In the twenty years I have dedicated to equitable education for the most marginalised, I have always reiterated that all children are born equal and it is their socioeconomic opportunities that shape them. I believe that in the first thousand days (from conception to two years) of a child’s life, his/her trajectory is determined.
Adequate nutrition for pregnant mothers and infants is important for normal brain development. This is because the human brain develops much more rapidly between birth and the age of five, especially, in the first three years than during any other subsequent period. Synaptic development in the first three years takes place at an astonishing speed. There are twice as many synapses in children’s brains, as compared to adult brains. Neuron formation in an ordinary three-year-old takes place at an accelerating rate, while the brain neurons in a malnourished child grow steadily. Evidence confirms that malnourished children have smaller brains. Thus, they are unable to learn and achieve at school, and ultimately fall in the large cohort of out of school children.
What are we giving to 14.8 percent of our population (children under five years of age)? According to the Global Nutrition Report 2015, almost 40 percent of the children in Pakistan are underweight, over 50 percent of children under the age of five are stunted and 9 percent are wasted. Malnutrition costs the country Rs200 billion every year (equivalent to more than 5 percent of GNP) in lost lives, disability and productivity. Annually, 53,300 children in the country die from pneumonia and diarrhoea, respectively.
Diarrhoea, pneumonia, and malaria collectively contribute to around 50 percent of the deaths in children (Das and Bhutta, 2013). Around 62.1 percent of children under five according, to the World Food Program, are anaemic in Pakistan and maternal anaemia is 52.1 percent. Overall, only 15 percent of children ages 6-23 months are fed appropriately, based on recommended infant and young child feeding (IYCF) practices. According to an ASER report, malnutrition and the lack of services for the early years is impacting the learning in schools – leaving one in four grade V students unable to read a sentence and one in two unable to read a story in Urdu, Sindhi or Pashto. These are simple tasks that they should be able to achieve after being in school for just two years.
The current education scenario exposes an alarming reality. According to Unicef’s 2014 report, Pakistan is among the 21 countries facing extensive learning crises. Over 6.5 million children are not enrolled in primary school; in other words, 3 out of 10 primary age children are not enrolled in school. The dropout rate is highest in grade five (42.8 percent), indicating that many children do not transition to lower secondary school and therefore do not complete basic education. More children from poorer households are out of school (49.2 percent compared to 17.5 percent in richest quantile).
During the early years, the foundation is laid for the development of cognitive, motor, and socioemotional skills throughout childhood and adulthood. Children with restricted development of these skills during early life are at risk of neuropsychological problems in later years, poor school achievement, early school drop-out, low-skilled employment and poor care of their own children, thus contributing to the intergenerational transmission of poverty. Therefore, preventing or reversing this loss in early childhood is crucial for fostering economic development and reducing economic disparities.
Unfortunately, the culture of exclusive breast-feeding for the first six months, which provides all the essential nutrients to a child that are required for brain development, is diminishing rapidly in Pakistan. Exclusive breastfeeding, as well as the duration for which a child is breastfed, is the lowest in Pakistan – as compared to our neighbouring South Asian countries, including India, Bangladesh, Nepal and Sri Lanka. Over the last seven years, the percentage of exclusively breastfed children in Pakistan has remained static, with just a microscopic increase.
According to the Demographic Health Survey, this percentage has risen only from 37.1 percent in 2006-2007 to 37.7 percent in 2012-2013. However, when it comes to the bottle-feeding race, Pakistan has no close competitors; bottle-feeding rates have risen from an already undesirable 32.1 per cent in 2006-2007 to an unfortunately high 41 per cent in 2012-2013. Micronutrient deficiencies, particularly iodine and iron, can lead to significant and irreversible cognitive damage. “I feel the difference in my kids IQ level. The ones who received exclusive breastfeeding are sharp compare to my caesarean kid who was given formula milk.” These were the views of a mother of four, who I interviewed during a focus group discussion in Khyber Pakhtunkhwa (KP), as part of a situation analysis activity on early childhood education and development (ECED) last year. Most of the mothers shared similar views.
Research supports that children who get the proper nutrition in their first 1,000 days are 10 times more likely to overcome the most life-threatening childhood diseases, complete 4.6 more grades of school, earn 21 percent more wages as adults and are more likely to have healthier families. So policymakers should invest in young children, for whom the return on investment is stronger than in low-skilled adults, as suggested by Nobel laureate John Heckman. Research also advocates that better care in early childhood improves performance in primary school.
The world community has made investing in ECED a priority to improve children’s outcomes and to advance human development in societies. In Pakistan, we need to particularly focus on the needs of 0-5 year age group, which will entail health, immunisation and learning opportunities for school preparedness. Education, health and nutrition are treated as separate entities but they should be integrated. We need to widen our attention from children’s survival to their full development, employing comprehensive, integrated approaches that engage all sectors: education, family and social protection and health and nutrition.
In the context of these challenges, the current government has realised the need to take immediate action and has recently held a national parliamentary meet on malnutrition, led by National Assembly Speaker Sardar Ayaz Sadiq. The meeting concluded with the recommendation to declare a national emergency of malnutrition, establishment of an autonomous and empowered National Commission on Malnutrition of Mother and Child and directing the media to dedicate at least 10 percent of airtime to create awareness regarding this grave concern.
Now that we have the political leadership on board, along with the national and provincial assemblies, urgent measures need to be taken to establish a governance framework to tackle these huge challenges. The proposed commission will be the right platform to redirect social policies to include 0-3 year olds and 3-5 year olds, integrated prenatal and early health, parent education services and early years learning facilities. The commission should be the coordinating body providing technical assistance to the provinces to mark the high-risk populations and children, as well as devise interventions to mitigate malnutrition. This commission will also set goals and serve as an umbrella body for the accountability and as the interlocutor of the relevant ministries and departments.
We owe it to all the children who are born in Pakistan to give them the best, so that they can give their best to the country. With the political will and right alliances of stakeholders, in the next five years, we should change this dismal picture and achieve Sustainable Development Goals 1, 2, 3 and 4.
The writer is chief executive and founding director of the Children’s Global Network Pakistan.