Undernourishment in Pakistan – daunting realities

Unfortunately, malnutrition is a public health challenge that the country is facing. Stunting, wasting and malnutrition are widespread in Pakistan. According to Food Security Assessment Survey (FSA), 2016, 18 percent of the population in Pakistan is undernourished in one form or the other. From the economic perspective, undernutrition erodes the very foundation of growth in the country; people lose energy, strength, cognitive capacities and the drive to contribute towards economic output. From low productivity to increased health costs to lost future labour, the economic cost of malnutrition stands at around $7.6 billion, or 3 percent of GDP every year for Pakistan, an agri-based country - something that should force policy makers burn the midnight oil in curating and implementing policies conducive to improving the situation.

While some work is being done (and we will look at nutrition from the political lens some other time), a great deal of effort is still missing. To understand malnourishment or undernutrition in Pakistan and address the challenge swiftly and correctly, it is important to identify the core reasons or factors behind. Let’s look at some that have been ignored time and again in policy making.

Looking at the poverty numbers, one can see that poverty levels have come down from 57.9 percent to 29.5 percent between 1999 and 2014. Even multidimensional poverty that uses different factors like education, health and standard of living to determine acute poverty has come down in the country.

Then why is it so that even though poverty in the country is generally declining, the incidence of poor nutrition is climbing at a rapid pace? One reason for poor nutrition is rising disparity despite falling poverty levels.

Whether its health, education or standard of living, there is a widening schism between provinces, and areas within provinces proven through various studies. Inefficient and unequal food distribution systems and access across provinces too come in here as income inequality continue to make the rich better off, while the poor continue to slide down the hill. As a result of this income inequality, food insecurity is a key issue in the country, despite increase in food production and some stabilisation of food prices recently. Also gender disparity (continuing to escalate in Pakistan) is another factor for developing countries as women generally have limited control over and access to resources and finances.

Unsuitable or insufficient food intake is the most unnerving factor behind malnutrition in the country. There is a high prevalence of micronutrient deficiencies – shortage of essential vitamins or minerals- indicating inadequate diet in children as well as adults especially mothers. According to WFP’s recent summary report, “Fill the Nutrient Gap Pakistan”, around two thirds of children in Pakistan are anemic; one third have iron deficiency anaemia; there is a high incidence of deficiencies in zinc, calcium, vitamin A and vitamin D in women; vitamin D deficiency affects over two thirds of women, while anaemia and calcium deficiencies occur in more than half of women.

Another key factor that directly and indirectly impacts undernutrition in Pakistan is inadequate access to water, sanitation and hygiene. Clean water supply, sanitation, and hygiene are important for preventing malnutrition due to their direct impact on intestinal infections and diarrhea.

So what needs to be done? While it has been all said before, fewer policies and recommendations have actually moved from paper to action. There is a need to improve food security and nutrition adequacy through education and awareness building, targeted food distribution schemes and livelihood enhancement programmes. Better distribution of not just food but also employment and education needs to be pursued to address the disparities. Awareness campaigns and action on gender disparity can also improvement women empowerment, which in turn can address some undernourishment issues.

At the fiscal level, pro-poor and equitable polices like reducing indirect taxation that largely burden the poor need to be taken to the discussion table. Better farming techniques that can result in better crops, and hence better food distribution by the government can go a long way in addressing the issues of food security.
Provinces that now have the task, need to buckle up and get going when it comes to curating policies. Food security and undernourishment should not be looked at in conjunction with other issues; 3 percent to GDP is a huge cost and needs to be dealt in isolation and on priority basis.

Improving access to water, sanitation facility and hygiene practices is not only necessary for the country’s rising water crisis but is highly linked to how malnutrition is addressed.

Legislation on food fortification, scaling up of micro-nutrients to children and Iron/folate to pregnant lactating women, and increasing the supply of iodized salt along with increased civic education efforts to raise awareness on the importance of iodine are some areas that need attention.

Fortification is a powerful took to address malnourishment precisely as it has played a significant part in reducing micronutrient deficiencies across the globe. Common fortification initiatives include adding micronutrients such as vitamin A and D, folate or iodine to foods like flour, salt and rice.