A cyclic relationship

Poverty is one of the biggest contributing causes of malnutrition, which is one of the most prominent problems found in Pakistan’s young. Malnutrition leads to stunted growth; costs lives, perpetuates poverty, and slows economic growth. Hence, addressing malnutrition is imperative in poverty graduation programmes. According to the National Nutrition Survey 2011, one-third of all children are underweight and nearly 44 percent are stunted. Studies have shown that in Pakistan, 43.7 percent of all children are stunted. In rural areas, stunting in children is much higher (46.3 percent) than in urban areas (36.9 percent). At the national level, 61.9 percent of children have been found to be anemic. The NNS 2011 findings revealed that only 3 percent of the children received a diet that met the minimum standards of dietary diversity.

Maternal nutrition is closely linked with child nutrition. Addressing maternal malnutrition is imperative in improving the nutritional status of children. The causes of maternal and child malnutrition are multi-faceted; they aren’t just about poverty and poor food-intake. Besides poor food consumption and dietary diversity, the determinants of maternal and child malnutrition are numerous: lack of awareness about nutritional practices for feeding infant and young children, lack of exclusive breastfeeding and discarding of colostrum which contains vital antibodies for the newborn, poor food choices, poor health and hygienic conditions, lack of access to health services, access to clean drinking water and sanitation as well as deeply entrenched gender-disparities.

The NNS-2011 further revealed a “majority of participants from Baluchistan, rural Sindh and southern Punjab said that we had to collect water from wells located outside the house and store it for our use and there is no proper system of collection and disposal of sewerage in the community/locality.” The lack of access to clean water and unsatisfactory sanitary conditions are important contributors to many childhood illnesses. Waterborne diseases and worm infestations are very common among those living in rural areas or where there is improper sanitation coverage.

As highlighted in NNS-2011, a majority of rural mothers shared the opinion that women lacked access medical care for themselves and their children unless the household decision-maker allowed them to do use it. Mothers from southern Punjab said: “Feeding the girl child is not a viable deal as she has to go another house after marriage.” Furthermore, it is also evident that the employment status and education level of a mother is directly associated with the nutritional status of her children. The findings of the NNS-2011 revealed that a mother’s education level is closely associated with children’s stunting, low weight-for-height, wasting and underweight status. Malnutrition in children was lower for those whose mothers had a higher education status.

Thus, prevention and reduction in malnutrition is crucial for poverty alleviation; and culturally customized social change communication strategies that engage community institutions and community resource persons are imperative for the promotion of nutrition and prevention of malnutrition behaviors, especially among women and children.Although the government is committed and has approved nutrition-specific and health-integrated nutrition projects in the provinces, along with ensuring nutrition inputs into Pakistan 'Vision 2025' and Five-Year Plan, there is still much to do. Prime Minister Imran Khan has also announced his policy statement on the Ehsaas programme, envisaging four focus areas with food and nutrition as priorities on the government’s agenda.

In 2013, Pakistan signed the global SUN (Scaling up Nutrition) Movement, a unique movement founded on the principle that all people have a right to food and good nutrition. At times, Pakistan even established a Nutrition Development Partners Group to help improve development partners’ coordination and multi-sectoral platform at the provincial level.

Pakistan Poverty Alleviation Fund (PPAF) is chair and executive council member of its national nutrition civil society network, SUN CSA Pak, created with the goal to promote sustainable improvement in nutritional status of the people of Pakistan. The PPAF’s biggest investments to date has been to organize community institutions, assist them to define their life priorities, articulate demand, and then advocate for their rights from relevant duty bearers. The PPAF is well positioned to evolve an institutional accountability mechanism, bridge the gap between demand and supply by linking both streams and testing and scaling up innovation, and the sustainable poverty graduation models that ensure access of the poor to quality nutrition and wellbeing.

The writer is senior manager, health &nutrition at the Pakistan PovertyAlleviation Fund.