In a recent report the World Bank (WB) has warned that stunting early in a child’s life can cause irreversible damage to cognitive development and has educational, income and productivity consequences that reach far into adulthood. According to WB, the economic costs of under-nutrition, in terms of lost national productivity and economic growth, are significant – ranging from 2% to 3% of GDP in some countries and up to 11% of GDP in Africa and Asia.
The importance that our governments attach to the problem of malnutrition can be gauged from the fact that the last nutrition survey was carried out in 2011. The next survey is overdue but is nowhere in sight.
Results from the 2011 National Nutrition Survey (NNS) showed little change over the last decade in terms of core maternal and childhood nutrition indicators. With regard to micronutrient deficiencies, while iodine status had improved nationally, vitamin A status had deteriorated and there had been little or no improvement in other areas linked to micronutrient deficiencies. The ratio of males to females was approximately 50.4% to 49.6% across Pakistan. A total of 45.7% of household heads were illiterate and 38.7% were workers or labourers. 15.5% of the population was unemployed – with higher rates in the urban population (18.9% urban unemployment, 14.0% rural unemployment). Using a standard questionnaire, the NNS 2011 found that 58.1% of households were food insecure nationally.
The National Nutrition Survey 2011 indicated that stunting, wasting and micronutrient malnutrition are endemic in Pakistan. According to NNS, 43.7% of children were stunted. In rural areas stunting in children was higher (46.3 %) than in urban areas (36.9%). The wasting rate was 15.1% and the proportion of wasted children was lower in urban areas (12.7%) than in rural areas (16.1%). About 31.5% of the children were underweight, with higher rates in rural areas (33.3%). Every fifth pregnant woman and every child under five years survives with severe Vitamin A deficiency; 62pc of children under five years of age are anaemic.
The Global Nutrition Report 2015 said that only a small minority of children are growing healthily in Pakistan, which is estimated to have more than half the children under the age of five as stunted or wasted. The report claimed that many countries, including Pakistan, Bangladesh, the Democratic Republic of Congo, Ethiopia and Nigeria, had only a minority of children who were growing healthily. It also presented a dismal picture of the global nutrition status and said that no country is on track to achieve the global nutrition targets set by the World Health Assembly.
During his recent visit to Pakistan the World Bank president said that Pakistan should address the high prevalence of stunting among its children on a priority basis. According to WB data, Pakistan has one of the highest prevalence of stunting in the world: as many as 45% of its kids under the age of five face stunted growth. He pointed out that if the problem of stunting is not tackled immediately, almost half of the workforce may not be able to participate in the digital economy in about 15 years.
Malnutrition and stunting are particularly severe in some parts of Pakistan, especially in Tharparker region of Sindh. But lack of appropriate nourishment exists even in the non-arid regions. There is not only inequitable distribution of wealth, income and food but there is very little food for too many mouths due to unwanted births and inaccessibility to family planning services. According to UNICEF, about 44 per cent of Pakistani children are estimated to be suffering from malnutrition. And stunting is a direct result of malnutrition. A stunted child is a handicapped child who remains enmeshed in a lifelong cycle of poverty.
Needless to say, malnutrition increases a country’s healthcare costs, reduces productivity and slows economic growth. It perpetuates the cycle of disease and poverty in the country. The malnutrition crisis is a long standing one but successive governments in Pakistan have paid little heed to it. Experts say that Pakistan can add 2-3% to its GDP by tackling the issue of malnutrition. The paradox is that despite Pakistan being one of the major food producing countries in the world, 50% of its population is food insecure.
Pakistan is the eighth largest food producing country, the sixth largest producer of apricot, fifth largest producer of milk and grows about 25 million metric tonnes of wheat. Yet, food insecurity is on the rise, and a growing majority of its children are malnourished and underweight due to lack of access to adequate food. It is time the authorities concerned prioritized the issue or malnutrition and food insecurity and allocated sufficient funds to tackle it on a long term basis. Fortunately, there are several international organisations committed to supporting countries like Pakistan to combat this condition, including UNICEF, the World Health Organisation, the Global Alliance for Improved Nutrition, etc.
Within the framework of the 2030 Agenda for Sustainable Development, world leaders at the United Nations General Assembly recently proclaimed the UN Decade of Action on Nutrition from 2016 to 2025 which marks a new vision and direction in global action to address nutrition challenges. The Decade represents a unique, collective opportunity for achieving better nutrition for all people through access to affordable, sustainable and healthy diets.
The National Maternal and Child Health Programme has recommended that to fight malnutrition, alleviation measures should be vigorously implemented. Increased awareness is needed about the lifelong damage caused by stunting, while providing the poor sections of people enhanced access to food and fortified milk at a fair cost to compensate for deficiencies in household income or in maternal health. Subsidies through state intervention and private philanthropy to enable low-income or the poorest families to purchase supplementary diets also deserve special attention.