M. Jehangir Khan Tareen MULTAN, Sep 6 (APP):A child's future may begin to take shape even before birth. The health and nutrition of a mother during pregnancy, the first feed after delivery, breastfeeding during infancy and the quality of food offered in the first two years of life can leave a lasting imprint on a child's growth, learning ability and future productivity. For millions of Pakistani children, however, this crucial …
Beyond Food: Pakistan’s intensifying fight against stunting and childhood malnutrition
M. Jehangir Khan Tareen
MULTAN, Sep 6 (APP):A child’s future may begin to take shape even before birth. The health and nutrition of a mother during pregnancy, the first feed after delivery, breastfeeding during infancy and the quality of food offered in the first two years of life can leave a lasting imprint on a child’s growth, learning ability and future productivity.
For millions of Pakistani children, however, this crucial beginning is overshadowed by the harsh realities of poverty, food insecurity, inadequate healthcare, unsafe drinking water, poor sanitation and limited awareness about nutrition.
This is why stunting cannot be viewed simply as a shortage of food. It is the visible outcome of a much deeper problem one involving maternal health, household income, education, sanitation, healthcare and social inequalities.
Pakistan’s continuing struggle with childhood malnutrition therefore requires more than food distribution.
It calls for sustained investment in human nutrition education, stronger health systems and coordinated action by the government, universities, healthcare institutions and communities.
Dr Tauseef Sultan of the Department of Human Nutrition and Dietetics, Bahauddin Zakariya University (BZU), said stunting defined as low height-for-age caused by chronic or recurrent under nutrition was one of the most important indicators of child well-being and social inequality.
“Stunting is not merely about a child’s height. It reflects prolonged nutritional deprivation and the social and environmental conditions in which that child grows,” he said.
He explained that growth faltering could begin during pregnancy and continue through the first two years of life, a period regarded as critical for physical growth and brain development.
Persistent stunting can impair physical development, cognitive and neuro developmental outcomes, educational achievement and productivity in adulthood. It can also increase the risk of chronic diseases later in life.
“Investing in maternal and child nutrition is ultimately an investment in human capital. The consequences of malnutrition can continue throughout a person’s life and affect the development of society as a whole,” Dr Tauseef said.
Recognized among the world’s top two per cent of scientists, Dr Tauseef noted that despite progress in reducing malnutrition globally, stunting remained a major challenge. In 2022, an estimated 148.1 million children under five worldwide were stunted, representing 22.3 per cent of children in this age group. Asia accounted for about 52 per cent of the global burden and Africa approximately 43 per cent.
The problem has become even more complicated as many low- and middle-income countries now face a “double burden” of malnutrition, with under nutrition existing alongside overweight and obesity.
PhD scholar Arooba Fatima said Pakistan continued to carry a substantial burden of childhood malnutrition, with millions of children affected by stunting.
“The prevalence of stunting in Pakistan shows that childhood malnutrition remains a persistent national challenge rather than a problem confined to a particular region or social group,” she said.
The National Nutrition Survey 2018 reported that around 40.2 per cent of Pakistani children under five were stunted, equivalent to nearly 12 million children. Analysis of Pakistan Demographic and Health Survey data has also reported a stunting prevalence of 37.7 per cent, while 23 per cent of children were underweight and eight per cent were wasted.
Arooba said the causes of stunting were interconnected and extended well beyond inadequate food intake.
“Poverty and food insecurity limit families’ ability to provide diverse diets, while unsafe water, poor sanitation and inadequate hygiene expose children to repeated infections that can interfere with nutrient absorption and healthy growth,” she said.
Maternal malnutrition, low birth weight, inadequate breastfeeding, inappropriate complementary feeding, recurrent infections, limited access to healthcare and socioeconomic inequalities also contribute to the problem.
The importance of maternal education is equally significant. Mothers and caregivers who understand the nutritional needs of infants are better positioned to make informed decisions about breastfeeding, complementary feeding, dietary diversity and hygiene.
PhD scholar Ahmad Mujtaba Noman said children living in poor, food-insecure and rural households were particularly vulnerable.
“Maternal education has a strong connection with child nutrition because mothers who have better access to information are more likely to adopt appropriate feeding, childcare and hygiene practices,” he said.
