An Open Access Journal

ISSN: 10683844
Multicultural Education
Research Article

Publisher: Caddo Gap Press

NUTRITIONAL DEFENSE AND PHARMACY STRATEGY TO

PREGNANT WOMEN: A STUDY OF PUBLIC HEALTH
PHENOMENOLOGY

Syahrul Tuba
Universitas Pertahanan RI, Indonesia
Sri Mulyani
STIKES Rajekwesi Bojonegoro, Indonesia
Imam Jayanto
Sam Ratulangi, Indonesia
Tonasih
STIKES Muhammadiyah Cirebon, Indonesia
Zaenal
Universitas Islam Makassar, Indonesia
Muntasir
Universitas Nusa Cendana, Indonesia
Pandu Adi Cakranegara
Universitas Presiden, Indonesia

ABSTRACT ARTICLE INFO

This study aims to describe the nutritional and pharmaceutical defense strategy of preg-
nant women: study of public health phenomology. This research is a descriptive qualita-
Keywords
tive research with a phenomenological approach. The research subjects were 56 preg- nutrition, health, phenome-
nant women from various working areas of public health centers in Indonesia. Based on nology, pharmacy
the results of the study found several lists of nutritional content needed during pregnan-
cy. Proteins, protein is useful for helping the growth and development of cells or tissues,
including brain cells in the fetus. Protein also helps the growth of breast tissue during
pregnancy, and plays an important role in increasing the blood supply in the body. Ex-
perts recommend 75 to 100 grams of protein per day. The best sources of protein for
pregnant women include lean beef, fish, seafood, chicken, lamb, tofu, and beans (red
beans, peas). Carbohydrate, carbohydrates are an important source of calories for preg-
nant women. The best sources of carbohydrates that you can consume include rice, pota- Article History
toes, cereals, pasta, vegetables and fruit. Calcium, not only strengthens your bones and Received: 22 August 2022
teeth, calcium is also useful for building the bones and teeth of the fetus. In addition, Accepted: 28 Sept. 2022
calcium helps the body regulate fluids, helps nerve function and muscle contraction.
The daily calcium requirement is about 1000 milligrams during pregnancy. The best
sources of calcium are milk, cheese, yogurt, sardines or salmon, and spinach. Folate,
this nutrient known as folic acid plays an important role in reducing the risk of birth de-
fects, including neural tube defects in the fetus that affect the brain and spinal cord of
the fetus. Examples of other birth defects such as spina bifida and anencephaly. The dai-
ly requirement of folic acid during pregnancy is 600 to 800 micrograms. You can get
sources of folic acid in green vegetables, beans, eggs, beef liver, citrus fruits, strawber-
ries, lemons, mangoes, and tomatoes. Iron, iron helps increase blood volume and pre- Corresponding Author
vents anemia. The ideal daily intake during pregnancy is 27 milligrams. Sources of iron syahrul.tuba@idu.ac.id
can be found in radishes, green vegetables such as spinach, lettuce, cabbage, whole
grains, breads, cereals, and oatmeal. The iron content in beef and seafood is also good
for nutrition for pregnant women.
© 2020 The authors.Published by CADDO GAP Press USA. This is an open access article under the Creative Commons Attribution Non Commercial 4.0
 Multicultural Education

1 INTRODUCTION

Pregnant women need adequate nutrition for the health of the mother and fetus (Permatasari
et.al, 2021; Jouanne et.al, 2021; Zelalem, T., Mikyas, A., & Erdaw, T., 2018). If the nutritional
needs of the mother are not fulfilled, it can potentially cause nutritional problems. However,
pregnant women are often not aware of the increased nutritional needs during pregnancy. The
purpose of writing is to discuss nutritional problems that are prone to occur in pregnant women.
The method used is a literature study. The data used is secondary data in the form of reports from
government agencies and previous studies. Pregnant women are susceptible to several problems
of malnutrition. Nutritional problems that often occur in pregnant women are Chronic Energy
Deficiency (KEK), Anemia, and Disorders Due to Iodine Deficiency (Srinadi et al, 2020; Synta
et.al, 2022).
Nutritional problems in pregnant women have an impact on the health of the mother and ba-
by. Babies born can experience delays in physical growth and mental development as well as de-
creased intelligence. According to Zhang et.al (2022) and Costanza et.al (2022) says that the nu-
tritional intake of pregnant women is an important factor both for the fulfillment of nutrition for
pregnant women or for the growth and development of the fetus in the womb. In fact, it can re-
duce the risk of chronic disease in your child in the future. Let's take a look at the list of nutri-
tional intakes for pregnant women that must be met below.
The body will go through many physical and hormonal changes during pregnancy. In this
case, Farmer et.al (2022) the nutritional intake of pregnant women will affect the health of the
mother and fetus in the womb. You must meet the needs of balanced nutrition during pregnancy
so that the baby is born healthy (Diana et.al, 2018; Thayer et.al, 2022; Karzmerski et.al, 2022).
Proper nutrition really helps your baby's growth and development. Nutritional needs are not
meant in terms of meal portions, where you “eat for two”. But more than that, you need more nu-
trients, such as micronutrients and macronutrients, to support the health of you and your foetus.
Micronutrients are components of food that include vitamins and minerals, while macronutrients
are nutrients that contain calories or energy such as carbohydrates, proteins, and fats (Seckold
et.al, 2019; Condo et.al, 2019; Echeverría et.al, 2019).
The need for each type of nutrition during pregnancy is certainly different from the nutri-
tional needs when not pregnant. During pregnancy, you need an additional 300 calories, especial-
ly in the second and third trimesters. The daily needs of pregnant women are 1000-1200 milli-
grams of calcium, 600-800 micrograms of folate, and 27 milligrams of iron (Cormick, G., &
Belizán, J. M., 2019; Gomes, C. S., & Silva, E. A., 2021; Johnson, M. A., & Bales, C. W., 2022).
The degree of health is one measure of the progress of a nation (Henley et.al, 2020). Since
the proclamation of independence, education is open to all. Indeed, the problem of cost is still an
obstacle, especially for higher education (Moore, C., & Shulock, N., 2009). However, thanks to
the efforts of various parties, we see that many children from simple families have succeeded in
completing higher education to the third strata level, even being able to produce useful findings
for the people of Indonesia, and even the world (Rulandari, N., 2020; Djalenta et.al, 2020).
In the health sector, there are still many rich people who seek treatment abroad (Bollyky, T.
J., & Bown, C. P., 2020). We certainly can't ban them, but what we can do is improve the quality
and convenience of medical treatment in the country. I myself feel confident in the ability of our
doctors and health workers. They generally enter education with a strict filter and education in the
fields of medicine and health is a long and strenuous education (Lobelo et.al, 2014; Keating et.al,
2000). They must go through various stages before being given the authority to practice, both in-
dependently and in hospitals.
In the first trimester, the energy needs of pregnant women increase by about 180 kcal and
protein by about 17 grams (Basir et.al, 2019; Angraini et.al, 2020; Wiseman, G., 2002). This need
can be obtained, for example, by consuming additional interludes in the form of 1 piece of biscuit,
1 boiled chicken egg, and 100 ml of milk. Then in the second trimester, the energy needs of preg-
nant women increase by about 300 kcal and protein by about 20 grams (King, J. C., 2000; Noblet,
J., Dourmad, J. Y., & Etienne, M., 1990).. This need can be obtained by consuming 1 bowl of
mung bean porridge and 1 boiled chicken egg.
 Vol. 08, No. 03, 2022 53
 Multicultural Education

