4
AS a special report published by this newspaper a fortnight ago pointed out in painful detail, malnutrition and, as a consequence, stunting, wasting and associated health risks are amongst the most serious issues the country currently faces. Indeed, it would not be incorrect to say that we risk losing an entire generation to this, with frightening implications for the future workforce and the associated strain on the already insufficient healthcare infrastructure.
An overview of the grim statistics was provided by Zulfiqar A. Bhutta, founding director of the Centre of Excellence in Women and Child Health at the Aga Khan University, Karachi. Quoting the National Nutrition Survey 2011, he pointed out that one-third of all children in Pakistan are underweight, nearly 44pc are stunted and 15pc wasted. On top of this, half of the young are anaemic, and almost one-third have iron-deficiency anaemia. A maternal and child nutrition study published by Lancet in 2013 shows that these rates have barely changed over the past two decades, with women and children among the rural and urban poor being at greatest risk.
The main reason for this state of affairs, tragically for a country that has a largely agrarian economy, is food insecurity. With millions of rural and urban households eking out an existence below the poverty line, according to Mr Bhutta’s research periodic or seasonal food insecurity is reported by up to half of the families in certain areas, particularly in Balochistan, Sindh and southern Punjab, and parts of KP and Fata. The situation is compounded by the lack of access to safe drinking water, unhygienic living conditions, and poor sanitation.
Children are not getting enough nutrients.
If this is a frightening picture, consider this: it masks another related, even more disturbing, reality concerning food and nutrition issues. Surveys have found a number of children in even food-secure households to medically be categorised as suffering from malnutrition or, on the flip side, having childhood obesity.
In other words, for a mix of reasons, despite getting enough to eat, they are not eating the right combinations of foods for their bodies and brains to grow healthily. The main reason for this is parents’ lack of awareness about the nutritional needs of children — women, for they are generally in charge of putting together the menu for their families, and men, for they generally control the family finances and food stocks.
Even anecdotally, on streets across the country, it is easy to see this play out. A hungry child is now more likely to be handed a packet of crisps than a banana, given how, in recent decades, the country has been flooded by an ever-increasing number of brands peddling ever cheaper ‘food’ that contains very little nutrition. The money available to big business in a globalised world means that aggressive and often misleading advertising campaigns dominate the airwaves and the hoardings, a mix that in a largely uneducated or undereducated population is, quite literally, lethal.
The World Bank’s ‘Nutrition at a Glance’ snapshot of Pakistan, for example, depressingly tells us that only 37pc of infants under six months are exclusively breastfed.
I know several women in the lower income but not poor economic bracket that have been convinced by the aggressive and ubiquitous advertisements that infant formulas, or food supplements — presented as they are of being fortified by all sorts of dietary benefits — are actually better for their children. That this is the prevalent rate despite a continuing but now-on, now-off state-run campaign to promote breastfeeding shows how the advocacy for health is failing to compete with big business.
Similarly, everyone would at some point or the other have seen a child pleading that XYZ brand of factory-made biscuits ‘contains real milk’, as though that means that it is healthy. And on the other side of the coin, childhood obesity amongst the elites is becoming more common, as poor food choices and the easy affordability of processed foods combine with more sedentary lifestyles to produce ill health.
I once encountered a paediatrician at one of Karachi’s priciest hospitals telling a well-to-do and educated couple that over a litre of milk per day for their toddler was absolutely unacceptable. The mother protested: “But milk is healthy!”
Pakistan urgently needs these trends reversed, and the only way to do it is through aggressive and sustained awareness-raising campaigns about human nutritional needs, and the risks associated with processed and junk foods. Further, it may be useful to consider regulating in some way either such food brands’ access to the market for children, or the aggressive advertising campaigns they run.
The West has in recent years awoken to the dangers of poor food choices that come at a heavy cost to the health infrastructure. Pakistan can still avoid treading the same path.
The writer is a member of staff.
Published in Dawn, December 19th, 2016
