During his recent visit to Pakistan World Bank (WB) President Dr. Jim Yong Kim 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.
Nutritional stunting means short height for an age or a reduced growth rate in human development. Stunting basically results from malnutrition. Stunted children cannot be expected to grow up as productive adults compared with those who are fed adequate food in the first five years of life. Malnutrition is a widespread problem in Pakistan and affects a large section of the population. At a recent conference organized by the Planning Commission, Country Director World Food Programme said that two out of every five (44 percent) children under the age of five are stunted, 32 percent are underweight and 15 percent children are suffering from acute malnutrition in Pakistan.
Another confirmation of the disturbing phenomenon comes from the Global Nutrition Report 2015 which says that only a 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 claims that many countries, including Pakistan, Bangladesh, the Democratic Republic of Con¬go, Ethiopia and Nigeria, had only a minority of children who were growing healthily. It also presents a dismal picture of the global nutrition status and says that no country is on track to achieve the global nutrition targets set by the World Health Assembly. One in three people in the world is malnourished and the problem exists in every country on the planet — yet strategies or “high-impact interventions” available to resolve it are not being implemented due to lack of money, skills or political pressure.
Childhood stunting and wasting remains a serious problem as more than 160 million children worldwide under five are too short for their age or stunted, while more than 50 million do not weigh enough for their height or are wasted. The report underscores the need for implementing critical nutrition actions urgently in countries with the greatest need, and especially in Pakistan where we face the double burden of persisting maternal and childhood under-nutrition and growing obesity.
According to the annual report of the National Economic Council, which was recently placed before the National Assembly by Finance Minister Ishaq Dar, one out of three Pakistanis “does not have regular and assured access to sufficient nutritious food”. The report suggests that the “poor performance of the agriculture sector in recent years” is responsible for this situation, and that the remedy must, therefore, be in making agriculture growth more “pro-poor”, that is by diversifying the base of incomes and creating more linkages between the farm and non-farm sectors.
A recent World Bank report has warned that malnutrition costs countries up to 3.0 percent of the annual GDP and malnourished children lose 10 percent of their lifetime earning potential, while stressing that malnutrition in Pakistan is the severest in the region. The statistics gathered from various United Nation (UN) and donor sources indicate that Pakistan ranks below China, India, Bangladesh and Sri Lanka on prevalence of stunting, micronutrient uptake, adolescent and adult nutrition status and various other indicators directly related to nutrition.
According to United Nations Children’s Fund (UNICEF)/ World Health Organization (WHO) data, prevalence of stunting below the age of five in India was 62 percent in 1990, but it has now declined to 48 percent, in China it has declined from 22 percent to 9.0 percent, while in Pakistan it has increased from 43 percent in 1992 to 45 percent 2012. In Bangladesh, prevalence of stunting below the age of five was 51 percent in 2004 and has now declined to 41 percent. Sri Lanka has even a better record where stunting has declined from 28 percent in 1995 to 15 percent now.
Here is another dimension of the problem. As per WHO statistics, 51 percent of the women population in Pakistan is suffering from anemia, whereas this ratio is 20 percent in China, 48 percent in India, 44 percent in Bangladesh, and 26 percent in Sri Lanka. Children aged 6-12 are suffering from severe iodine deficiency in Pakistan, while iodine uptake is optimal in Indian children.
The malnutrition crisis is a long standing one but successive governments have paid little heed to it. Experts say that Pakistan can add 2-3 per cent 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 8th largest food producing country, the 6th largest producer of apricots, 5th 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.
But, according to experts, malnutrition can occur widely even in areas of food abundance, and should not be just linked to incomes. Increasing the supply of food, or producing greater rural incomes will have only a marginal effect on nutritional outcomes if the larger issue of poverty reduction and inclusive economic growth is not addressed. There is need for interventions in other sectors as well. These include overcoming the social deficit by setting up a comprehensive social protection system and providing significantly better quality education and health services to low income groups.
Experts also recommend redirecting resources to accelerate growth in less developed areas and regions through ideas developed and implemented by them within the plan framework and to reduce disparities in human development. In this connection there is an urgent need for redesigning public policy to achieve better distribution of income and wealth and to ensure that incremental incomes are now more evenly distributed than in the past.
The fight against malnutrition is also closely linked to social variables such as female education and women empowerment. The list of remedies required to improve the nutritional status of children include measures such as marrying girls at a later age, greater awareness of prenatal health, improved health programmes to give women access to trained birth attendants, targeted safety nets in rural areas, early childhood development programmes, etc.
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