In the early trimester, pregnant women often experience nausea and vomiting, so it is neces-
sary to regulate eating so that their nutritional needs are still met. Mothers can eat food in small
portions but frequently (Smiciklas et.al 2003), besides that pregnant women can also consume
ginger candy, the gingerol content can interact with the central nervous system and stomach to
improve symptoms of nausea (Barr, J., & White, R. R., 2019; Rayner, C. K., Jones, K. L., & Hor-
owitz, M. (2019).
Breast milk is the best intake for babies in the process of growth and development (Ma etal,
2018; Dima, A., 2021; Rehman et.al, 2020). In addition to containing important nutrients, breast
milk also contains antibodies that form immunity. The benefits of breastfeeding are not only for
the baby but also for the mother. Breast milk can also increase the bond between mother and baby
(Ciampo, L. A. D., & Ciampo, I. R. L. D., 2018; Dreyer, J. L., & Liebl, A. L., 2018).
Talking about breastfeeding, it turns out that there are still many who believe in the myths
circulating in the community, if the information is wrong, they are worried that it will have an im-
pact on the baby's health. RSUI Nutritionist, Tetri Pawestri, S. Gz said “Some people think that
when the weather is hot, babies aged 0-6 months need additional water, even though the baby's
fluid needs are fulfilled from breast milk. In addition, there are many cases in the community
where babies who are under 6 months old have been given honey. Giving honey to babies has the
potential to be a source of C (Pashte et.al, 2020; Majtan et.al, 2020). Botulinum spores that can at-
tack the nervous system of the brain, spine and other nerves.
At the end, Tetri motivates pregnant women to be ready and calm in preparation for breast-
feeding (Danckert, J., & Eastwood, J. D., 2020; Pickles, C., & Herring, J. (Eds.). (2019). The key
is to be sure, don't forget that support from your husband and family is also very important in im-
proving the mother's mood so that milk production can run smoothly (Asih, Y., & Nyimas, A.,
2020). This activity was well received by the participants at the Health Center, Depok. There were
participants who asked questions about the themes being discussed and shared experiences about
pregnancy.
This counseling is very useful for us who are pregnant, especially young mothers, to increase
our knowledge (Say-Sallaz et.al, 2019; Crocetta e.al, 2020), we also understand the myths about
breastfeeding and pregnancy. With this counseling, we feel helped and pay more attention to our
diet,” said Mrs. Surni, one of the participants who attended. The enthusiasm of puskesmas officers
and participants was quite high for this activity, with 19 participants from the group of pregnant
women. RSUI hopes that this community service activity can continue to be present as one of the
promotive and preventive efforts to the wider community.

2 LITERATURE REVIEW AND METHOD

Nutrients are basic food substances needed for growth and health of the body. Balanced nu-
trition is a daily diet that contains nutrients in the type and amount according to the body's needs,
namely gender, age and health status. An unbalanced diet is at risk of causing nutritional deficien-
cies such as anemia and underweight, excess nutrition (obesity) can also occur which can be at
risk for degenerative diseases such as hypertension, coronary heart disease and diabetes mellitus.
In nutrition, there are five kinds of nutrients, namely carbohydrates, fats, proteins, minerals and
vitamins. In general, the functions of food substances are.
Source of energy or power. If this function is impaired, people become less active or less ac-
tive and feel tired quickly. Supports body growth, namely the addition of new cells to existing
cells. Maintain body tissue, replace damaged or worn out, such as replacing cells that are clearly
visible in body wounds, namely the occurrence of wound covering tissue. Regulate metabolism
and various balances in body fluids (balance of water, acid base, and minerals). Play a role in the
body's defense mechanism against various diseases as antioxidants and other antibodies.

