ISLAMABAD: A landmark mixed methods study has revealed that Pakistan achieved an 11 percentage-point reduction in anaemia among women of reproductive age between 2011 and 2018, with key drivers including household economic improvement and better nutritional status, and poverty alleviation programmes like the Benazir Income Support Programme (BISP).
However, challenges such as persistent inequalities, weak implementation, and gender-related barriers continue to limit broader gains.
Led by internationally renowned health scientist Prof Dr Zulfiqar A Bhutta and supported by the Directorate of Nutrition at the Ministry of Health, the study highlighted the importance of indirect non-health sector investments in achieving better health outcomes. “Our findings show that the biggest contributors to anaemia reduction were poverty-targeted interventions, such as BISP, followed by improvements in women’s nutrition, particularly body mass index and vitamin A levels,” Prof Bhutta noted.
The study, published in the American Journal of Clinical Nutrition, found that average haemoglobin levels among non-pregnant women increased from 11.7 gm/dL in 2011 to 12.1 gm/dL in 2018, corresponding to a decline in anaemia prevalence from 51 per cent to 40 per cent.
Using Blinder-Oaxaca decomposition analysis, researchers estimated that 89 per cent of the improvement could be explained by measurable factors-with BISP enrolment alone accounting for 36 per cent of the haemoglobin gain.
Dr Baseer Achakzai, former director general Health, described the findings as a validation of multi-sectoral approaches. “The study shows how important it is to integrate social protection, nutrition-sensitive interventions, and healthcare services. While programmes like BISP and lady health workers (LHWs) have proven impactful, we must now focus on ensuring equity and sustainability.”
He further emphasised the importance of addressing maternal nutrition early in life. “Focusing on adolescent girls with iron and folic acid supplementation is particularly impactful in a country like Pakistan, where early-age marriages are common. This can help reduce deficiencies and improve pregnancy outcomes in the long term,” he said. Dr Achakzai also highlighted the efforts of the Nutrition Wing in developing a comprehensive national nutrition programme targeting six million women and an equal number of adolescents. “This programme, which could have been a game-changer, failed to capture the interest of planning officials primarily due to a lack of domestic investment. We cannot expect foreign investment to drive change unless nutrition is prioritised with a guaranteed domestic budgetary share.” Nutrition expert Dr Naveed Bhutto emphasised the critical role of food security and dietary diversity. “The proportion of women consuming a minimally diverse diet increased dramatically-from just 5 per cent in 2011 to 27 per cent in 2018-while access to fortified foods surged to over 66 per cent. These gains show that targeted policies and awareness can create real change.”
Dr Bhutto also called for urgent nationwide scale up of large scale food fortification. “Fortifying wheat flour with iron, folic acid, zinc and other essential micro-nutrients can be an effective strategy to combat anaemia not only in women, but also among children, adolescents and men across the country.”
However, the study also underscored lingering gaps. Anaemia prevalence remains disproportionately high among women from poor households and those with low education. In provinces like Balochistan, prevalence actually rose to 60 per cent in 2018, highlighting significant regional disparities.
Field interviews revealed deep-rooted gender discrimination, with women in many households lacking autonomy to seek healthcare or spend cash transfers independently. “There’s still a long way to go in addressing gender-based constraints, which impact not just nutrition but overall maternal health,” said Prof Bhutta. Healthcare access remains another challenge. While the Lady Health Worker Programme was widely praised for delivering doorstep services, infrastructure weaknesses, drug shortages, and lack of skilled care in rural areas hindered its full potential. Many stakeholders also criticised the hurried devolution of health sector to the provinces post-18th Amendment, citing poor resource planning and implementation gaps. The researchers concluded that while Pakistan had made significant progress, the anaemia burden remains high-especially among vulnerable groups. “There is a pressing need to strengthen iron supplementation strategies, expand food fortification efforts, and improve access to modern contraception and maternal healthcare.” Prof Bhutta stressed the importance of sustained investment. “Pakistan must not lose momentum. Achieving SDG targets on nutrition will require focused attention on women’s empowerment, inter-sectoral coordination, and stronger accountability mechanisms.”