The joint report of the Planning Commission and World Food Program, ‘Minimum Cost of Diet in Pakistan’, indicates nearly 70 percent of households in Pakistan are unable to provide a staple, adjusted nutritious diet. A direct consequence of this is that children in Pakistan suffer from malnutrition. In urban areas, for example, some 2.5 million children have stunted growth. More than children with the same condition in Afghanistan, Yemen, Syria, Sri Lanka and Papua New Guinea combined. The report went on to say that child nutrition statistics are worse in rural areas.
High levels of child stunting, as are now being recorded in Pakistan, is often associated with poor socio economic conditions. The 2011 National Nutrition Survey reported that one-third of the young children in Pakistan are counted as underweight, and therefore at risk of stunting. According to the NSS-2011, around 44 percent of children were stunted.
What does this mean? How did it happen? And what can be done about it? Malnutrition in children manifests itself in different ways: malnourished children can be underweight or obese, or their height can be stunted. Unlike underweight children, who can readily gain weight after a few days of being sick or, worse, hungry, stunting is the result of chronic malnourishment. And more than merely a matter of appearance, stunting is a marker for an array of developmental problems. Stunted children are likely to have their brain, kidney or other organs affected as well.
The association between malnutrition and mortality is well-established. In Pakistan, malnutrition is responsible for 54 percent of over 10 million deaths per year in children under five. Malnourished children expend all their energy fighting or resisting disease, leaving little more than a lifeless body with a child’s soul inside. This is an important point to make, as malnourishment is not just about food security, it’s also about prevalence and risk of disease.
Diarrhea and worm infestations are common in Pakistan, with upto 350,000 children deaths per year. This puts Pakistan in the top 5 countries where child diarrhea deaths are prevalent. It’s difficult to distinguish any one case from another, but malnutrition plays a significant part in susceptibility to something as easily as preventable as diarrhea deaths in children.
Impure drinking water, therefore, is a factor in child stunting and malnourishment. And it is an environmental problem. This makes malnourishment and its impacts on children a very complex issue that relates not just to “socio-economics”, but to economic development, food security, healthcare and medical infrastructure, sanitation and, of course environmental pollution and degradation. The levels of child stunting in Pakistan don’t come as a surprise if you consider the the scale of the water quality situation in Pakistan. A 2007 survey of water resources by the Pakistan Council for Research in Water Quality suggests
It’s not just the water, either. In urban areas, for example, poor air quality results not just in epidemic levels of chest infections in children, but also lung stunting, asthma, bronchitis and the prospect of permanent reduction in lung capacity.
Environmental pollution is adding stress on malnutrition in children in Pakistan, exposing them to disease and requiring their little bodies – wasting already – to expend all its energies in resistance, not physical development.
The result, if we step back and consider, is that we are producing a generation of people who will suffer permanent physical and physiological health issues on account of stunting. For a country where we are told there is a “youth bulge”, this is a disastrous prospect. Not only will individuals and families suffer so will the economy as sickness pervades the workforce. And consider the burden on our already underprepared medical system if millions upon millions of people require regular healthcare when not even in middle or old-age.
What can we do? It’s simply platitudes and hollow slogans if one were to suggest the “government do something”. And it won’t do to point to the expenditure on Lahore’s Orange Line, for example, and shout that resources should not be diverted from child and healthcare for White Elephant projects. The fact that over 50% percent of the population doesn’t have a balanced diet points to incredible inequality that pervades Pakistan and Pakistan’s development discourse. Child stunting and malnutrition point to a systemic problem: where the poor, the rural and the sick are excluded. One place to start is to recognize this flaw and to acknowledge there are no quick solutions to this problem.***
(Partner, Saleem, Alam & Co. and Member of the