 Vol. 08, No. 03, 2022 54

 Multicultural Education

If the body does not get enough nutrients, then these functions will suffer from disturbances
and obstacles, starting from function number one, and spreading towards that in the series. The
Principle of Balanced Nutrition consists of 4 (four) Pillars which are basically a series of efforts to
balance the outgoing and incoming nutrients by monitoring body weight regularly. In based there
are 4 (four) Pillars of balanced nutrition include (1) consuming a variety of foods with a balanced
proportion of food (carbohydrates, fats, proteins, minerals and vitamins) (2) get used to clean liv-
ing behavior (3) doing regular physical activity (4) monitor body weight (BB) regularly to main-
tain normal weight.
By paying attention to the principles of food diversity, physical activity, clean living behavior
and maintaining a normal weight will be able to prevent nutritional problems. To achieve a bal-
anced intake of nutrients it is impossible to fulfill only one type of food, but must consist of a va-
riety of food ingredients. In choosing food intake (especially children2), it is not only seen from
the fun factor, but also needs to choose healthy foods.
In choosing healthy foods, what needs to be observed is (especially parents for children).
Choose a balanced diet according to your needs, balanced nutrition and nutritional value. An un-
balanced diet will lead to an unhealthy body. The body must get a complete balanced diet starting
from carbohydrates obtained from rice and flour, protein from side dishes such as meat and fish,
vegetables that contain lots of fiber, and fruits that are rich in vitamins. Serve food in a form that
suits the needs and condition of the body (healthy/sick).
Prepare food according to the food pyramid that is good and healthy. The foods that are at the
bottom of the pyramid are the foods that should be consumed in the largest amount, so up to the
top are the foods that are consumed in the least amount. Cook food and choose food outside that
does not contain artificial flavors, colors, and preservatives and is harmful to the body. It is advis-
able to eat more vegetables and fruits. Foods that contain sugar, salt and fat are recommended to
be reduced because they can increase the risk of several diseases. Drinking adequate amounts of
water has been included in the components of a balanced diet because of the importance of water
in metabolic processes and in the prevention of dehydration.
Sugar consumption that exceeds the need will have an impact on increasing body weight
(obesity), even if done for a long time will directly increase blood sugar levels and have an impact
on the occurrence of diabetes, and even indirectly contribute to diseases such as osteoporosis,
heart disease and cancer.
In the elderly, especially those over 60 years of age, various changes occur in the body,
namely the decline in the function of various organs and tissues of the body. These changes in-
clude, among others, the sensory organs including the olfactory function so as to reduce appetite,
weakening of the digestive organ system so that the digestive tract becomes more sensitive to cer-
tain foods and experiences constipation, disorders of the teeth so that it interferes with chewing
function; weakening of the work of the heart muscle, in women entering menopause with various
consequences, and others.
This causes the elderly group to be more susceptible to nutritional disorders and various dis-
eases, including being too fat, too thin, hypertension, heart disease, diabetes mellitus, osteoporo-
sis, osteoarthritis etc. Therefore, the nutritional needs and food consumption patterns in the elderly
group are somewhat different from those in the adult group, for example limiting the consumption
of sugar, salt and oil, as well as high purines. Instead, eat more vegetables and fruits in sufficient
quantities.
Children will experience a period of rapid growth and development, thus requiring adequate
food consumption to achieve balanced nutrition.Therefore, a guide is needed for supervisors and
extension workers or doctors in order to provide understanding in the context of disseminating in-
formation and education to the public, so that they can choose foods that suit their needs and dis-
eases in order to get balanced nutrition. Hearing the word nutrition, of course we immediately im-
agine food or drink with all the substances they contain and are needed by the body such as vita-

 Vol. 08, No. 03, 2022 55

 Multicultural Education

mins, minerals, proteins or other substances, especially in order to support the health of our bodies
everyday.
It is true, nutrition is closely related to the substances found in the food and drinks that we
consume every day. Food that is lacking or nutritionally unbalanced when consumed will cause
various problems that result in nutritional disorders in the human body itself. Then, is it just that
simple the meaning of nutrition? Then, how much benefit to the human body? Well, to find out,
take a look at the following review.
Nutrients are substances as components of building the human body in order to maintain and
repair tissues so that the functions of the human body itself can run properly. Ignoring nutritional
intake also means that we let the body's tissue functions not work optimally. Sources of nutrition
are found in every food and drink that we have consumed so far. While the various substances that
are included in nutrition are as follows.
Let's start from the understanding in nutrition. In fact, there are many experts who define var-
ious terms in the science of nutrition. For convenience, in this Topic you given only one defini-
tion. The definition of nutrition science (nutrition science) is "The science that learn everything
about food in relation to health optimal". While what is referred to as food is "Ingredients other
than drugs that are contains nutrients and or elements/chemical bonds that can be converted into
nutrients by the body, which are useful when taken into the body. From that understanding it is
clear that medicine is not a food, and all supplements that contain substances nutrition can be cat-
egorized as food.
Need to know that the definition of nutrition classical or ancient nutrition is only associated
with body health. It means that it is said that nutrition is an aspect related to the basic function of
these nutrients, namely: produce energy, grow and maintain tissue, and regulate processes metabo-
lism in the body. In this modern era, the understanding of nutrition is not only limited to basic
functions of nutrients and health only, but nutrients have been associated with work ability,
productivity, IQ, and economic status. The purpose of nutrition itself is achieve, improve, and
maintain body health through consumption food.
Nutrients or nutrients are organic substances needed by organisms for the normal functioning
of body systems, growth, and maintenance of health. Research in the field of nutrition studies the
relationship between food and drink on health and disease, particularly in determining the optimal
diet. In the past, research on nutrition was only limited to preventing malnutrition and determining
the basic needs (standards) of nutrition in living things. This basic nutritional requirement is
known internationally as the Recommended Daily Allowance (RDA).
Along with scientific developments in the medical field and molecular biology, medical evi-
dence shows that the RDA is not sufficient to maintain optimal body function and prevent or help
treat chronic diseases. Medical evidence shows that the root of many chronic diseases is oxidative
stress caused by an excess of free radicals in the body. The use of nutrients in optimal levels,
known as Optimal Daily Allowance (ODA), is proven to prevent and treat oxidative stress, there-
by helping prevent chronic diseases. This optimal level can be achieved when the right amount
and composition of nutrients are used. In disease management, the use of nutrition as a comple-
mentary medicine can help the effectiveness of treatment and at the same time overcome the side
effects of treatment. Therefore, nutrition / nutrition is closely related to optimal health and improv-
ing the quality of life. The results of measuring can be done with the method of anthropometry.
While nutrition is a science that studies the relationship of food and drink to the health of the
human body so as not to experience nutritional disorders, where nutritional disorders themselves
are a disease caused by a lack of certain vitamins so that our bodies experience nutritional disor-
ders. The nutritional disorder that was first discovered was scorbut in 1497 or more popularly
known as thrush. At that time Vasco da Gama on his voyage to Indonesia had lost more than half
of his men who died from this disease.

