Why do child stunting and maternal health feature so high on Prime Minister Imran Khan's priorities?
As a development economist, I have always been interested in questions like: why are some individuals and countries poor and unproductive but others rich and productive? My belief is that Pakistan’s economy has been left stunted because of neglect of early childhood health and development.
The first 1,000 days of life beginning from conception in pregnancy to age 2 are particularly critical for child health and brain development; IQ is largely developed before age 10.
This is a source of major concern in Pakistan, where even before a child is born their fate may be sealed due to neglect of maternal and child health services.
In 2013, Pakistan ranked 120th out of 134 countries on the planet in terms of skilled birth attendance.
That year, only about 52.5pc of births were attended by skilled heath staff in Pakistan, placing us behind even most African countries, many of whom like Ghana and Congo have similar or even lower per capita income than us.
Earlier, in 2010, just 2.2pc of our Gross Domestic Product (GDP) was spent on health by private or public sector combined, which was among the lowest on the entire planet.
A recent report by the United Nations unearthed a shocking statistic which highlights the extent to which Pakistan as a society ignores its children. The stat claims that one in every 22 newborn dies in Pakistan, which makes Pakistan the worst country on the entire planet in neonatal mortality.
Dig deeper and you will find that fetal growth restriction, suboptimal breast-feeding, stunting, wasting (low weight for height), and micronutrient deficiencies in vitamin A and zinc are among the leading reasons for all child deaths.
Stunting is the impaired growth and development that children experience from poor nutrition, repeated infection, and inadequate psychosocial stimulation.
Children are defined as stunted if their height-for-age is too low relative to World Health Organization Child Growth Standards. A child who is stunted at age 2 may never be able to completely catch up.
According to the National Nutrition Survey 2011, nearly 44pc of Pakistani children are stunted. According to another estimate, Pakistan loses $7.6 billion or three percent of its GDP each year due to malnutrition.
Stunting before the age of 2 years is a precursor of poorer cognitive and educational outcomes in later childhood and adolescence, and has significant educational and economic consequences at the individual, household and community levels.
According to the World Bank, a one per cent loss in adult height due to childhood stunting is associated with a 1.4pc loss in economic productivity. It is estimated that stunted children earn 20pc less as adults compared to non-stunted individuals.
Some policy-makers have traditionally mistaken investments in maternal and child health as an economic burden. They believe that there is a trade-off between what is socially just and what is economically efficient.
They believe that to kick-start economic growth we must make “hard” investments in infrastructure like China–Pakistan Economic Corridor (CPEC), metro buses and macro governance institutions to get high economic growth.
They also believe that “soft” redistributive expenditures on issues like maternal and early life health can wait later when economic growth is high enough and when all the IMF loans are repaid.
But latest research across biological and economic sciences suggest that investments in early childhood development are one of the most sound ones as, once mature, they improve labour productivity, boost economic growth and reduce budget deficits.
In fact, recent estimates suggest that there exists a highly lucrative benefit-cost ratio of around 30 to 1 for stunting reduction in Pakistan. It means that for every rupee invested in stunting reduction, Pakistan will earn 30 rupees back.
In 2008, a distinguished panel of economists and scientists — including several Nobel laureates — ranked the most effective solutions to the world’s 10 biggest challenges.
The panel had declared combating malnutrition as the world’s best investment. In fact, five of the top 10 solutions involved addressing malnutrition early in life.
Pakistan currently has 15pc of its population, or about 25 million children, between 0-4 years of age. These children are the country's future. If they are stunted today during a critical period of their development, Pakistan will continue to be stunted for the foreseeable future.
The question is: will the new government follow through on its promises and turn this crisis into an opportunity for reviving Pakistan’s economy?
The writer is a PhD in Economics and works on global health economics at Rice University's Baker Institute for Public Policy in Houston, Texas.