He pointed out that gender inequality, child marriage, high fertility rates, natural disasters and disruptions to food systems could further increase nutritional vulnerability.
Pakistan’s experience with devastating floods, locust attacks and the COVID-19 pandemic has demonstrated how quickly household food security and access to healthcare can deteriorate during crises.
“Stunting cannot be solved simply by giving children more food. It is the result of a complex interaction of nutrition, poverty, education, sanitation, healthcare and the wider social and environmental conditions surrounding families,” Ahmad observed.
Experts believe the strongest opportunity to prevent stunting lies in the first 1,000 days from conception to a child’s second birthday.
Improving women’ s nutrition before and during pregnancy, promoting exclusive breastfeeding during the first six months and introducing appropriate complementary foods at six months can provide a strong foundation for healthy growth.
For vulnerable families, affordable and locally available nutrient-dense foods can play an important role. But these measures must be accompanied by safe water and sanitation, vaccination, infection prevention and treatment, accessible healthcare and nutrition education.
Community-based nutrition education can help mothers and caregivers understand not only what children should eat, but also how, when and why different foods are important.
Routine growth monitoring, nutrition screening, feeding assessment, supplementation where required and parental counseling should become integral parts of primary and maternal-child healthcare.
Dr Tauseef said universities could help bridge the gap between nutrition research and the needs of ordinary families.
“Universities have the expertise and human resources to turn nutrition research into practical solutions through community outreach, capacity building and evidence-based education,” he said.
The Department of Human Nutrition and Dietetics at BZU has undertaken research into food and nutrition challenges, including a project in collaboration with the DOABA Foundation on traditional medicinal plants and vegetables. The initiative focuses on developing nutrient-rich recipes and food products for health promotion among pregnant women.
The department has also participated in the Pak-Korea Nutrition Centre (PKNC) project, focusing on indigenous resources, capacity building and nutrition education to support sustainable improvements in the nutritional status of communities in food-insecure areas.
Such academic work can be taken directly to communities through nutrition camps, hospital visits, awareness campaigns, screening programmes and practical education for mothers and caregivers.
Pakistan has introduced several nutrition-related programmes, including the National Multisectoral Nutrition Programme, Benazir Nashonuma Programme, food fortification and micro nutrient supplementation initiatives, community-based management of acute malnutrition and early-childhood development interventions.
Provincial governments have also launched programmes aimed at reducing stunting and improving school nutrition, including Punjab’s stunting reduction and school meal initiatives, Sindh’ s Accelerated Action Plan for Reduction of Stunting and Malnutrition, nutrition and food-security initiatives in Khyber Pakhtunkhwa and a school-meal pilot in Balochistan.
The challenge, however, is not merely launching programmes but ensuring their continuity, financing, coverage and measurable impact.
Pakistan needs stronger monitoring of nutrition budgets, programme coverage, human resources and outcomes.
Nutritionists and dietitians should be integrated into public hospitals and primary healthcare services, while nutrition screening and counseling should become routine components of antenatal, pediatric, adolescent and community healthcare.
School nutrition programmes should be expanded and sustained, incorporating nutritious meals, micro nutrient interventions, growth monitoring, safe water and sanitation, and age-appropriate nutrition education.
The Benazir Nashonuma model can also be further strengthened by linking social protection with health, agriculture and education interventions, particularly for mothers and children during the first 1,000 days.
A unified federal and provincial nutrition accountability mechanism could help measure progress through indicators such as nutritionist posts filled, programme coverage, budget utilization, children screened and treated, and changes in stunting, wasting and micro nutrient deficiencies.
The message is clear: Pakistan does not necessarily need more policies on paper; it needs stronger implementation of existing commitments.
Reducing stunting requires healthy mothers, nutritious and diverse diets, clean water, sanitation, education, accessible healthcare, social protection and economic opportunities.
For universities such as BZU, the opportunity is equally significant to combine research with community service, develop affordable and culturally acceptable foods, train nutrition professionals and take evidence-based knowledge to households.
Ultimately, every child who escapes stunting represents more than a health statistic. It represents a better chance to learn, complete education, enter the workforce and contribute productively to society.
Pakistan’s fight against stunting is, therefore, not only a battle against malnutrition. It is a struggle to protect the country’s most valuable resource its children and to build the human capital on which its future depends.