 Vol. 08, No. 03, 2022 56

 Multicultural Education

This research is a descriptive qualitative research using a phenomenological approach. Ac-

cording to Lebahn-Hadidi (2021) phenomenology is a qualitative methodology that allows re-
searchers to apply and apply their subjectivity and interpersonal skills in the exploratory research
process. Phenomenology is the study of the various structures of consciousness experienced from
a first-person perspective. Phenomenology as a discipline differs from other branches of philoso-
phy, such as ontology, epistemology, logic and ethics, but at the same time is related to these dis-
ciplines (Dangal, M., & Joshi, R., 2020; Geniusas, S., 2022).
Phenomenological research is increasing in popularity in nursing research for good reason. The quali-
tative research method allows an in-depth exploration of patient lived experience. This knowledge has the
potential to enhance quality of holistic patient care. To undertake this method of inquiry, however, it is im-
perative that holistic nurse researchers understand the philosophical underpinnings of the method and are
familiar with the two major types of phenomenology in order to approach the study in a scholarly manner.
The purpose of this article is to explicate the method’s historical roots of phenomenology, its evolution, its
two major traditions and their differences, and some of the specialized terminology unique to phenomenolo-
gy’s jargon so that their studies can contribute to sound nursing science and complete patient care.
So that what is studied in phenomenology is considered as a method of study that does not re-
ject elements that are generally not related to facts or are not taken into account from the start be-
cause they are considered wrong. This study is deductive in nature and starts from the relationship
with the environment, with the good, the bad, the right and the wrong.
There are 2 (two) research data, namely first, based on statements from pregnant women re-
garding their real conditions during pregnancy and second, based on the results of interviews with
informants who were used as research sources. There were 56 pregnant women who were the tar-
gets of this study. However, only 43 people were used as the main data. The rest are used as sup-
port.

3 RESULT AND DISCUSSION

Suboptimal nutritional conditions are associated with health problems and poor health condi-
tions, as well as increasing the risk of infectious diseases and non-communicable diseases such as
cardiovascular disease (heart and blood vessel disease, hypertension and stroke), diabetes and can-
cer. Optimal nutrition is essential for normal growth and physical and intellectual development of
infants, children and all age groups. Good nutrition makes a normal or healthy body weight, the
body is not susceptible to infectious diseases, work productivity increases and is protected from
chronic diseases and premature death due to disease.
Balanced nutrition is a daily food composition containing nutrients in the type and amount ac-
cording to the body's needs, taking into account the principles of food diversity, physical activity,
clean living behavior and monitoring body weight regularly in order to maintain a normal weight to
prevent nutritional problems. The Principle of Balanced Nutrition consists of 4 (four) Pillars which
are basically a series of efforts to balance the outgoing and incoming nutrients by monitoring body
weight regularly; namely as follows.

Consume a variety of foods

Food diversity is a variety of food groups consisting of staple foods, side dishes, vegetables
and fruits and water as well as diverse in each food group. What is meant by variety in this princi-
ple, apart from the diversity of food types, also includes a balanced proportion of food, in sufficient
quantities, not excessive and carried out regularly. Dietary recommendations in recent decades
have taken into account the proportion of each food group in accordance with the supposed needs.
Similarly, the number of foods containing sugar, salt and fat which can increase the risk of several
non-communicable diseases, is recommended to be reduced. Recently drinking adequate amounts
of water has been included in the components of a balanced diet because of the importance of water
in metabolic processes and in the prevention of dehydration.
The staple foods include: Rice, potatoes, cassava, sweet potatoes, corn, taro, sago, breadfruit.
Side dishes of protein sources include: Fish, eggs, poultry, meat, milk and nuts and their processed
products (tofu and tempeh). Vegetables are greens and other colorful vegetables; Among others:
 Vol. 08, No. 03, 2022 57
 Multicultural Education

Broccoli, Winged Beans, Young Papaya, Mustard Greens, Cauliflower, Beans, Pumpkin, etc.
Fruits are colored fruits; among others: avocado, grapes, red apples, poor apples, star fruit, canta-
loupe, duku, durian, guava; etc.
One of the messages of balanced nutrition that is quite interesting is the recommendation to
consume a variety of staple foods. What is meant by a variety of staple foods is consuming foods
that are carbohydrate sources from several types of foodstuffs, such as rice, sweet potatoes, sago,
corn, and some processed products such as noodles and bread. Indonesia is one of the rice produc-
ing countries in the world. This makes most of the Indonesian people their staple food is rice.
However, the research results show that a diet dominated by rice has a negative impact on the
body's metabolism so that it triggers non-communicable diseases.
Research in Thailand shows that a high-carbohydrate diet characterized by rice consumption is
associated with metabolic syndrome with a risk value of 1.82 times for men and 1.60 times for
women (Aeplapkorn, et al 2015). Likewise, research in Korea showed that a diet dominated by
white rice alone had a higher risk of metabolic syndrome compared to consuming white rice which
was also accompanied by the consumption of a variety of other grains (Y Ahn, et al, 2013).

Figure 1 Examples of Various Foods

The nutritional content of staple foods also differs from one another. Rice, is a food that is
high in carbohydrates but low in fiber due to the milling process from grain to rice. Other grains,
such as corn, contain high fiber which is then beneficial in controlling blood cholesterol. Some tu-
bers such as purple sweet potato and yellow sweet potato contain anthocyanins which act as antiox-
idants in the body, so they can prevent non-communicable diseases (Balanced Nutrition Guidelines,
2014). Some practices that can be done are to try to replace the staple food of rice with other staple
foods in a week.
For example, eating 2 pieces of bread in the morning accompanied by stuffing vegetables and
meat or eggs can be one of the breakfasts. You can also eat special foods such as lime which is
processed from sago then mixed with vegetables and fish can be an alternative for lunch. Replacing
white rice with brown rice can also be an alternative in practicing a variety of staple foods. One of
the advantages of the Indonesian nation is its diverse culture, so that food processing also differs
from one region to another. Certain regions can process corn into delicious staple foods, but other
regions can process sweet potatoes into food that is no less delicious. This can be a reference for us
to be able to process a variety of foods, one of which is the type of staple food. Hopefully this brief
explanation can encourage us to try to replace the staple food of rice with other staple foods so that
it can prevent or reduce the risk of non-communicable diseases.
 Multicultural Education

