The first speech of Prime Minister Imran Khan took many unexpected turns, and one of them was when he showed the photographs of stunted brain cells. Since then stunting has become a buzz word, and a lot of people are quoting the rate of stunting in the country to shame a political opponent. Many people have criticized the current federal government for not preventing stunting so far. However, most of these discussions fail to touch on many important aspects of this issue.
First of all, a lot of these discussions fail to explain the meaning of stunting, and its causes; it is hard to eliminate something without understanding it and its causes. Furthermore, there is hardly any discussion on the solutions of stunting, because many discussion on stunting are not well researched. Moreover, after the 18th Amendment health became a provincial subject, so the burden of eradication of the disease is on the provinces. This makes it complicated for the federal government to make a national stunting or nutrition policy, so the federal government can’t do much about stunting. It can only encourage provinces to eliminate stunting.
Let’s begin with defining stunting, our government in the National Nutrition Survey (NNS) 2011, has defined it as “Failure to reach liner growth potential because of inadequate nutrition or poor health, also defined as a chronic restriction of growth and height indicated by low height-for-age. Stunting is usually a reliable indicator of long-term under nutrition among young children.” Though this definition focuses a lot of the children being too short for their age, stunting also affects the brain development of a child. One does not need to explain this in detail, the whole nation has seen the photographs of the stunted brain in the first speech of PM Khan.
Furthermore, according to this NNS 2011, the rate of stunting in Pakistan is 44%, which means that 44% of the children in this country have short height and stunted neurological development. How will Pakistan be a great economic power, and the next Asian Tiger when 44% of its population has stunted growth? In addition, stunting is an irreversible disease, which means that this cannot be cured, and it can only be prevented. According to the Pakistan Demographic and Health Survey (PDHS) 2017-18, stunting is highest in the former FATA, GB, Sindh, and Balochistan. For the children, in these areas, who were diagnosed with stunting, it is too late and the damage has been done. The focus of the government now needs to be on preventing this disease so that other children are protected from it.
Stunting is one of the biggest problems faced by Pakistan and it is not only affecting the physical abilities of the people, but also their cognitive abilities. There is also a need to create awareness about a balanced diet and breastfeeding, and empower women. This requires gender mainstreaming, which is a public policy concept that encourages policies to be designed while making ‘gender’ a central theme
Coming to the causes, one of the main cause of stunting in Pakistan is maternal malnutrition. When a woman is pregnant, she doesn’t get the required nutrients for the healthy growth of her child and there are multiple reasons for this insufficiency in diet. First of all, there is poverty in the country, as most of the people cannot afford food to properly feed their family members. Secondly, the dietary habits of Pakistanis do not align with nutritional standards. For instance, people consume a lot of grains like wheat and rice, and a lot of time important vitamins are left out.
Thirdly, one of the most crucial reasons behind maternal malnutrition is the poor status of women in Pakistan. A lot of females are married off at a very young age, and their nutritional needs are not taken care of, which makes them malnourished. In the rural areas, it is believe that men need more energy than women as they work in the fields, while women sit at home, so man are given a better diet. When these girls get married and give birth to their child, the child is born malnourished leading to stunting. This situation is known as chronic malnutrition, where malnutrition is passed from one generation to another.
Other than that, stunting is also caused due to lack of exclusive breastfeeding during the first six months of the baby’s life after birth. In villages, people start giving the solid diet to their child while the child is just a few months old, and in big cities breastfeeding alternatives are very popular. Contrary to the popular belief, most of the baby milk formulas are not sufficient for the baby, as all the basic nutrients to prevent stunting are present in mother’s milk. Other than that, breastfeeding increases the immunity of the baby, and reduces the chances of breast cancer in women. Therefore, breastfeeding awareness and gender mainstreaming have to be two key components of any stunting prevention program.
It is equally important to highlight the potential solutions for stunting. According to the experts, nutrition and health are life-cycle processes that start at one’s birth and end at death, but due to lack of resources it is not feasible to make a policy focusing on the entire life-cycle.Other than that a lot of nutrition related problems occur in early childhood, so a good policy must focus on the early stages of childhood. Therefore, nutrition policy approaches, around the world, focus on the first 1000 days of a child’sexistence -starting from pregnancy till the age the child is 2 years old. It’s called 1000 days window of opportunity because it provides a unique opportunity to improve the life-long nutritional wellbeing of the mother and the child. However, poor nutrition during this time will lead to life-long nutrition issues for both mother and child and stunting is one of them. Stunting is a condition that is irreversible, but it can be prevented in these 1000 days. Therefore, any intervention for preventing stunting will be effectivewithin these 1000 days.
However, the question here arises that can the mother afford healthy diet within these 1000 days? If she can afford it, then is this country producing enough food to satisfy her dietary needs? This is not merely a health issue, but it is directly related to food security and agriculture.Currently, there is a huge debate about changing the name of Benazir Income Support Program (BISP). Any debate on BISP must not be revolving around its name, but its flaws. This social security is providing women with cash without much conditions. There must be conditions placed on the cash transfers that make the recipients liable to spend on the nutritious diet of the mother and the child.
Stunting is one of the biggest problems faced by Pakistan and it is not only affecting the physical abilities of this nation, but also its cognitive abilities.There is also a need to create awareness about a balanced diet and breastfeeding, and empower women. This requires gender mainstreaming, which is a public policy concept that encourages policies to be designed while making gender a central theme. There is alsoa need to bring this problem on the agendas of all the provincial governments. However, the biggest risk for effective implementation of any policy related to stunting is the coordination between centre and the provinces. Therefore, PM Khan needs to go beyond showing photographs of stunted brains, and make efforts to bring all provincial governments on one page on this issue.
The author is a freelance columnist