When I began voluntary work in Pakistan’s arid region of Tharparkar in February 1985, perhaps the first reason I became enduringly engaged with the area was the ultra thin, emaciated infants in the laps and arms of underfed teenage mothers. Though their eyes cast a spell, their faces were grim and gaunt.
Malnutrition has spanned generations and impacted parents as well as children. Fortunately, in the past three decades, global research, new knowledge and potentially effective solutions have emerged to create scope for alleviating malnourishment in Tharparkar, and also in those parts of Pakistan where poverty, ignorance and inaction still prevail.
Lack of appropriate nourishment exists even in the non-arid regions. There is inequitable distribution of wealth, income and food. There’s very little food for too many mouths due to unwanted births and inaccessibility to family planning services. Girls, who prematurely become mothers, are second-priority recipients of choice food; males, including boys, come first in a misogynistic culture. There are anaemic mothers unable to provide even minimal levels of breast milk for, ideally, two years. There’s no awareness of relatively low-cost food fortifications – many can’t even afford them. Unhealthy food is consumed. The scale of the challenge is huge.
About 44 per cent of Pakistani children are reliably estimated by the Unicef to be suffering from malnutrition. This is not a transient illness that medicines can cure. Once the adverse effects of malnutrition are imprinted onto the molecules and muscles of infants and children, they become like permanently embedded organisms. They prevent the child from developing potential brain and body power, they stultify and suppress the spontaneous urge to grow freely and fully. A single cruel word – “stunting” – can enslave a human being for life. Its very sound reflects the affliction’s debilitating nature.
Beginnings shape future happenings. Only 38 per cent of infants under six months are breastfed. The percentage declines after the first six months, without an adequate supplementary diet compensating the loss of mother’s milk. Research conclusively shows that there is also need for fortified food in the first 1,000 days.
My instinctive opposition to powdered infant milk as a substitute for mother’s milk has been tempered in view of the undernourished, overworked dimensions of the lives of the vast majority of Pakistan’s women of child-producing age.
Voluntary work over three decades has taken me to villages and towns in all the four provinces where female deprivation – from young girls to adult woman – is vividly visible.
Every fifth pregnant woman and every child under five years survives with severe Vitamin A deficiency; 62 per cent of children under five years of age are anaemic. In examples of the over 12 million children who are out of school, one can discern distractedness and listlessness. If in school, there is passivity and lack of energy in classroom interactions. Invariably, they are the ones who reveal poor learning indicators. They face frequent episodes of infection and illness contributing to high dropout rates.
A World Bank study has estimated that large-scale malnutrition causes a country to lose about 3 per cent of its GDP. Pakistan has fallen behind other nations in adjacent regions in tackling this threat.
Fortunately, there are several international organisations committed to supporting countries like Pakistan to combat this condition – for example the World Health Organisation, the Global Alliance for Improved Nutrition, the US Centres for Disease Control, Nutrition International and others.
Just as imbalanced population growth has a cross-cutting effect on virtually every sector of the country’s development, so too does malnutrition on a large scale and in multiple spheres – for the individual, in body, mind, and even soul; for the nation, in health, education and the economy. The July 2018 elections afford an opportunity to citizens and political parties to prioritise this subject, alongside critical issues of enhanced access to family planning services and innovative approaches to primary school education.
The National Maternal and Child Health Programme acknowledges the significance of malnutrition. Alleviation measures should be vigorously implemented. Increased awareness is needed of the lifelong damage caused by stunting as is enhanced access to food and fortified milk at a fair cost to compensate for deficiencies in household income or in maternal health.
Subsidies through state intervention and/ or through private philanthropy to enable low-income or the poorest families to purchase supportive diets also deserve focus, as does participation by community organisations, side by side with the government, in a shared duty to effectively address this major challenge.
JAVED JABBAR is a community development practitioner and a former federal minister and senator