Get used to clean living behavior

A culture of clean living behavior will prevent a person from being exposed to sources of in-
fection. A person suffering from an infectious disease will experience a decrease in appetite so that
the amount and type of nutrients that enter the body decreases. On the other hand, in a state of in-
fection, the body requires more nutrients to meet the increased metabolism in people suffering from
infection, especially when accompanied by heat (fever). And vice versa, someone who suffers from
malnutrition will have a risk of getting infectious diseases because in a state of malnutrition a per-
son's immune system decreases, so that germs are easier to enter and develop.
In the household setting, PHBS also includes exclusive breastfeeding, giving birth to the assis-
tance of health workers (midwives or doctors), following a schedule according to a schedule, and
checking the growth and development of infants and children at clinics, health centers, or posyandu
regularly until children are 6 years old. In addition, health protocols during the COVID-19 pandem-
ic, such as wearing masks, maintaining a physical distance of at least 1 meter, and carrying out reg-
ular disinfection, are also included in PHBS.
If you are a smoker, PHBS can also be done by quitting smoking. Although some things are
easy, there are several ways you can do, starting from yourself from smoking triggers to undergo-
ing hypnotherapy. If you're still having trouble, you might consider switching to alternative tobacco
products, such as pleasurable tobacco products, nicotine patches, nicotine gum, or e-cigarettes.
These various products are known to be lower risk when compared to cigarettes so that they can
help smokers to reduce the adverse effects that may arise.
Benefits of Implementing PHBS (Clean and Healthy Living Behavior). PHBS is important to
be carried out regularly because it can provide the following benefits. First, prevent infectious dis-
eases. One of the main objectives of implementing PHBS is to maintain the cleanliness of the body
and the environment. By getting used to living clean and healthy, you will avoid various viruses,
bacteria, fungi, and parasites that cause infectious diseases. Second, supports productivity. A
healthy body and a clean environment will support the smooth process of teaching and learning,
work, and other activities. In addition, you will become more comfortable and enthusiastic in your
activities.
Third, supports child development. PHBS applied in households also plays a role in optimiz-
ing children's growth and development and preventing stunting. With good hygiene, children will
be protected from germs that cause disease. This can be an important factor to support the health
and development of children from an early age. Fourth, preserving the cleanliness and beauty of the
environment. A clean, beautiful, and green environment will certainly be more comfortable to live
in. Therefore, every member of the community needs to apply PHBS habits to keep their environ-
ment clean.
This can be done by not littering, not urinating and defecating in rivers, and doing reforesta-
tion by planting trees around the house. In some areas in Indonesia, especially in remote areas, the
implementation of PHBS may still have many obstacles. These constraints are generally related to
the lack of clean water, as well as inadequate sanitation facilities and health services. However,
these obstacles do not only exist in remote areas. Although health services and access to infor-
mation in urban areas are easier to reach, there are still many urban communities who are not aware
of the importance of PHBS.
The implementation of PHBS brings many benefits to your health, your family, and the sur-
rounding environment. Therefore, apply clean and healthy behavior starting from yourself. If you
still have questions about the importance of PHBS, don't hesitate to consult a doctor. A clean and
healthy lifestyle is important to apply to maintain physical and mental health. The first step in prac-
ticing it is to identify unhealthy habits and learn new, positive habits to replace them. This can be
done by eating a healthy and balanced diet, getting regular sleep, managing stress, limiting alcohol
consumption, and being physically active.

Doing physical activity

Physical activity which includes all kinds of body activities including sports is an effort to bal-
ance the expenditure and intake of nutrients, the main source of energy in the body. Physical activi-
ty requires energy. In addition, physical activity also facilitates the metabolic system in the body,
including the metabolism of nutrients. Therefore, physical activity plays a role in balancing the nu-
trients that come out of and enter the body.
 Vol. 08, No. 03, 2022 59
 Multicultural Education

Physical activity is the activity of the body's muscles that move the skeleton and produce en-
ergy and power. Physical activity is not always done by doing special sports, but also through vari-
ous simple daily activities such as sweeping, gardening, walking, mopping, cleaning the house,
ironing, and others. A person is advised to carry out good, measurable, and regular physical activity
needs to be done 3-5 times a week or every day for 30 minutes. Physical activity can actually be
done anywhere, be it at home, at school, or outside the home. In general, physical activity is divid-
ed into 3 (three) types, namely light, moderate, and heavy activities. Light physical activity ex-
pends energy of less than 3.5 Kcal/minute, light physical activity expends energy of 3.5 – 7
Kcal/minute, while strenuous activity expends energy of more than 7 Kcal/minute.
Physical activity is very important because it has many benefits for the body, one of which is
to reduce the risk of non-communicable diseases. In addition, physical activity also has many other
benefits such as (1) control cholesterol levels (2) control your weight (3) control blood pressure (4)
increase endurance and immune system (5) prevent diabetes mellitus or diabetes (6) improve pos-
ture (7) improve joint flexibility and muscle strength (8) lowering the risk of osteoporosis in wom-
en (9) control stress (10) reduce anxiety.
Physical activity is a conscious movement of the body produced by skeletal muscles that re-
quires energy expenditure. Physical activity includes all activities, of any intensity, that are per-
formed at any time. Mobile activity is very important because it can help in the prevention and
treatment of disease. So that moving activities can be used for a healthy lifestyle. Physical activity
is categorized as sufficient if a person does physical exercise or sports for 30 minutes every day or
at least 3-5 days a week.
Some examples of physical activity that can bring benefits to health such as exercise, walking,
swimming, running, cycling, to cardio exercise. Physical activity Not only limited to certain sports,
but various routine activities that are usually done, such as doing housework (cooking, sweeping,
mopping floors, etc.). Physical activity does not only have an impact on physical health but also
benefits mental health.
Busy work makes you forget to take care of your body? Even though during a pandemic like
now, you are required to maintain your health as an effort to protect the body from exposure to the
virus. You can maintain your health by adopting a healthy lifestyle, such as giving your body the
nutrients it needs and doing regular physical activity. Talking about physical activity, this is not on-
ly related to strenuous exercise that will take time. Anything that keeps your body moving can be
categorized as an example of physical activity. For example, doing housework, walking, etc. This
activity can be done anywhere, whether at home, in public places, in the gym, even in the office. In
addition, there are many benefits that you can get from doing this activity

