recently published Save the Children report says Pakistan has the second highest number of babies born into hunger globally.

What does that mean for a child born in Pakistan?

Pakistan is a country where one out of 26 newborns die within the first 28 days of life; nearly one in 20 infants die in their first year of life; and one in 16 children do not survive past the age of 5. We are also a country where 4 out of 10 children under five years of age are stunted, meaning chronic malnourishment with low height for age; 17.7 per cent suffer from wasting, which is acute malnourishment with low weight for height. This double burden of malnutrition is increasingly apparent, with almost one in three children underweight.

While the menace of malnutrition remains equally distributed among genders, children living in rural areas are more likely to suffer from all forms of undernutrition than their peers in urban areas. Pakistan is the fifth most climate-vulnerable country in the world. It has a high exposure to flooding - riverine, flash, urban – as well as droughts. Acute food insecurity is projected at 20-25 per cent. It also faces significant disaster risk, (ranking 23rd out of 194 countries according to the 2024 Inform Risk Index due to its exposure to earthquakes and internal conflict). Pakistan has a social vulnerability ranking of 37 out of 191 because of high rates of multidimensional poverty.

Let us deconstruct our question in this context.

In politics and social sciences, hunger is a condition in which a person does not have the physical or financial capability to eat sufficient food to meet basic nutritional needs for a sustained period. This is different from the physiological definition of hunger, which is a physical sensation that motivates the consumption of food.

When a Pakistani child is born in hunger it means that they are born into circumstances where there is a lack of adequate food and nutrition. This can severely impact their health and development. It means that the child may face malnutrition from birth, leading to serious consequences like stunted growth, weak immune system and cognitive development issues. These consequences are apparent throughout the entire life course of the child.

The intrinsic effects start before the child is born. When maternal health is compromised, the fetus is exposed to an adverse and harsh environment. They may not receive adequate essential nutrients and oxygen. This leads to poor fetal growth and development. As a result the child is born smaller than the usual size.

Such babies are frequently born pre-term, i.e., delivered before 37 weeks of pregnancy, and underweight. They may face several challenges, including difficulty breathing, maintaining body temperature, feeding issues and a higher risk of infections. Long-term, they may be at risk for developmental delays, learning disabilities and chronic health issues. As early initiation of breastfeeding with colostrum is not widely practiced, these vulnerable babies lose another opportunity to gain strength.

The neonatal period is another icy ground. A malnourished mother with scarce means and often a large family to feed struggles with breastmilk production and sustainability of exclusive breastfeeding. She typically settles for bottle feeding, mixed feeding and dilution of formula/ animal milk to meet the demand within limited resources. All these factors cause diarrhoea, infections and poor nutrition supply to an already compromised child.

Introducing age-appropriate complementary foods is crucial alongside breastfeeding once a child reaches six months of age. However, only one out of three children receives complementary foods between 6–8 months old and 2 years. Furthermore, just one in seven children aged 6–23 months enjoys meals with minimum dietary diversity, which includes at least four different food groups. Additionally, only one in five children gets the minimum number of meals a day. Complementary foods that meet the criteria for a minimum acceptable diet for optimal growth and development are provided to fewer than one in 20 children (3.6 per cent) aged 6–23 months.

Let’s pause and connect the dots to answer the question: What does the journey of this fragile new life, born in hunger, mean?

The potential of countless children is stunted not by lack of will, but by the circumstances. A baby born in hunger is a poignant reminder that in a world abundant with resources, the disparity in their distribution leads to preventable suffering.

Such is the fate of 1.4 million Pakistani children every year.

The findings of this report call for deep reflection on the collective responsibility. We need to act with empathy and urgency, to move beyond “policy prescriptions” and address the operationalisation issues. It is all about the need for comprehensive support systems, from accessible healthcare and nutritional programmes to educational initiatives that empower mothers, parents and local communities. In a setting where community bonds are strong and hope is often a guiding light, addressing hunger and malnutrition is not just a matter of survival; it’s also about nurturing the dreams and future of the youngest and most vulnerable.

Martin Luther King Jr once said: “When I die, don’t build a monument to me. Don’t bestow me degrees from great universities. Just clothe the naked. Say that I tried to house people experiencing homelessness. Let people say that I tried to feed the hungry.”

Dr Rehma Iqbal Gilani is a PhD scholar in population and public health stream at Aga Khan University.

Dr Rozina Nuruddin is an associate professor at Aga Khan University