ISLAMABAD: Despite limited progress overall, some regions of the country did show significant gains in reducing childhood stunting between 2011 and 2018, two major national and global studies published in the American Journal of Clinical Nutrition have revealed.
In parts of Punjab and Khyber Pakhtunkhwa provinces, stunting rates declined at an average rate of 1.6 per cent per annum. Despite its fragile socio-economic indicators, the country showed modest gains in linear growth among children under five. Yet, stunting remains alarmingly high. According to the National Nutrition Survey 2018, 40.2 per cent of children under five in Pakistan were stunted—one of the highest rates in South Asia, exceeded only by Afghanistan.
The research, led by Pakistan’s foremost public health expert Prof Zulfiqar A. Bhutta, assessed decades of child nutrition data in low- and middle-income countries, including Pakistan. Notwithstanding the limited dietary trend information available, the study found that around 54 per cent of the change in children’s height-for-age scores could be explained by measurable risk factors—of which nearly 80 per cent stemmed from improvements outside the traditional health sector.
Mixed methods analysis showed that the bulk of progress was associated with broader investments in maternal education, poverty reduction strategies, family planning, and sanitation, underscoring the need for a comprehensive, multisectoral approach to combating childhood stunting.
Prof Bhutta, who leads child health and development initiatives at the Institute for Global Health and Development at Aga Khan University and the Centre for Global Child Health in Toronto (Canada), emphasised that stunting was not merely a biological problem but a manifestation of deep-rooted inequities and social deprivation.
“Our research reaffirms that improving child growth outcomes requires more than mere food or dietary supplements—it demands action on multiple fronts including maternal education and empowerment, clean water, adequate quality antenatal care, and poverty reduction,” he said.
Impressively, Benazir Income Support Programme was cited in previous research by Prof Bhutta as a key factor in improving nutritional outcomes among women, and by extension, their children. Yet, the new study notes that many high-impact interventions remain under-implemented or unevenly distributed. For example, maternal under-nutrition—especially low body mass index and short stature—remains a critical determinant of child stunting, and many mothers in rural areas still lack access to adequate prenatal services.
Stunting is known to have irreversible effects on brain development, immunity, and educational attainment, often perpetuating inter-generational cycles of poverty and poor health. “Investments in reducing stunting are not just about child survival—they are about national development,” Prof Bhutta added.
The study also highlighted how short birth intervals, adolescent pregnancies, and poor maternal empowerment continue to undermine child nutrition outcomes in Pakistan. Access to modern contraception and family planning services remains patchy, despite being integral to breaking the cycle of under-nutrition.
The research team used rigorous multivariate regression and Blinder-Oaxaca decomposition analyses across household survey data to pinpoint risk factors. The study found that in Pakistan, children born to mothers with low education, low body mass index, and limited healthcare access were significantly more likely to be stunted. Wealth inequalities were another powerful predictor.
To achieve meaningful gains, the study recommends that Pakistan adopt a 10-step implementation strategy that includes evidence-based planning, targeting marginalised populations, promoting female education and empowerment, and ensuring integration of nutrition goals into all sectors. The researchers also stress that WASH (water, sanitation, and hygiene) interventions, while not universally effective across countries, showed modest but meaningful benefits in Pakistan.
Pakistan’s progress, though limited, shows that positive change is possible when policies are made on the basis of data and implemented at scale. However, the gains remain fragile. Without scaling up proven interventions and allocating domestic funding to complement international assistance, the study warns Pakistan risks stagnation or reversal of progress.
As the global nutrition community prepares for the next round of Sustainable Development Goals tracking, Prof Bhutta’s study offers a clear roadmap—and a reminder—that child stunting can be reduced, but only through multi-sectoral action anchored in political will and evidence.
