AN ENORMOUS CHALLENGE

Key Takeaways

• Financing is the biggest obstacle in the way of reforms needed to make nutrition a major objective rather than treating food security as a question of
• PAKISTAN’S children are among the most malnourished in the South Asian region, behind Sri Lanka, Maldives, Bangladesh and Nepal
• Multiple statistics from studies and official sources indicate that around 30-40 per cent of children aged under five (<5) are stunted, meaning low he
• Moreover, newborns in Pakistan face the additional challenge of cognitive disabilities that can emerge from maternal malnutrition
• Approximately one in three mothers is malnourished

Financing is the biggest obstacle in the way of reforms needed to make nutrition a major objective rather than treating food security as a question of producing enough calories.

PAKISTAN’S children are among the most malnourished in the South Asian region, behind Sri Lanka, Maldives, Bangladesh and Nepal. Multiple statistics from studies and official sources indicate that around 30-40 per cent of children aged under five (<5) are stunted, meaning low height for age, 30pc are underweight and 17.7pc are affected by wasting.

Moreover, newborns in Pakistan face the additional challenge of cognitive disabilities that can emerge from maternal malnutrition. Approximately one in three mothers is malnourished. Among women of childbearing age, 42.7pc are anaemic, 27pc are deficient in vitamin A, and 80pc are deficient in vitamin D. This contributes to low birth weight among newborns the prevalence of which has been reported at 22.7pc. Children of malnourished women are more likely to experience cognitive impairments, short stature, lower resistance to infections, and a higher risk of disease and death throughout their lives.

Rather intriguingly, Pakistan’s overall dietary energy availability is adequate. The national food supply, however, falls short of what is needed to support healthy diets in line with national guidelines. Gaps persist in the availability of key food groups, including fruits and vegetables, pulses and legumes. These shortages directly weaken the population’s access to, and ability to choose, a healthy diet.

The challenge of poor nutrition is historical. The state institutions made several attempts to initiate a reform since the creation of Pakistan. The First Five Year Plan (1955-60) led to the initiation of reforms in the dairy sector to improve milk delivery to various stakeholders, including malnourished children. Around large urban centres, such as Karachi and Lahore, policies and initiatives encouraged dairy development for small and medium sized dairy owners. A pilot school milk programme was also launched with the delivery of bottled milk to government and private schools at various frequencies. However, this project could not last long, and it could not be replicated at a wider scale. One must, however, recognise the significance of this intervention given the fact that Pakistan has one of the highest livestock numbers in the region, all the inefficiencies and systemic problems notwithstanding.

Financing is the biggest obstacle in the way of Reforms needed to make nutrition a major objective rather than treating food security as a question of producing enough calories.

Pakistan’s approach to food security needs to move beyond simply ensuring an adequate supply of staple foods, such as wheat. While the country has sufficient overall dietary energy availability, the food system does not provide adequate access to the range of foods required for a healthy and diverse diet. Significant gaps remain in the availability of fruits, vegetables, pulses and legumes, making nutritious diets less accessible to many households, specifically to those in marginalised areas. Therefore, reforms should focus on transforming the entire food system from what farmers produce and how food is processed to how it is distributed and consumed. This would allow nutrition to become a central objective of agricultural and food policy rather than treating food security primarily as a question of producing enough calories.

A major reform should involve creating stronger incentives for the production of nutrient-dense foods. Agricultural policies have historically prioritised staple crops, but increasing the supply of fruits, vegetables, pulses, legumes and appropriate animal-source foods would improve dietary diversity. This does not necessarily mean abandoning staple-food production; rather, agricultural policies should balance food security with nutritional needs. Government incentives can encourage farmers to diversify production while maintaining price stability, making healthier foods more consistently available and affordable to households. Such a shift is particularly important because the problem in Pakistan is not simply a lack of food, but limited access to a sufficiently diverse range of nutritious foods.

Moreover, reducing food losses throughout the agricultural supply chain is another important strategy. An estimated 20-40pc of food is lost after production, meaning that a substantial amount of potentially nutritious food never reaches consumers. Improving storage, transportation, processing and distribution could, therefore, increase the effective supply of nutritious foods without requiring additional agricultural land or water. Reducing these losses would also make better use of the food that Pakistan already produces and could contribute to making nutritious foods more consistently available in the markets.

Nutrition reforms also need to be integrated into Pakistan’s healthcare system. Malnutrition cannot be addressed through agricultural policies alone because maternal and child nutrition is closely connected to access to healthcare and nutrition services. Programmes supported by the United Nations and its various agencies have focused on expanding high-impact interventions, including training healthcare workers in infant and young-child feeding and strengthening health facilities, so that they may provide the required nutrition services. Expanding these services would allow nutritional problems to be identified and addressed earlier, particularly among pregnant women, infants and young children who are most vulnerable to the long-term effects of malnutrition.

