., & Abubakar, A. (2017). Relation zwischen Atomgewicht, specifischem Gewicht und Härte metallischer Elemente. Annalen Der Physik, 226(12), 644–644. https://doi.org/10.1002/andp.18742261215
Kia, A. A., Rezapour, A., Khosravi, A., & Abarghouei, V. A. (2017). Inequality in malnutrition in under-5 children in Iran: Evidence from the multiple indicator demographic and health survey, 2010. Journal of Preventive Medicine and Public Health, 50(3), 201–209. https://doi.org/10.3961/jpmph.17.028
Li, Z., Kim, R., Vollmer, S., & Subramanian, S. V. (2020). Factors Associated With Child Stunting, Wasting, and Underweight in 35 Low- And Middle-Income Countries. Jama Network Open, 3(4), e203386. https://doi.org/10.1001/jamanetworkopen.2020.3386
Maniriho, A., Musabanganji, E., & Lebailly, P. (2022). Food security status and coping strategies among small-scale crop farmers in Volcanic Highlands in Rwanda. 23(1), 165–178.
Mehar, M., Mittal, S., & Prasad, N. (2016). Farmers coping strategies for climate shock: Is it differentiated by gender? Journal of Rural Studies, 44, 123–131. https://doi.org/10.1016/j.jrurstud.2016.01.001
Mulyaningsih, T., Mohanty, I., Widyaningsih, V., Gebremedhin, T. A., Miranti, R., & Wiyono, V. H. (2021a). Beyond personal factors: Multilevel determinants of childhood stunting in Indonesia. PLoS ONE, 16(11 November). https://doi.org/10.1371/journal.pone.0260265
Mulyaningsih, T., Mohanty, I., Widyaningsih, V., Gebremedhin, T., Miranti, R., & Wiyono, V. H. (2021b). Beyond Personal Factors: Multilevel Determinants of Childhood Stunting in Indonesia. Plos One, 16(11), e0260265. https://doi.org/10.1371/journal.pone.0260265
Popkin, B. M. (1998). Urbanization and the nutrition transition. Health, 1(11), 5–21.
Rao, N., Bala, M., Ranganathan, N., Anand, U., Dhingra, S., Costa, J. C., & Weber, A. M. (2023). Trends in the Prevalence and Social Determinants of Stunting in India, 2005–2021: Findings From Three Rounds of the National Family Health Survey. BMJ Nutrition Prevention & Health, 6(2), 357–366. https://doi.org/10.1136/bmjnph-2023-000648
Rizal, M. F., & van Doorslaer, E. (2019). Explaining the fall of socioeconomic inequality in childhood stunting in Indonesia. SSM - Population Health, 9, 100469. https://doi.org/10.1016/j.ssmph.2019.100469
Rizal, S., Sumarni, S., Aji, A. S., Fatimah, F. S., & Sarwadhamana, R. J. (2022). Stunting Prevention Program of West Sumbawa Regency Health Office: A Qualitative Study in West Nusa Tenggara, Indonesia. Open Access Macedonian Journal of Medical Sciences, 10(T8), 211–214. https://doi.org/10.3889/oamjms.2022.9496
Tomiyama, J. M., Takagi, D., & Kantar, M. B. (2020). The effect of acute and chronic food shortage on human population equilibrium in a subsistence setting. Agriculture and Food Security, 9(1), 1–12. https://doi.org/10.1186/s40066-020-00261-x
Ungar, M. (2011). The social ecology of resilience: Addressing contextual and cultural ambiguity of a nascent construct. American Journal of Orthopsychiatry, 81(1), 1–17. https://doi.org/10.1111/j.1939-0025.2010.01067.x
Vilar-Compte, M., Burrola-Méndez, S., Lozano-Marrufo, A., Ferré-Eguiluz, I., Flores, D., Gaitán-Rossi, P., Teruel, G., & Pérez-Escamilla, R. (2021). There is an increasing global trend towards urbanization. In general, there are less food access issues in urban than rural areas, but this "urban advantage" does not benefit the poorest who face disproportionate barriers to accessing healthy food and hav. International Journal for Equity in Health, 20(1).
Vollmer, S., Harttgen, K., Subramanyam, M. A., Finlay, J., Klasen, S., & Subramanian, S. V. (2014). Association between economic growth and early childhood undernutrition: Evidence from 121 Demographic and Health Surveys from 36 low-income and middle-income countries. The Lancet Global Health, 2(4), e225–e234. https://doi.org/10.1016/S2214-109X(14)70025-7
Walls, H., Nisbett, N., Laar, A., Drimie, S., Zaidi, S., & Harris, J. (2021). Addressing Malnutrition: The Importance of Political Economy Analysis of Power. International Journal of Health Policy and Management, 10(12), 809–816. https://doi.org/10.34172/ijhpm.2020.250
Wertheim-heck, S. C. O., & Raneri, J. E. (2020). Food policy and the unruliness of consumption : An intergenerational social practice approach to uncover transforming food consumption in. Global Food Security, 26(August), 100418. https://doi.org/10.1016/j.gfs.2020.100418
Wertheim-Heck, S. C. O., & Raneri, J. E. (2020). Food policy and the unruliness of consumption: An intergenerational social practice approach to uncover transforming food consumption in modernizing Hanoi, Vietnam. Global Food Security, 26(August), 100418. https://doi.org/10.1016/j.gfs.2020.100418
Widyaningsih, V., Mulyaningsih, T., Rahmawati, F. N., & Adhitya, D. (2021). Original Research Abstract : Full Article : Rural and Remote Health, 21(3), 1–11.
Williams, D. S., Máñez Costa, M., Sutherland, C., Celliers, L., & Scheffran, J. (2019). Vulnerability of informal settlements in the context of rapid urbanization and climate change. Environment and Urbanization, 31(1), 157–176. https://doi.org/10.1177/0956247818819694
Zimmer, D. (2025). The Power to Kill Life Itself: Michel Foucault, Biopolitics, and the Political Challenge of Human Extinction. Perspectives on Politics, 1–16. https://doi.org/10.1017/S1537592725000027
Copyright (c) 2025 Endah Wahyuningsih, Siti Kholifah, Anif Fatwa Chawa, Alifiulahtin Utaminingsih
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
