With steadily increasing inflation, poverty and population growth, the number of chronically malnourished is growing and food insecurity is touching dangerous levels, writes Hilda Saeed

Amina clung worriedly to her little son; he had been wailing all night from hunger. Her labourer husband Hafeez had been without work these last three days, and so there has been nothing to eat. Her milk had dried up…Thank God her daughter had awoken, cried a bit, then gone back to sleep with a drink of water.

Amina too was thirsty, but felt deadened, unable to move… Maybe later she’d borrow a little daal and rice from her neighbour, to cook khichri for the children. Hafeez at least would get a square meal at the nearby Edhi Centre, but how long would she and her children survive like this?

Amina represents more than half the nation’s chronically malnourished women and children. With steadily increasing inflation, poverty and population growth, their numbers are growing; food insecurity is touching dangerous levels. The Pakistan National Nutrition Survey 2011 is a shocking eye-opener. It provides evidence of the unacceptable extent of malnutrition in Pakistan.

Eleanora Genovese of Unicef states, “Between 2001 and 2011, nutrition levels have not only stagnated, they have, in some cases, plummeted further. Sindh, for instance, consistently presents poorer outcomes than the national average. Food insecurity has affected 60 per cent of the population here, predominantly women and children.” Malnutrition is least in Punjab, increasing in Sindh and Fata regions. Balochistan too presents the worst scenario.

Malnutrition constrains economic growth and national progress: an estimated half the nation (49.6 per cent) is growing up stunted, unable to reach their full physical and mental potential, while the adult half is too weak to contribute fully to the country’s production efforts. The World Health Organisation cites malnutrition as the single greatest threat to public health, and a significant factor in maternal and child mortality, killing six million children each year in Pakistan. A 2006 survey estimated that 58 per cent or over 36 million died of causes linked to malnutrition.

Severely malnourished children show marked behavioural changes; they are apathetic and less active; and many experience loss of cognitive and spatial memory. In adults, malnutrition is associated with depression. Deficiency of micronutrients is common; scarcity of iron, anaemia and Vitamin A are widespread; fortunately, paucity of iodine is decreasing.

At a discussion by health experts, Mona Shaikh of the World Food Programme in Pakistan considered the country’s nutritional status alarming. Chronic and acute malnutrition, parallel poverty and higher illiteracy especially among mothers, and the government’s lack of commitment towards ensuring food security are to blame. Besides these structural problems are the inherent ones of improper infant feeding practices, and inadequate access to the right foods.

The situation is already taking its toll, leading to complex nutritional problems. Dr Zulfiqar Bhutta of Aga Khan University states that stunting in children is emerging as a major problem. “The country’s future and that of our children is at stake.”

Women’s status and nutrition are closely intertwined. Weman’s nutritional status, assessed relative to men’s, has been found deficient; from childhood onwards, gender discrimination emerges in lower calorie intake, more visible among the poor. Girls’ greater vulnerability is evident in their care and upbringing; the differences that arise reflect the economic and cultural premium placed on boys as against girls.

Daughters are considered unproductive, an economic drain on family resources and generally considered a burden. Traditionally they receive a disproportionately smaller share of household food, yet they are constrained to spend longer hours, and utilise more ‘household energy’ than men. The daily calorie shortfall eventually takes its toll.

Poverty promotes discrimination in access to food; young girls receive fewer calories, consume less solid and supplementary food than boys, and grow up weak and malnourished. Early marriage and childbearing further depletes the body’s nutritional resources and multiple childbirths may lead to early death.

“The primary relationship between a woman’s household responsibilities and her own serious malnutrition is tragic: she denies herself food to feed her children,” states Levinson, 1983 in a South Asian study of comparative nutritional practices.

The end result of such centuries-old cultural attitudes is inevitable: it has now crystallised as starkly visible national statistics. A host of factors have led to this tragedy: high population growth, significant socio-economic and gender disparities, high and growing illiteracy, particularly female illiteracy, hide-bound traditions, overt extremism and patriarchy that further constrain women’s role in society.

Nutritionally speaking, Pakistan is now literally on the brink; it simply cannot afford to continue in this fashion. Essential steps are urgently required if Pakistan is to attain nationally optimal food security: health and nutrition have proven links to overall educational attainment and thereby to national progress.

The answers lie in improving nutrition, including with emergency fortified foods. Consistent and concerted multi-sectoral health and nutrition programmes which prioritise public health are urgent necessities, especially maternal and child health, while simultaneously ensuring strong development and outreach at the provincial level.

Also, we have had twisted customs and ‘cultural’ traditions, myopic policies that promote poverty and illiteracy; there are patent violations of the law where such legislation exists and severe gender discrimination. Successive governments have neglected human resource development—but positive change may be in the offing with the right planning and policies. For Pakistan to grow as a prosperous, viable and food-secure nation, these problems can and must be overcome.