Does urban living contribute to better nutrition? An ecological study on urban–rural disparities in Indonesia

Background Indonesia faces a double burden of malnutrition, with urban children generally less affected by undernutrition but increasingly prone to being overweight. However, national trends may mask sub-provincial disparities driven by uneven access to health services, food quality, and socioeconomic conditions—patterns that remain underexplored. Objectives To assess disparities in child nutritional and maternal care indicators between urban and rural areas at the national level and to conduct sub-provincial analyses in selected districts to uncover patterns masked by aggregated national data. Methods We performed an ecological analysis using data from the 2024 Indonesian Nutritional Status Survey. First, we assessed national-level disparities in child nutritional and maternal care indicators between urban and rural areas using odds ratios (OR) and chi-square tests. To capture localized patterns hidden by national aggregates, we then conducted sub-provincial case studies in selected districts of Central Java and South Sulawesi, comparing outcomes across different urban and rural settings. Results Nationally, urban children had lower odds of undernutrition—including severely underweight (OR 0.78; 95% CI: 0.75–0.81), underweight (OR 0.82; 95% CI: 0.80–0.84), and stunting (OR 0.77; 95% CI: 0.75–0.78)—but higher odds of being at risk of overweight (OR 1.35; 95% CI: 1.31–1.40) and consuming unhealthy foods (OR 1.22; 95% CI: 1.19–1.25). Rural areas consistently showed worse access to dietary diversity and antenatal care. In Central Java, Kota Magelang showed lower risk of severe underweight compared to Kota Surakarta (OR 0.25; 95% CI: 0.09–0.70; p = 0.008) and Kota Tegal (OR 0.15; 95% CI: 0.06–0.39; p = 0.001). In South Sulawesi, Kota Makassar had lower odds of severe underweight than Kota Pare-pare (OR 0.42; 95% CI: 0.23–0.77; p = 0.005), but higher underweight risk than Tana Toraja (OR 1.79; 95% CI: 1.30–2.48; p < 0.001). Conclusions While urban areas generally have lower undernutrition, this study reveals that substantial disparities also exist between and within urban and rural districts. Kota Magelang, a small urban city, shows more favorable outcomes—possibly due to proximity to referral centers—while cities like Palopo and surrounding rural areas remain vulnerable.