Stunting all around

Stunting is the phenomenon witnessed in children growing less than a normal child should. The principal cause is malnutrition leading to underdevelopment of brain. A stunted child will have poor cognitive ability, educational competency and, eventually, job prospects. According to the National Nutrition Survey 2011, 44 per cent of Pakistan’s under-five children were stunted, far above the global average of 25 per cent and the third highest in the world. The absolute number was a staggering 9.6 million. The only time stunting in Pakistan was below the global average was in 1990-94; otherwise it has been persistently above since the 1960s.

The rich-poor divide is even more visible here than the income distribution, suggesting an endemic reproduction of poverty. Stunting is 10 percentage points higher in rural areas and 6 percentage points higher in male children. All provinces except Punjab lie above the national average of stunting.

The problem is that stunting is not just a nutrition or health issue. It requires a multi-sectoral approach, something that is an anathema for our governments at federal and provincial levels that are organised into sectoral silos. Children of educated mothers are far less likely to be stunted than those of the illiterate mothers. Theoretically, planning agencies are supposed to act muti- and cross-sectoral. In reality, these agencies are also divided into sectoral turfs. They lack the expertise to combine the nutrition-specific and nutrition-sensitive interventions so as to get synergetic effect. The former comprise the improvement of breastfeeding practices for the newborn, quality of complementary foods for ages 6-23 months; focus on micronutrient deficiency in pregnant and lactating mothers; early detection and treatment of severe wasting in younger children. The later include improved family and community hygiene and leveraging inter-sectoral programmes to prevent stunting.

It seems that the persistence of stunting in children has also translated into the stunted growth of the economy. In the last ten years, the GDP growth has been around 3 per cent per annum. This is about the same as the population growth guesstimated in the absence of the population census. Important crops, which include the staple wheat, experienced an even lower growth at 1.6 per cent per annum. Vision 2025 of the Planning Commission devoted a special box to nutrition. It said all the right things — Hunger free Pakistan; ready to use food for breast feeding mothers and pregnant women; food for work; livelihood initiatives for improved access to food; nutrition specific and sensitive interventions; feeding programmes for infants and young children; involvement of academia; presence of a nutritionally trained teacher in every school; enforcement of food quality standards, etc., etc. Of course, this is a long-term vision. The action lies in the annual development programmes of the federal and provincial governments. The latest of these documents do not contain much in terms of concrete, funded projects and programmes. Nor is there any approved policy content. The Annual Plan has a separate chapter saying that the federal and provincial governments with the support of development partners are formulating projects and programme to improve the nutrition. The Economic Survey, which lumps health and nutrition together, had nothing of significance to report. The stunted economic growth does not generate enough resources to prevent stunting of children.

It is not hard to see that stunting in children and stunted economic growth happens in a stunted political environment. The pursuit of power for ends other than the greatest good of the greatest number is a sure recipe for stunting all around. Overcoming the huge nutritional gap requires collective political will, effective multi-sectoral governance and adequate allocation of resources. Only then will the stage be set for the people and the economy to grow together.

Published in The Express Tribune, October 21^st, 2016.

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