FeaturedNationalVOLUME 16 ISSUE # 05

Roadmap to stunting prevention

Prime Minister Imran Khan has accelerated his efforts to address the issue of stunting among children. He has directed his health and social protection team to provide a roadmap to prevent the stunted growth of children, which badly impacts their mental and physical development.

The challenge to prevent stunting, which not only affects children’s mental and physical abilities, but also deprives society of benefiting from their constructive abilities, has compounded after the onset of the coronavirus pandemic. According to the World Bank, Pakistan’s economic outlook will remain fragile for at least two years, as the outbreak of the disease has compounded the country’s miseries and poverty is expected to worsen. Pakistan already faces a serious flour crisis. Prices of edibles have skyrocketed. Poverty has increased by 33pc in India and the situation in Pakistan is not different. Over 14m people have already lost jobs during the pandemic in Pakistan. In this situation, it is not easy to meet the challenge of stunting.

According to the State Bank of Pakistan, almost half of Balochistan’s households face mild to severe food insecurity. Among the 36.9pc food insecure households in the country, 18.3pc face severe food insecurity. The pandemic is projected to push over 10 million more people below the poverty line. Lockdowns and restrictions aimed to contain the spread of the disease are feared to have caused a loss of 18.53m jobs in the country. These are the government’s own estimates mentioned in the Economic Survey 2019-20 and the real situation could be even worse. After Covid-19’s negative impact on Pakistan’s economy, the number of people living below the poverty line may rise from the existing figure of 50 million to 60m. Calculated on the basis of Rs3,250.3 per adult per month by the Planning Commission, 24.3pc of the population is below the poverty line. If a household’s consumption goes down by 5pc, the headcount will rise from existing 24.3pc to 29pc, and that would lead to around 10pc people falling below the poverty line. If a household’s consumption goes down by 10pc, the headcount in the case could rise to 33.5pc.

More worryingly, almost half of the children under five years are stunted (low height-for-age) and one in ten has been suffering from low-weight-for height. Incorporating the factors, Pakistan was ranked 106th among 119 countries surveyed for the Global Hunger Index, and has been characterised as facing a “serious” level of hunger. In fact, Pakistan is among those seven countries that cumulatively account for two-thirds of the world’s undernourished population along with Bangladesh, China, Congo, Ethiopia, India and Indonesia. Under-5 malnutrition costs heavily. About $2.24b is estimated as the loss of future labour force resulting from under-5 mortality; over $1b is the estimated healthcare expense, which the families incur to address diarrhea and respiratory infection among children; $3.7b is the estimated cost of low labour productivity emanating from stunting, anemia or iodine deficiencies in childhood; and $657m is the estimated cost of prevalence of chronic weakness and fatigue among 10m working adults with anemia experience.

According to the SBP, almost a quarter of Pakistan’s population lives below the poverty line. It means that around 50 million people in the country are unable to meet their basic needs. Most of these people live in rural areas where the poverty rate is 30.7pc. The central bank noted provincial disparities in terms of food security in Pakistan. In Balochistan, at least 30pc households experience hunger on a chronic basis. On the other hand, Gilgit-Baltistan has the most food secure households, nearly 80pc in the region, followed by Khyber Pakhtunkhwa (70pc). Only 63.1pc of the country’s households are “food secure” despite the fact that Pakistan is self-sufficient in major staples. According to the Ministry of Health and UNCEF’s National Nutrition Survey, 2018, Pakistan is ranked 8th in producing wheat, 10th in rice, 5th in sugarcane, and 4th in milk production. However, Pakistan is among seven countries that cumulatively account for two-thirds of the world’s undernourished population.

A high population growth and unfavourable water and climatic conditions in the country mean that concerns about food security may increase manifold over the next two to three decades. “In case of Pakistan, estimates suggest that malnutrition and its outcomes cost the economy 3pc of GDP ($7.6 billion) every year,” says the SBP report. With per capita income of $1,497, Pakistan is still struggling with issues such as undernourishment, micronutrient (iron, calcium, vitamin-A, etc) deficiencies, and a deficit of safe drinkable water. “Per capita consumption of food products that possess high-nutritional value, like beef, chicken, fish, milk, vegetables and fruits, is almost 6-10 times lower than that of developed countries,” it noted.

Only 0.3pc of the population in Balochistan and 1.8pc in the Punjab benefit from social protection programmes of some kind. The ratio, however, is relatively higher for the people in Sindh (12.7pc), Gilgit-Baltistan (10.3pc) and KP (5.1pc). “Although the country relies heavily on imports for certain food items such as edible oil, tea and pulses, yet it is able to provide for major staples on its own. If the population increases at the existing pace over the next couple of decades, it will become extremely challenging for Pakistan to sustain even the food self-sufficiency,” the report warned.

Currently, water productivity of most crops in Pakistan is lower than the desirable range. For instance, sugarcane and wheat use around four times the global average of irrigation water, while rice consumes more than six times the world’s average. Going forward, growing water shortages are expected to drag down yield of different crops on a considerable scale.

The United Nations has warned that the number of people going hungry in the world is rising. In a report, the UN blamed conflict, climate shocks and economic slowdowns for rising hunger in the world. More than 2 billion people lack access to healthy food, putting them at risk of health problems – and many of them live in North America or Europe, the UN said, urging governments to “look beyond hunger.” More than a quarter of the world’s population now struggles to eat “safe, nutritious and sufficient food”, according to the UN’s State of Food Security and Nutrition in the World 2019 report. It includes about 8pc of people in Europe and North America, according to the annual study, which for the first time includes people affected by “moderate food insecurity” as well as outright hunger. The findings show governments need to pay more attention to different aspects of food availability instead of just focusing on producing more. The report said there were 822 million obese people in 2016, the most recent year for which figures were available, when 796.5 million people were undernourished.

It is alarming that only 63pc of Pakistan’s households are food secure, which is despite the fact that Pakistan is self-sufficient in major staple foods. The fact that one-third of all households in the country are not food secure in a country which produces almost all of its food means that the problem lies in the mechanism for distribution as well as the low rate of compensating rural labour. The bottom 60pc of households in the country spend a substantial part of their incomes (45pc on average) on food, which compromises their nutritional security. Even if prices are relatively low and stable, the poorest of the poor still lack the purchasing power to buy food. Pakistan will have to take measures to increase the real incomes of the poor. It will also have to expedite its efforts to check the population.

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