Childhood Stunting is Undermining Pakistan’s Human Development Potential: WB

Over 40 percent of Pakistani children under five are stunted compared to 38 percent in Afghanistan and 35 percent in India, says the World Bank.

The Bank, in its policy, “Stunting in Pakistan: A Challenge Undermining the Country’s Human Development Potential,” stated dire levels of childhood stunting present a major public health threat, and it remains a key human development challenge for Pakistan.

Since 2011, the 0.5 percent average annual rate of reduction in stunting is despairingly slow to reach the national SDG and World Health Assembly targets. While stunting levels are worse in rural and poor households, more than 20 percent of under-five children from the wealthiest income quintile also suffer from stunting confirming that poverty is not the sole driver of chronic malnutrition (stunting).

Key Drivers of Stunting

Adequate food intake, environmental health, and care for children and women have a strong association with Pakistan’s stunting levels. Less than 2 percent of under-five children confirm all three adequacies, indicating Pakistani children will continue to be at increased risk of illness and death, poor cognitive development, slower educational attainment, and diminished life-long income generation potential.

The repeated waves of COVID-19 since March 2020 exacerbating food insecurity and disrupting the provision and use of basic health and nutrition services have put an even larger number of under-five children at increased risk of stunting.

Nutrition Strategies and Programs

Nutrition is prominent on Pakistan’s policy agenda as evidenced by the comprehensive Pakistan Multisectoral Nutrition Strategy 2018 (PMNS). However, multiple weaknesses in implementing nutrition programs across sectors remain a significant challenge. PMNS advocates for all industries to adopt a “nutrition lens” in program planning and proposes a common results framework to guide implementation to achieve enhanced nutrition results across provinces.

It recognizes the stewardship role of the provincial Planning and Development Departments in operationalizing multisectoral approaches (such as social protection or universal education with a gender focus) and coordinating with vital sectoral departments for nutrition outcomes.

The PMNS guides provinces suffering from high levels of stunting on the implementation of interventions suggested by the 2021 Lancet Maternal and Child Nutrition Framework1, and these comprise direct healthcare sectors nutrition interventions, such as maternal and child micronutrient supplementation including home fortification, maternal and child food supplementation.

Other direct healthcare sectors nutrition interventions include support for early immediate breastfeeding initiation, delayed cord clamping, promotion, and support for exclusive and continued breastfeeding, promotion of age-appropriate complementary feeding practices, management of moderate acute malnutrition, treatment of severe acute malnutrition, anemia treatment, and promotion of healthy diet and physical activity during childhood and adolescence.

These interventions specially target pregnant and nursing mothers, adolescent girls, and children up to two years of age from socioeconomically vulnerable population groups.

Recommendations Based on Evidence and From Discussions With Key Stakeholders

• Success in tackling stunting relies on geographic convergence of cross-sectoral action plans that are implemented sectorally, and encompass at the very least health, food, agriculture, poverty, water, and sanitation sectors with strong coordination between federal and provincial levels, and with relevant stakeholders such as the Scale Up Nutrition Movement and the private sector entities.
• Political championing at the highest provincial level for nutrition strengthened governance bodies at provincial, district, and sub-district levels, and rigorous coordination and oversight of multi-sectoral nutrition actions by the Provincial Departments are crucial for Pakistan to achieve its stunting targets.
• In-depth learning review of World Bank-supported health, nutrition, and population portfolio to identify lessons and barriers that prevent the effectiveness of evidence-based nutrition interventions across each province.
• Develop Health Workforce and revise the mandate of community- and facility-based workers employed in different programs to integrate nutrition within work programs. Concerted investment for technical capacity building, particularly at operational levels when designing and delivering stunting reduction operations, including in community education, cross-sectoral social and behavior change communication strategy, and a comprehensive monitoring and evaluation plan with strengthened routine data collection of standardized indicators.