Monitor body weight (BB) regularly to maintain normal weight

For adults, one of the indicators that shows that there has been a balance of nutrients in the
body is the achievement of a normal weight, which is a weight that is appropriate for their height.
This indicator is known as Body Mass Index (BMI). Monitoring of normal weight is something that
must be part of a Balanced Nutrition Lifestyle, so that it can prevent weight deviations, and if there
is a deviation, preventive and corrective measures can be taken immediately.
Health experts suggest that you don't forget to monitor your weight regularly as a way to avoid
obesity. According to a clinical nutrition specialist from Pondok Indah Hospital, Puri Indah, dr.
Raissa Edwina, M. Nutrition, SpGK, obesity can cause a number of diseases. "It's better to monitor
your weight regularly, so you know when your weight starts to increase, so you can start improving
your diet to be healthy, increasing physical activity," Raissa said at the "AIA Healthy Living Day"
event in Jakarta, Thursday (6/12/2018) , as quoted by Antara.
Citing 2018 Basic Health Research (Riskesdas) data, the obesity rate in Indonesia has in-
creased since 2013 from 14 percent to 21 percent, an increase of 7 percent. Raissa said, 1 in 3 peo-
ple are obese, while in men 1 in 5 people. This confirms previous data regarding weight gain in
both women and men. "The trend of obesity rates is increasing. Data on monitoring nutritional sta-
tus over the age of 18 years, those who are obese are around 40.4 percent.
Obesity can cause several life-threatening diseases. As reported by Web MD, diseases caused
by obesity include: High blood pressure and high cholesterol. Both conditions make heart disease
or stroke more likely. Type 2 diabetes. Cancers, including cancer of the colon, breast (after meno-
pause), endometrium (lining of the uterus), kidney, and esophagus are linked to obesity. Several

 Vol. 08, No. 03, 2022 60

 Multicultural Education

studies have also reported an association between obesity and cancer of the gallbladder, ovaries,
and pancreas. Gallbladder disease. Gallbladder disease and gallstones.
Osteoarthritis, a common joint condition that most commonly affects the knees, hips, or back.
Gout, a disease that affects the joints. It occurs when you have too much uric acid in your blood.
The extra uric acid can form crystals that get deposited in the joints. Sleep Apnea, a respiratory
condition associated with being overweight. Sleep apnea can cause a person to snore heavily and
briefly stop breathing during sleep. Sleep apnea can cause daytime sleepiness and make heart dis-
ease and stroke more likely. The way to reduce these risks is to keep your weight in balance. Main-
taining weight should be slow, as rapid weight loss can lead to gallstones.
Ideal body weight needs to be maintained for three reasons. First, so as not to cause various
metabolic diseases. Second, not triggering the occurrence of pre-existing disease, and third, avoid-
ing premature death. In addition to making you look more attractive, maintaining your weight can
also make you healthier. What is healthy is not fat, but also not thin, but ideal. Ideal body weight
can be calculated using the BMI (body mass index) formula, which is body weight (kilograms) di-
vided by the square of height (meters). If the index ranges from 18.5-23, it is considered ideal. On
the basis of that benchmark we can keep our weight around a BMI of 18.5-23. If the BMI index ex-
ceeds the ideal value, it means that what you eat exceeds your body's needs. Therefore, the portion
of food should be reduced.
Weight is one of the risk factors for a number of metabolic diseases, high blood pressure, dia-
betes, excess blood fat. However, maintaining an ideal body weight is not easy. Diet and lifestyle
often trigger people to become fat. It also occurs because it is difficult to brake excessive appetite
and high-calorie menu choices. Fried foods, fatty menus, and red meat are modern daily menus that
tend to be excess calories. So it is true that obese people carry a greater risk of disease than people
who are not obese.
In medical language, human age is determined by the circle of the belt and the condition of the
blood vessels of the body. The normal waist circumference for men is less than 90 centimeters and
for women less than 80 cm. Likewise, if the condition of the blood vessels is rusty fat (plaque).
Belt circumference and body blood vessels that are in normal condition will increase a person's po-
tential to live long. Most of the triggers for premature death is the problem of being overweight.
The most important solution in order to get the ideal weight is to organize the menu and main-
tain daily food intake. People often severely limit the portion of their main food, but forget that
snacks can also provide excessive calories. Many people don't take into account the calories from
fried foods, soft drinks, sweets, sugary teas, and anything sweet and fatty.
Weighing is often considered trivial by many people, except those who want to lose or gain
weight. In fact, weighing regularly has benefits. One of them is to measure whether our weight is
still ideal or already excessive. "You should monitor your weight regularly. So that we know if our
weight starts to increase, it's time for us to reduce weight, run a healthy diet, increase physical ac-
tivity." It was expressed by dr. Raissa E. Djuanda M. Gizi, Sp.GK when attending the launch of the
AIA Healthy Living Index 2018 at Elite Club, Epicentrum, South Jakarta, Thursday (6/12/2018).
Also read: Weighing Your Body Every Day Can Avoid Obesity Because, Raissa added, the number
of people who are obese continues to increase. The results of the 2017 Nutritional Status Monitor-
ing, for example, showed the number of obese people reached 40.4 percent. The 2018 Basic Health
Research (Riskesdas) also showed an increase in the proportion of obese adults in the last five
years. The figure reached 21.8 percent, an increase from 2013 which was only 14.8 percent.
Breastfeeding mothers should maintain ideal body weight so that they are not too thin or too
fat. Immediately after the mother gives birth, monitor BB regularly. Some mothers tend to limit
their food intake to return the weight to its original weight. In this case, breastfeeding mothers are
advised not to drastically reduce their body weight, because the rapid reduction in nutrient intake
will affect the nutritional intake of the baby. Supposedly, if the lifestyle of breastfeeding mothers
remains balanced, which includes food intake with the principles of Balanced Nutrition, physical
activity, and adequate water consumption, the ideal body weight will be achieved.
Routinely weighing a child's weight can be the first step to early detection of malnutrition so
that it is not too late to get the right treatment. This is because weight gain according to the growth
chart is one of the parameters for the nutritional status and health of children. Balanced nutrition is
a daily diet that contains nutrients in the types and amounts that are adapted to the needs of a per-
son's body by taking into account the principles of variety of types of food, physical activity, main-
taining cleanliness, and paying attention to ideal body weight (BB).

 Vol. 08, No. 03, 2022 61

 Multicultural Education

The food pyramid from bottom to top shows the amount and type of food we should eat.
Where water, must be the substance we consume the most. Furthermore, sources of carbohydrates
such as rice, bread, and pasta. Sources of fiber, vitamins, and minerals that can be found in fruits
and vegetables. Then sources of protein, both animal and vegetable and fatty foods. As for sweet
food, it should be the least consumed.

4 CONCLUSION

Maintaining health during pregnancy is something that needs to be considered carefully.

