By Zubeida Mustafa
ON May 28, an email was circulating on the web from Dr Shershah Syed, whose services to women’s reproductive health are widely acclaimed.
Doctor Sahib wrote, “Today we are celebrating the atom bomb day when we are a country where millions of children are not going to school — where millions of kids start their morning without food and will work in factories.…”
How true. While chasing the bomb, we have destroyed our people. What Dr Shershah can add is that this is also a country where one cannot escape the heart-wrenching sight of little rag-pickers rummaging through the garbage for food leftovers to ease their hunger pangs. Their emaciated bodies taunt our bomb-makers with misplaced priorities. Defence spending is expected to increase in the budget to be presented later this month. At this rate, though, there will be no one left to protect. The data given out by the health authorities of the prevalence of malnutrition and stunting in Pakistan are not exaggerated.
It is said that nearly half of our child population is not sufficiently nourished. According to the Pakistan government’s National Nutrition Survey 2011, 60 pc of families in the rural areas (72pc in Sindh) and 52pc in the urban areas, suffer from moderate or severe hunger. They are the families that are described as food insecure.
The fact is that food insecurity is not caused by shortage of food. Dr Amartya Sen, the Nobel Prize winning economist, had said that a long time ago when he had researched the 1943 famine in India. Pakistan grows more wheat today than ever before. Yet many don’t have access to food as it is priced in such a way that it goes beyond the purchasing power of the poor. If food price inflation is higher than that of other items it becomes a matter of life and death for the low-income classes. Thus in Pakistan, the price of the ‘food basket’ escalated by 81.19pc in 2007-2011 when general inflation was 61pc in the same period. (Data from Pakistan Economic Survey 2011-2012.) Today, on an average, a low-income Pakistani family spends nearly half its income on food and yet cannot procure enough to feed the children properly.
This is an acute human problem with grave implications for every sector of national life — health, education and productivity. It is no coincidence that the food insecure and malnourished households are also illiterate, in poor health and have weak income-generating power. The cost to sustain them even at this appalling level amounts to 3pc of the GDP. These triple problems — malnourishment/bad health and low productivity — are symbiotic, with one reinforcing the other and making it impossible for these families to break out of the poverty they are trapped in.
More has to be spent on their healthcare than would have been needed had people been better nourished as malnourishment makes them more vulnerable to diseases of all kinds. Ill health means the lack of vitality and resistance to illnesses that results in higher working days lost due to the disease burden (the disability-adjusted lost year, or Daly) as the measure to assess the state of health of people in Pakistan and its impact on the economy. Not surprisingly, the years lost are high in number.
The problem of malnutrition affects education profoundly and as a result the future of Pakistan. It has also been established conclusively now that the thousand days between the start of a woman’s pregnancy and her child’s second birthday offer a unique window of opportunity to shape healthier and more prosperous futures. How? If the mother herself is well nourished during her pregnancy she will give birth to a healthy baby who will stand a better chance in life. Babies fed balanced and healthy diets for the first two years of their life have a better mental development and their capacity to think and learn is enhanced.
It has now been discovered that this thousand-day window of opportunity is time-bound. If infants receive the necessary nutrients — especially proteins and iron — at the right time their mental growth will be healthy. The neurons in the brain, which are going through a crucial phase of growth and networking, will grow optimally if the requisite nourishment is provided. On the contrary, children denied adequate nourishment will be slow learners and their cognitive development will be retarded. What is worrying is that this deficit cannot be recompensed at a later stage; irreversible damage has already been done.
This explains why teachers today are constantly complaining about the large number of children who suffer from attention deficit disorder or are slow learners. Even mothers who have enough resources to feed their child but neglect to address their nutritional needs could also unwittingly cause malnutrition and the resultant deficiencies. They need to be educated about the basics of child-rearing.
Of greater concern are the impoverished who cannot afford to feed their children adequately. It is the duty of the state to focus on its human resources while it is shaping its economic policy. If wheat has to be subsidised it must be done to bring down its price. In the year 2000 wheat flour cost Rs8 per kg. Today it is over Rs26. There is need for nutrition-related multiple interventions if our mothers and children are to be saved.