Overcoming our nutritional challenge

The results of the National Nutrition Survey (NNS) 2018 are indeed upsetting, as they not only highlight the poor nutritional status of our people but also the poor progress we have made since the last survey seven years ago. A comparison between the findings of the two rounds of the Survey in 2011 and 2018 shows that the prevalence of wasting (i.e. low weight and height among under-five years old) has risen from 15% to 18% in the last seven years, signifying a nutritional emergency, as it is the highest rate of wasting in the history of Pakistan. Four out of ten children under five years of age are stunted i.e. have low height for age. While stunting fell slightly from 43% to 40%, the average annual reduction rate of 0.5% is considered too low to significantly bring down the stunting rate for many years to come. More than half of our children (53%) are anaemic. Sixteen per cent of children of ages 6-12 years have a deficiency of iodine—a crucial micronutrient for cognitive development.

Nutritional deficiencies ring alarm bells for good reason—their linkages with mental and intellectual development and immunological resistance are well established. If current trends persist, the physical and intellectual capacity of our future generations will be compromised.

The survey results have galvanised the government and development partners including UN agencies into action. The recently-launched EHSAAS programme includes a number of nutritional initiatives some of which will be directly overseen by the Prime Minister. To deal with the current nutritional emergency both preventive and curative interventions are needed. The curative measures include food fortification; distribution of high caloric food supplements to the vulnerable population; and treatment of micronutrient deficiencies.

Preventing under-nutrition from manifesting in women and children by addressing its major predetermines is a cost-effective strategy. Preventing low birth weight and preterm births can substantially avert nutritional deficiencies later in life. Many studies have found that infants spaced at least two years apart are less likely to be born preterm or to suffer from low birth weight and malnutrition. Pakistan has the highest fertility rate in the region with currently 37% of births taking place in an interval of less than 24 months. The NNS 2018 also shows that 42% of women of reproductive age in Pakistan are anaemic, with a higher prevalence in rural women. Maternal anaemia, exacerbated by repeated pregnancies again increases the risk of having low-birth weight babies.

Short birth intervals also mean less availability of breast milk for the previous child. Early weaning increases the risk of childhood nutritional deficiencies. Preventing repeated and short interval pregnancies by improving access to voluntary family planning services and information can protect families from the deleterious effects of maternal and childhood malnutrition. This should not be difficult considering that a substantial proportion (nine per cent) of women of reproductive age who want to space births for a variety of reasons, are unable to do so.

There is also a need to create greater awareness through the use of mass media to address common nutritional myths and misconceptions and encourage better food preparation practices. Misconceptions about pregnancy diets, especially the uncalled-for dietary restrictions during pregnancy, should be removed. Parents should be made aware of the importance of colostrum and the need for exclusive breast feeding for six months after birth. This gains special importance considering that we have the lowest exclusive breast feeding rate in the South Asian region.

Beyond the purview of health and nutrition efforts, another significant preventive intervention required is enhancing women’s agency by improving opportunities for them to enter the formal labour force. This has several advantages including enhancing family income, improving women’s ability to afford better and more food for their family, and empowering them to have a greater say in family decisions including when and how many children to have.

Our nation’s poor nutritional status reflects a confluence of diverse but interlinked factors including societal constructs and women’s agency; peoples’ economic empowerment; governance structures; infrastructure availability, such as clean potable water, toilets, and sanitation; and, most importantly, population dynamics. All of these factors need to be addressed through a multi-sector coordinated strategy in order to protect our mothers and nurture the growing minds and bodies of our children.

Published in The Express Tribune, July 13^th, 2019.

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