Maintaining a healthy body can be done both physically and emotionally. During pregnancy, a
mother really needs to take care of her health because of the changes that occur in her body. The
reason is, during pregnancy there is also a fetus in the womb. Proper health can be very important
to determine fetal development. This can further affect the growth of the baby after birth.
Fulfillment of nutrition for pregnant women is the most important during pregnancy. By get-
ting balanced and good nutrition, pregnant women can reduce health risks, therefore, paying atten-
tion to food intake and nutrition is very important by pregnant women and their families. By
providing enough food. Contains carbohydrates and fats as a source of energy. And as a source of
substances. Protein builders get a minimal addition of iron, calcium, vitamins, folic acid and ener-
gy.
Health conditions during pregnancy are very dependent on the healthy lifestyle adopted by
pregnant women. Fill your dinner plate with a variety of healthy foods that are highly nutritious to
support the health of yourself and the fetus in the womb. For mothers, eating nutritious foods can
help increase stamina, avoid the risk of pregnancy complications, control weight during pregnancy
and stay healthy. By adopting a healthy diet, the health of pregnant women will be much better. In
addition, pregnant women who adopt a healthy diet also tend to avoid depression during pregnancy.
The reason is, nutritious food helps stabilize the mother's mood throughout pregnancy. Nutri-
tious foods that must be consumed so that the health of pregnant women is maintained are (1) pro-
tein foods, such as hard-cooked eggs, chicken breasts, and whole grains (wheat bread and brown
rice); (2) foods that contain vitamin C, such as citrus fruits, guavas and strawberries; (3) foods and
drinks that contain calcium, such as pasteurized milk and leafy green vegetables; (4) iron-rich
foods, such as broccoli and beans; (5) foods that contain healthy fats, such as salmon (cooked) and
avocados; and (6) foods that contain folic acid, such as egg yolks and spinach.
Meanwhile, in order to maintain the health of pregnant women, avoid eating undercooked
meat, animal offal, and fast food that is high in trans fat as long as pregnant women lead a healthy
lifestyle. Also avoid eating fish that are high in mercury during pregnancy, such as tuna, mackerel,
and swordfish so that the health of pregnant women is maintained.

References
1. Angraini, D. I., Aryani, L. D., Sari, M. I., & Imantika, E. (2020). The effect Of Chronic Energy
Deficiency And Protein In Take On The Incidence Of Preeclampsia In dr. H. Abdul Moeloek
Hospital Lampung Province. Prosiding ICoISSE, 1(1), 705-715.
2. Asih, Y., & Nyimas, A. (2020). Hypnobreastfeeding to increase motivation and breast milk pro-
duction: A study. International Journal of Innovation, Creativity and Change, 13(2), 122-37.
3. Barr, J., & White, R. R. (2019). Motility disorders of the stomach and small intestine. In Shackel-
ford's Surgery of the Alimentary Tract, 2 Volume Set (pp. 755-763). Elsevier.
4. Basir, S. M. A., Ghani, R. A., Ibrahim, M., Khan, M. M. A., Khattak, M. N. O., & Shukri, N. A.
M. (2019). Dietary intake of mothers who practised traditional confinement during exclusive
breastfeeding period. Malaysian J. Med. Heal. Sci, 15, 39-46.
5. Bollyky, T. J., & Bown, C. P. (2020). The tragedy of vaccine nationalism: only cooperation can
end the pandemic. Foreign Aff., 99, 96.
6. Ciampo, L. A. D., & Ciampo, I. R. L. D. (2018). Breastfeeding and the Benefits of Lactation for
Women’s Health. Revista Brasileira de Ginecologia e Obstetrícia, 40, 354-359.
7. Condo, D., Lohman, R., Kelly, M., & Carr, A. (2019). Nutritional intake, sports nutrition

 Vol. 08, No. 03, 2022 62

 Multicultural Education

knowledge and energy availability in female Australian rules football players. Nutrients, 11(5),
971.
8. Cormick, G., & Belizán, J. M. (2019). Calcium intake and health. Nutrients, 11(7), 1606.
9. Costanza, J., Camanni, M., Ferrari, M. M., De Cosmi, V., Tabano, S., Fontana, L., ... & Agostoni,
C. (2022). Assessment of pregnancy dietary intake and association with maternal and neonatal
outcomes. Pediatric research, 91(7), 1890-1896.
10. Crocetta, F., Bitar, G., Zibrowius, H., & Oliverio, M. (2020). Increase in knowledge of the marine
gastropod fauna of Lebanon since the 19th century. Bulletin of Marine Science, 96(22), 10-5343.
11. Danckert, J., & Eastwood, J. D. (2020). Out of my skull: The psychology of boredom. Harvard
University Press.
12. Dangal, M., & Joshi, R. (2020). Hermeneutic phenomenology: Essence in educational research.
Open Journal for Studies in Philosophy, 4(1).
13. Diana, R., Rachmayanti, R. D., Anwar, F., Khomsan, A., Christianti, D. F., & Kusuma, R. (2018).
Food taboos and suggestions among Madurese pregnant women: a qualitative study. Journal of
Ethnic Foods, 5(4), 246-253.
14. Dima, A. (2021). The Importance of Innovation in Entrepreneurship for Economic Growth and
Development. A Bibliometric Analysis. Revista de Management Comparat International, 22(1),
120-131.
15. Djalante, R., Lassa, J., Setiamarga, D., Sudjatma, A., Indrawan, M., Haryanto, B., ... & Warsilah,
H. (2020). Review and analysis of current responses to COVID-19 in Indonesia: Period of Janu-
ary to March 2020. Progress in disaster science, 6, 100091.
16. Dreyer, J. L., & Liebl, A. L. (2018). Early colonization of the gut microbiome and its relationship
with obesity. Human Microbiome Journal, 10, 1-5.
17. Echeverría, F., Valenzuela, R., Bustamante, A., Álvarez, D., Ortiz, M., Espinosa, A., ... & Videla,
L. A. (2019). High-fat diet induces mouse liver steatosis with a concomitant decline in energy
metabolism: attenuation by eicosapentaenoic acid (EPA) or hydroxytyrosol (HT) supplementation
and the additive effects upon EPA and HT co-administration. Food & Function, 10(9), 6170-
6183.
18. Farmer, E. E., Gao, Y. Q., Lenzoni, G., Wolfender, J. L., & Wu, Q. (2020). Wound‐and
mechanostimulated electrical signals control hormone responses. New Phytologist, 227(4), 1037-
1050.
19. Geniusas, S. (2022). The phenomenology of pain (Vol. 53). Ohio University Press.
20. Gomes, C. S., & Silva, E. A. (2021). Health Benefits and Risks of Minerals: Bioavailability, Bio-
Essentiality, Toxicity, and Pathologies. In Minerals latu sensu and Human Health (pp. 81-179).
Springer, Cham.
21. Johnson, M. A., & Bales, C. W. (2022). Vitamins and minerals. Pathy's Principles and Practice
of Geriatric Medicine, 1, 213-227.
22. Jouanne, M., Oddoux, S., Noël, A., & Voisin-Chiret, A. S. (2021). Nutrient requirements during
pregnancy and lactation. Nutrients, 13(2), 692.
23. Kazmerski, T. M., West, N. E., Jain, R., Uluer, A., Georgiopoulos, A. M., Aitken, M. L., & Tay-
lor‐Cousar, J. L. (2022). Family‐building and parenting considerations for people with cystic fi-
brosis. Pediatric pulmonology, 57, S75-S88.
24. King, J. C. (2000). Physiology of pregnancy and nutrient metabolism. The American journal of
clinical nutrition, 71(5), 1218S-1225S.
25. Kondili, L. A., Andreoni, M., Alberti, A., Lobello, S., Babudieri, S., Roscini, A. S., ... & Craxì,
A. (2021). Estimated prevalence of undiagnosed HCV infected individuals in Italy: a mathemati-
cal model by route of transmission and fibrosis progression. Epidemics, 34, 100442.
26. Lebahn-Hadidi, M., Abildgren, L., Hounsgaard, L., & Steffensen, S. V. (2021). Integrating cogni-
tive ethnography and phenomenology: rethinking the study of patient safety in healthcare organi-
sations. Phenomenology and the Cognitive Sciences, 1-23.
27. Ma, X., Zhao, H., Xu, W., You, Q., Yan, H., Gao, Z., & Su, Z. (2018). Co-expression gene net-
work analysis and functional module identification in bamboo growth and development. Fron-
tiers in genetics, 9, 574.
28. Majtan, J., Bucekova, M., Kafantaris, I., Szweda, P., Hammer, K., & Mossialos, D. (2021). Hon-
ey antibacterial activity: A neglected aspect of honey quality assurance as functional food. Trends
in Food Science & Technology, 118, 870-886.
29. Noblet, J., Dourmad, J. Y., & Etienne, M. (1990). Energy utilization in pregnant and lactating
sows: modeling of energy requirements. Journal of animal science, 68(2), 562-572.
 Vol. 08, No. 03, 2022 63
 Multicultural Education

