AT the recent Act for Nutrition Conference in Islamabad, organised by DawnMedia, where I joined a panel examining the link between poor water, sanitation and child stunting, much of the discussion was rightly about food: what children eat, how mothers are supported, and why so many families still struggle to access a nutritious diet.
But sitting on that panel, I kept returning to another part of the stunting story that receives far less attention: what is the child drinking?
What happens when the water available at home is unsafe, sanitation is poor, or repeated diarrhoea becomes part of a child’s earliest years?
A child can be fed and still struggle to grow.
Pakistan’s water figures make this difficult to ignore. According to the WHO/Unicef Joint Monitoring Programme (JMP, 2025), 91 per cent of Pakistan’s population used at least basic drinking-water services in 2024, but only 45pc used safely managed drinking-water services.
That distinction matters. Safely managed water comes from an improved source that is on the premises, available when needed and free from contamination. A water source may therefore be available without the water necessarily being safe.
This is particularly important during the first 1,000 days of a child’s life. Good food, breastfeeding and maternal nutrition are essential. But so is the environment in which a child is growing. Repeated exposure to contaminated water and poor sanitation can mean repeated illness at precisely the stage when healthy growth matters most.
Yet our response is still organised in separate boxes. Nutrition has its programmes. Health has another set of structures. Water and sanitation are often treated as infrastructure. Social protection and climate sit elsewhere.
Children do not experience those divisions. They experience the water available at home, the food they are given, where they play and how often they fall sick.
Our work in rural Punjab has made this very clear.
Through the Behaviour Change and Capacity Development project, WaterAid Pakistan led a consortium, working with the Punjab Rural Municipal Services Company across 200 villages.
The work began not by assuming that people simply needed more information, but by looking at what they were already doing and why.
How was drinking water stored? When were hands washed? How was food prepared? Where did child and animal faeces go? What made a safer practice easy to adopt, and what made it difficult?
That research informed a Hygiene Behaviour Change Package covering safe water, handwashing, food hygiene, sanitation, breastfeeding, vaccination, menstrual hygiene and household and animal waste. Families were engaged repeatedly through community sessions, practical activities, visual materials, videos and behavioural cues.
Our evaluation covered 1,072 households, alongside focus groups, interviews and household observations. Ninety-eight per cent of surveyed households reported adopting new hygiene-related behaviours, 89pc reported washing their hands with soap at critical times, and 86pc reported safe drinking-water use and storage practices.
These figures do not mean behaviour change is the answer to stunting. Nor does one project offer a solution to a national problem. But they do show why infrastructure and behaviour cannot be treated separately.
There is little point in asking a family to use safe water when safe water is not available. But installing a water system does not automatically change how water is stored, how hands are washed or how waste is managed.
The approach and communication materials tested in Punjab now form part of PRMSC’s planned expansion to another 1,800 villages. That is important because Pakistan does not lack pilots. The harder task is getting useful evidence into public systems and taking what works to scale.
The same thinking should shape our nutrition response.
When a programme identifies a child at risk of stunting, safe water and sanitation at home should be part of that picture. When a child is treated for diarrhoea, the conditions they return to matter. And when money is being spent on nutrition, health, water or social protection, those investments should work together.
WASH is not the only answer to malnutrition. Food insecurity, poverty, maternal health and access to healthcare remain central.
But what a child eats is only part of the story.
If we want children to grow well, we also need to pay attention to what they drink and the environment in which they spend their earliest years.
The writer is Country Director, WaterAid Pakistan.
Published in Dawn, October 30th, 2026
