Pakistan'da 2026: Çoklu Krizler Gölgesinde Zor Bir Yıl

BETTER, BUT NOT QUITE GOOD

THE year 2026 has not been a kind year for Pakistan. In terms of headlines, doomsday is right around the corner. Economic crises, energy crises, debt renegotiations, political uncertainty, inflation, floods, poverty and other issues that might turn a beautiful morning dark and murky have dominated the national conversation. Health issues in particular have people running to check if they are taking the right and the right quantity of medicine. This is so because we have, generally speaking, not been kind to our own cause. Against this backdrop, there is something genuinely heartening in a story emerging from Pakistan: the country’s long-running stunting crisis is showing signs of improvement. The progress is neither spectacular nor complete, and it would be misleading to suggest that Pakistan has solved its nutrition problem, but after decades in which child stunting remained stubbornly high, evidence from national surveys and more recent research suggests that concerted interventions can make a difference. As per the World Health Organisation (WHO), stunting is the impaired growth and development that children experience from poor nutrition, repeated infection and inadequate psychosocial stimulation. Some of the consequences of stunting include poor cognition and educational performance, low adult wages, lost productivity and, when accompanied by excessive weight-gain later in childhood, an increased risk of nutrition-related chronic diseases in adult life. Stunting is not simply a question of a child being shorter than other children. It is the result of chronic lack of proper nutrition. Stunting has been observed to begin early, often during pregnancy or the first two years of life. This is the time when insufficient maternal nutrition, poor diets, repeated infections and unhealthy living conditions can permanently affect growth and development for the rest of the life. In this light, it is quite rightly labelled as a threat to human capital. And, in Pakistan, where the economy is always jumping from one crisis to another, it is seen as a debilitating factor. Pakistan’s stunting problem is not a new one. Progress in tackling the problem has been one with hiccups. Pakistan had a stunting prevalence of about 48 per cent in 1965, falling to 36.3pc by 1994. But the gains then stalled and reversed. Stunting was measured at 41.6pc in 2001 and 43.7pc in 2011. This progress can be equated with the growth of the economy. The World Bank notes that Pakistan’s growth has historically been low and volatile, with per-capita output increasing by only about 2.2pc a year over the past two decades and around 40pc of children aged under five (<5) suffering from stunted growth. In other words, the past 20 years cannot honestly be described as a period of steady decline. Pakistan first lost ground before beginning to recover. For years, our nutritional problems have silently been chipping away at the country’s future. Progress has been made, but there are miles to go before we can hope to be out of the woods. The 2018 National Nutrition Survey (NNS-2018) put stunting among children aged <5 at 40.2pc, about four percentage points lower than the 2011 figure, a 4pc decrease. The Pakistan Demographic and Health Survey (PDHS) also recorded a decline from roughly 45pc in 2012-13 to 38pc in 2017-18. Another data analysis found stunting at 40.7pc in 2001-02, 45pc in 2012-13 and 38.3pc in 2017-18, illustrating the same broad pattern: deterioration followed by a meaningful reversal. The improvement may look modest on paper, but in a country of more than 240 million people, even a few percentage points represent hundreds of thousands of children. More importantly, researchers are beginning to understand why the decline happened in some parts of Pakistan, and why it has been slower elsewhere. From 2011 to 2018, Khyber Pakhtunkhwa (KP) and parts of Punjab recorded significant improvements, with stunting falling from 43.0pc to 38.3pc in the areas studied. The lessons observed led to a significant conclusion. Stunting is not caused by one missing vitamin or one bad meal. Nutrition is intertwined with poverty, women’s status, education, healthcare, sanitation, food prices and household decision-making. The most successful interventions have recognised that reality. In 2020, the Benazir Nashonuma Programme (BNP) was launched, combining conditional cash transfers with specialised nutritional support for pregnant and lactating women and young children. The pilot project was launched in the Islamabad Capital Territory (ICT) before being expanded nationwide by December 2022. BNP is an example of a broader shift in thinking. Instead of treating nutrition as something that happens only inside a clinic, programmes increasingly connect food assistance with antenatal care, vaccination, breastfeeding, complementary feeding and health education. Under BNP, beneficiaries receive nutritional supplements and cash transfers linked to health and nutrition-related behaviours, including antenatal visits, vaccination and participation in awareness sessions. By 2025, the programme was operating through hundreds of facilitation centres across Pakistan. Through its vast network of lady health workers (LHWs), Pakistan has effectively implemented nutritional interventions. In rural Sindh, pregnant and lactating women and young children were provided nutritional supplements, and older children were handed micronutrient powders. The programme was accompanied by behaviour-change communication on complementary feeding and hygiene. One important development has been the increasing focus on the first 1,000 days, from pregnancy through a child’s second birthday. This period is a critical window for preventing growth failure. However, it is clear Pakistan’s stunting crisis is not merely a medical problem. It is as much an education problem, a poverty problem, a gender problem, a water-and-sanitation problem, and, in some communities, a cultural problem. Cultural sensitivities continue to make conversations about breastfeeding, maternal diets, contraception, birth-spacing and child feeding difficult. Stigma still prevents families from acknowledging that a child is malnourished. Traditional beliefs about what pregnant women or young children should and should not eat can sometimes limit dietary diversity. Tradition dictates that milk directly from the animal is better than supplements. Mothers may know what a child needs, but lack the money or the time to provide it. Besides, a patriarchal setup does not help the cause much. And, in households where women themselves entered pregnancy undernourished, the cycle can begin before the child is even born. Education is, therefore, one of the most powerful long-term nutrition interventions. Evidence repeatedly points to maternal education as a determinant of child nutrition, while research also highlights the importance of improving women’s health and social status. Better education can influence everything, from breastfeeding practices and hygiene to healthcare utilisation and household food choices. Then there is the economic dimension. Pakistan’s recent economic difficulties have made nutritious food less affordable for many families. Researchers studying the stunting status between 2011 and 2018 identified poverty and rising food prices as important barriers to access to nutritious diets. The NNS-2018 found that stunting is strongly associated with household income, food insecurity, maternal education, household size, diarrhoeal illness and sanitation. Children in lower-income households had substantially higher odds of being stunted, while lack of improved sanitation was also associated with greater risk. The relationship between sanitation and nutrition is especially revealing. A child may receive nutritious food, but repeated exposure to contaminated water and an unhygienic environment can contribute to infections and undermine the body’s ability to absorb nutrients. A 2026 study found that lack of hygiene facilities and inadequate water and sanitation services were associated with higher odds of stunting. The study reported stunting prevalence of 38pc, and found that lack of hygiene facilities increased the odds of stunting by about 61pc, while unimproved sanitation increased the odds by about 30pc. With so many insights in hand as well as years of experience in maternal health, change for better should take place. And it has. Earlier this year, the BNP recorded a major decline in child stunting along with improvements in maternal and newborn health outcomes. An evaluation revealed that stunting rates among beneficiary children were 22pc lower at six months of age and 18pc lower at 12 months. There was a 6pc reduction in low-birthweight cases, an 11pc decline in premature births, and a 7pc decrease in weak and vulnerable newborns. Despite all these ‘good’ numbers, stunting at around 40pc remains a critical issue, and the country continues to carry one of the largest burdens of child undernutrition in the region. There are miles to go before we can hope to be out of the woods. Among other things, the country surely needs better and more regular national data so that progress may be measured accurately, and interventions may be targeted. The fight against stunting is not merely about making children taller. It is about giving Pakistan’s next generation a stronger foundation on which to build the country’s future. The writer is a freelancer based in Islamabad.