30. Pashte, V. V., Pashte, S. V., & Said, P. P. (2020). Nutraceutical properties of natural honey to
fight health issues: A comprehensive review. J. Pharmacogn. Phytochemi, 9, 234-242.
31. Permatasari, T. A. E., Rizqiya, F., Kusumaningati, W., Suryaalamsah, I. I., & Hermiwahyoeni, Z.
(2021). The effect of nutrition and reproductive health education of pregnant women in Indonesia
using quasi experimental study. BMC Pregnancy and Childbirth, 21(1), 1-15.
32. Pickles, C., & Herring, J. (Eds.). (2019). Childbirth, Vulnerability and Law: Exploring Issues of
Violence and Control. Routledge.
33. Rayner, C. K., Jones, K. L., & Horowitz, M. (2019). Is making the stomach pump better the an-
swer to gastroparesis?. Gastroenterology, 156(6), 1555-1557.
34. Rehman, F. U., Kalsoom, M., Adnan, M., Toor, M., & Zulfiqar, A. (2020). Plant growth promot-
ing rhizobacteria and their mechanisms involved in agricultural crop production: A review.
SunText Rev. Biotechnol, 1(2), 1-6.
35. Rulandari, N. (2020). The impact of the Covid-19 pandemic on the world of education in Indone-
sia. Ilomata International Journal of Social Science, 1(4), 242-250.
36. Say-Sallaz, E., Chamaillé-Jammes, S., Fritz, H., & Valeix, M. (2019). Non-consumptive effects
of predation in large terrestrial mammals: Mapping our knowledge and revealing the tip of the
iceberg. Biological conservation, 235, 36-52.
37. Seckold, R., Fisher, E., De Bock, M., King, B. R., & Smart, C. E. (2019). The ups and downs of
low‐carbohydrate diets in the management of Type 1 diabetes: a review of clinical outcomes. Di-
abetic Medicine, 36(3), 326-334.
38. Smiciklas-Wright, H., Mitchell, D. C., Mickle, S. J., Goldman, J. D., & Cook, A. (2003). Foods
commonly eaten in the United States, 1989-1991 and 1994-1996: are portion sizes changing?.
Journal of the American Dietetic Association, 103(1), 41-47.
39. Srinadi, N. L., Puspitawati, T., & Wantini, N. A. relationship of family economic status with
chronic energy deficiency in pregnant women in jetis community health center, Yogyakarta. In
7th International Conference on Public Health 2020 (pp. 29-33). Sebelas Maret University.
40. Synta, D. N., Arif, A., Indriani, P. L. N., Anggraini, H., & Ciselia, D. (2022). Relationship Be-
tween ANC Visits, History Of Illness, And Distance Of Pregnancy With Chronic Energy Defi-
ciency (CED) Events In Trimester Iii Pregnant Women At Cahya Maju Puskesmas, Lempuing
District, Oki Regency In 2021. Science Midwifery, 10(3), 2471-2476.
41. Thayer, Z. M., Rutherford, J., & Kuzawa, C. W. (2020). The maternal nutritional buffering mod-
el: An evolutionary framework for pregnancy nutritional intervention. Evolution, medicine, and
public health, 2020(1), 14-27.
42. Wiseman, G. (2002). Nutrition and health. Taylor & Francis.
43. Zelalem, T., Mikyas, A., & Erdaw, T. (2018). Nutritional knowledge, attitude and practices
among pregnant women who attend antenatal care at public hospitals of Addis Ababa, Ethiopia.
International Journal of Nursing and Midwifery, 10(7), 81-89.
44. Zhang, Z., Fulgoni III, V. L., Kris-Etherton, P. M., & Mitmesser, S. H. (2018). Dietary intakes of
EPA and DHA omega-3 fatty acids among US childbearing-age and pregnant women: an analysis
of NHANES 2001–2014. Nutrients, 10(4), 416.

 Vol. 08, No. 03, 2022 64