Improving the availability of nutritious food needs to be accompanied by greater public awareness about healthy diets. Mothers, caregivers and adolescents need accessible information about nutrition and the health consequences of unhealthy and ultra-processed foods. Nutrition education can also complement social protection programmes by helping families use available resources to make healthier dietary choices. Pakistan and its development partners have already used nutrition messaging at a large scale, reaching more than 2.9 million mothers and caregivers in 2024. Expanding these efforts could create greater public demand for healthier food and strengthen support for broader nutrition reforms.

Furthermore, reforming the food environment surrounding our children is also necessary. Children are increasingly exposed to packaged snacks, sugary drinks and fast food through food advertising that influences their dietary choices.

Stronger regulations could restrict the marketing and promotion of unhealthy foods in and around schools, including through digital environments. Clearer ingredient and nutrition labelling, restrictions on unhealthy-food advertising and penalties for violations could help protect children from commercial influences that encourage unhealthy diets. The United Nations Children’s Fund (Unicef) specifically recommends restricting the promotion and marketing of unhealthy foods within a 5km radius of schools.

For safeguarding the nutritional interest of children, Pakistan needs stronger coordination between institutions responsible for agriculture, health, food policy and social protection at the national level.

One of the major weaknesses identified in the current system is that food security is often treated primarily as an agricultural issue even though nutritional outcomes are shaped by healthcare access, household income, food prices, production, processing and consumer environments.

A more integrated governance structure would allow these different areas to be addressed together. Pakistan has already taken steps in this direction through initiatives like the National Nutrition Action Plan, Sindh’s Breast Milk Substitutes Act and Punjab’s Multisectoral Nutrition Strategy, but stronger coordination across sectors remains necessary for sustained reforms.

A rational strategy could be to focus on the upgradation and reform of existing initiatives. The Benazir Income Support Programme (BISP) has a component named Benazir Nashonuma Programme (BNP). It aims at improving maternal and child health for the first 1,000 days of pregnant and breastfeeding women and children under two years of age. The support comes in the shape of cash transfer.

It has a platform that is spread across the country and there is a possibility of its growth and expansion. To enable the BNP to graduate to the next level, an impartial performance assessment may be carried out by a reputable organisation.

The objectives of the BNP, its key performance indicators (KPIs) and progress achieved thus far should be examined. Based upon the results, the programme should be scaled up to reach almost every deserving mother and child in the country. There are several donor platforms that can be leveraged to contribute to the scaling up of this programme.

In addition, a mechanism may be devised to attract corporate social responsibility (CSR) support to augment the available resources. Large corporate and business houses, especially those linked with food and agro-related businesses, may be seriously encouraged to contribute to this national cause through monetary and resource-sharing arrangements.

One of the most important financing options is to reallocate existing agricultural support rather than relying entirely on new government spending. Pakistan’s food policies have traditionally prioritised staple crops, particularly those that provide calories and support food security.

A portion of existing commodity support and agricultural incentives could instead be directed towards the production of fruits, vegetables, pulses, legumes and other nutrient-dense foods. This would allow the government to use existing fiscal resources to support dietary diversity while gradually changing the incentives within the agriculture sector. The UN specifically identifies reviewing commodity support as part of a nutrition-focused fiscal policy.

Additionally, the government could also provide targeted subsidies for nutritious foods consumed by vulnerable households. The central problem is that having food available does not necessarily mean that families can afford a healthy diet. More than 60pc of people in Pakistan are estimated to be unable to afford a healthy diet, demonstrating the importance of affordability alongside food availability. Subsidies could, therefore, be targeted towards low-income households or specific nutrient-dense food groups rather than providing broad subsidies that benefit all consumers equally. This would directly reduce the financial barriers that prevent vulnerable families from purchasing diverse and nutritious foods.

Another financing option is the use of fiscal measures on unhealthy foods. Taxes on products associated with unhealthy diets could both discourage excessive consumption and generate government revenue that could be directed towards nutrition programmes. The UN identifies food taxation as an important component of a nutrition-first fiscal policy and recommends assessing the health impact of food taxes. Revenue generated through such measures could potentially support child nutrition services, public awareness programmes and nutrition-sensitive social protection. The purpose would, therefore, be twofold: changing the relative prices of healthy and unhealthy choices while creating additional fiscal space for nutrition interventions.

Government financing can also be channelled through targeted social protection programmes. The existing cash-transfer mechanisms can be expanded or redesigned to specifically support pregnant women, lactating mothers and vulnerable households with young children. Pakistan already has an example of this approach, where cash transfers for pregnant and lactating women are linked with antenatal check-ups, nutrition counselling and vaccinations.

Expanding these programmes would provide families with the financial resources that are needed to purchase nutritious food, and would simultaneously connect these families to all the essential health and nutrition services.

Dr Noman Ahmed is an academic and researcher based in Karachi; Arfah Ahmed is a social scientist with interest in human rights issues.

Frequently Asked Questions

What is AN ENORMOUS CHALLENGE?

PAKISTAN’S children are among the most malnourished in the South Asian region, behind Sri Lanka, Maldives, Bangladesh and Nepal. Multiple statistics from studies and official sources indicate that aro

Originally reported by Dawn News. Enhanced and optimized for search by TechVeb.