Why Do Stunting Interventions Remain Unequal in Urban Areas? A Multivariate Analysis of Subdistrict Risk Profiles in Cirebon City, Indonesia

Purpose: Childhood stunting remains a persistent human development barrier in Indonesia. While national prevalence has declined to 19.8% as of 2024, aggregate data frequently mask profound micro-level disparities that threaten the 14% national target. A critical research gap exists in meso-level diagnostics; traditional monitoring evaluates indicators in silos, failing to capture the systemic convergence of interventions. We selected four principal indicators, namely Health Insurance (PBI-JKN), Food Assistance (BPNT), Iron Supplementation, and Unmet Contraceptive Need, as they represent the essential intersection of social protection and reproductive health required for effective prevention. This study addresses the problem of localized systemic risk, where standardized city-wide policies fail to reach “red zones” within urban villages. Our objective was to quantify subdistrict-level inequality and identify specific performance typologies across 22 subdistricts in Cirebon City. Patients and Methods: We conducted a retrospective, cross-sectional analysis of 2023 administrative data. ANOVA-Simultaneous Component Analysis (ASCA) with 1000 permutations was used to decompose variance, followed by SVD-based biplot visualization to map the multivariate performance landscape. Results: The subdistrict effect was statistically significant (), with the first two components capturing 92.99% of total variance. Biplot analysis distinguished between “access-lagging” facing structural deficits in social protection and “compliance-lagging” clusters hampered by behavioral and service-outreach gaps. Conclusion: Urban stunting risk is not monolithic; geography remains a decisive determinant of intervention coverage. This study contributes to the precision public health paradigm by providing a diagnostic framework that enables local governments to move beyond one-size-fits-all models. By identifying neighborhood-specific vulnerabilities, including administrative exclusion and behavioral barriers, policymakers can implement targeted, risk-informed governance to ensure more equitable health outcomes. Plain Language Summary: Stunting is a significant health issue that affects a child’s ability to grow and reach their full potential. In Indonesia, national averages often hide the fact that some neighborhoods receive much more support than others. This study was done to find these hidden gaps so that local leaders can provide better, more targeted help to every family. The researchers looked at 22 neighborhoods in Cirebon City to see how well four key programs were reaching the community. These programs include health insurance for vulnerable families, food assistance, iron supplements for women planning to marry, and family planning services. Instead of looking at these programs one by one, the study used a modern analytical tool to see how all these services work together in each specific area. The results show that each neighborhood has its own unique strengths and needs. For example, some areas are very successful at providing food aid but need more support with health supplements. Other neighborhoods have the opposite situation. This means that a “one-size-fits-all” approach is not the best way to help children. These findings are a valuable resource for city officials. By understanding the specific needs of each neighborhood, they can now move away from general plans and instead create “precision” solutions. This approach ensures that resources go exactly where they are needed most, helping more families benefit from health services and ensuring a healthier future for all children in the city.