Tuesday July 05, 2022

Hunger and its discontent

September 26, 2018

The prime minister passionately cites a harrowing statistic: 45 percent of Pakistani children under the age of five suffer stunting in physical and mental development, as per the UN’s Food and Agriculture Organization (FAO).

Compared to non-stunted children, these children are likely to have lower learning abilities and lower lifetime earnings. The truth is that hunger blights Pakistan. As per FAO estimates, 11 percent of the global population is undernourished. With an estimated 40 million Pakistanis undernourished, every 20th undernourished person in the world is a Pakistani.

Let’s look at the simple arithmetic of food: by WHO standards, anyone receiving less than 1,800 kilo-calories (kcal) per day is suffering chronic hunger and malnutrition. For Pakistan, this figure is taken to be 1,750 kcal per day. A calorie is a measure of the energy you receive from food. For example, a human being needs 24 kcal to ride a bicycle for one mile.

Above 2,800 kcal a day is the territory of our elite gourmands – excess food is likely to increase body weight. Between 2,300 kcal and 2,800 kcal a day is considered an adequate food intake. Those taking in 1,750 kcal to 2,300 kcal a day are facing an energy deficit. And Pakistanis who receive less than 1,750 kcal a day are in an acute energy deficit.

Elite Pakistanis only think of calories when trying to lose weight. But a majority of Pakistanis barely get enough calories to maintain the weight they should have for their height. A 2009 SDPI survey funded by the Swiss government and the World Food Programme estimated that 48 percent of Pakistani households are likely to be in an energy deficit given the insufficient availability of food. Some 22 percent Pakistani households are likely to face an acute energy deficit.

This was broadly corroborated when households were asked what they were actually eating. Some 15 percent Pakistani households reported that every day, they were able to get bread/roti, rice, corn with edible oil/ghee or butter and sugar/gur. But they only drank milk once a week, and ate meat once a month and fruits only once in two months.

‘Meat only once a month’ gives you an idea of what chronic hunger really is. Compare it to your own diet. Some 58 percent of Pakistani households reported that they were able to get the same daily intake plus milk five days a week, but meat only once a week, vegetables three days a week, legumes/daal two to three days a week, and fruit once every fortnight. The remaining 27 percent reported sufficient food intake, which means all this and more, notably meat five days a week and fruit more than twice a week.

The effects of insufficient food are all around us. Even privileged Pakistanis don’t need a calorimeter to detect stunting and wasting (thinning). Find out the height, weight, and age of your house help’s children. If a child’s weight is significantly low for his/her height, the child is probably suffering from wasting. If his/her height is significantly low for his/her age, the child may be suffering from stunting.

Pakistan has the distinction of being in the top 10 countries where more than half of the number of children under the age of five suffer from stunting or wasting, or both. Stunting is mainly a result of the undernourishment of a mother and child, inadequate breastfeeding, and infections. It starts in the womb and sets in within the first 1,000 days of conception. So, interventions must focus on this period.

Breast-feeding exclusively for the first six months is critical. The WHO estimates that infants who are not breast-fed during their first six months are 15 times more likely to die of pneumonia and 11 times more likely to die of diarrhoea. The FAO estimates that only a third of Pakistani mothers exclusively breastfeed their infants in the first six months.

The Mughal emperors and their aristocrats often held langars (traditional soup kitchens with free food served to the destitute). But these were usually an exercise in self-congratulation. Their goal was to secure the prayers of the destitute rather than to eliminate hunger from society. Although a programme for the distribution of meals to about 100 million people comes across as a noble thought in today’s Pakistan, it would be an organisational nightmare and an invitation for massive corruption.

In the modern era, food stamps are an example of direct action on undernourishment. The US launched a food stamps programme in 1961, which was formalised through the Food Stamp Act of 1964. Under the original mechanism, the poor would purchase the stamps and then get discounts from food retailers who would be compensated by the government.

In 1977, the purchase requirement was removed to allow the poor to spend all their precious dollars on food. By the 1980s, food stamps were replaced with electronic transfers.

The global experience with such direct transfers for food reveals that electronic transfers are the best mechanism, and transfers to women are more likely to be spent on food. To reduce fraud and mistargeting, such programmes should be run in conjunction with other forms of social services.

Pakistan already has the Benazir Income Support Program (BISP) with debit cards issued to over five million of the poorest Pakistani families and multiple social services based on poverty scorecards.

The irony is that hunger pervades rural Pakistan where food crops grow. Pakistan’s food policymakers often justify self-sufficiency in wheat by assuming that the average Pakistani needs 140 kilogrammes of wheat every year.

The great Urdu poet Faiz Ahmed Faiz was wise to all this when he asked: ‘Yay haseen khait phata parta hai joban jin ka/Kyoon in main faqat bhook uga karti hai?’ (These flowing fields that burst in bloom/why is hunger their only crop?)

The cycle of hunger can be broken. But it is important to realise that widespread reduction in hunger is a longer-term process, sustainable in the wider context of poverty reduction. Brazil reduced child stunting over three decades from 37 percent in 1975 to seven percent in 2007. This was achieved through Brazil’s multi-pronged approach to reducing poverty, inequality, and food insecurity.

A national programme to promote of breast-feeding was started in 1981. The transformation in women’s education between 1996 and 2007 was found to be the single most important factor associated with the decline in child undernutrition. Brazil now links its school food programme with its policies for family-run farms.

The global experience says that we must address hunger right from the Prime Minister’s Office with multiple ministries working in coordination to strengthen community-based health services, women’s education and awareness, the direct transfer of funds to the needy, and an increased availability of food.

Community-based health services, including the assistance of trained mid-wives, can be sought from Pakistan’s lady health workers. With support from mobile technology, they can deliver awareness about breastfeeding and food choices. Pakistan has already addressed iodine deficiency. The same is needed for vitamin supplements and food fortification.

BISP can deliver a national programme for funds transfers targeted at food purchases. Overall, food availability can be increased by helping growers raise the output of their plots of land and of their livestock. The government must also devise a strong mechanism to track malnutrition in each Pakistani household. You cannot change what you don’t measure.

Overall, this is mainly about how Pakistan treats poor women. They are underweight at birth, fed last during meals, married off early, pregnant during adolescence, overworked during pregnancy, bear babies with low birth weight, and unable to breastfeed well.

The weakness passes on to children – male as well as female – and it starts again in the next generation. Our leaders must pull our women out of this medieval life cycle and end this hunger amid plenty.

The writer advises on development policy and strategy.