alnutrition, particularly undernutrition, characterised by low weight, stunting and wasting, is a major contributor to child mortality in low- and middle-income countries. Pakistan faces a severe malnutrition crisis, with 40 percent of children under the age of five suffering from stunting, 17.7 percent experiencing wasting and 28.9 percent being underweight. This situation has far-reaching implications as malnutrition has been identified as a causal or contributing factor in 39.5 percent of under-five deaths, often in combination with infectious diseases. Beyond childhood survival, malnutrition in infancy has long-term consequences, reducing child life expectancy and labour productivity in adulthood. Pakistan’s infant mortality rate stands at 52 deaths per 1,000 live births, while the under-five child mortality rate is 67 deaths per 1,000 live births. The economic burden of malnutrition is also substantial, costing the country an estimated 3 percent ($7.6 billion) of its GDP annually due to lost productivity and increased healthcare expenses.

Malnutrition is a complex phenomenon as it is both a cause and a consequence of broader socio-economic and health challenges, creating a self-perpetuating cycle. As a cause, malnutrition directly affects physical and cognitive development, leading to weakened immune systems, impaired learning abilities and reduced economic potential. This contributes to poorer academic performance, decreased workforce productivity and increased healthcare costs. Furthermore, undernourished mothers are more likely to give birth to low-birth-weight infants, perpetuating malnutrition across generations. Conversely, malnutrition is a consequence of systemic social and economic disparities, particularly in low-income households. Factors such as food insecurity, poverty, gender inequality, inadequate healthcare and political instability exacerbate undernutrition. Gender inequality, in particular, is a significant barrier to maternal and child nutrition, as women and girls in many communities have limited access to food, education and healthcare. These disparities are further aggravated by patriarchal norms that restrict women’s decision-making power, leading to poor maternal and child health outcomes.

Empowering women is essential in tackling malnutrition because mothers play a central role in the health and nutrition of their children. This is particularly crucial during the first 1,000 days of life, from conception to a child’s second birthday, a critical period for growth and cognitive development. Malnutrition during this window can lead to irreversible damage, including stunted growth, impaired cognitive function and increased vulnerability to infections.

Women in Pakistan face significant barriers in accessing education, healthcare and economic opportunities. The country ranks 145 out of 146 in the Global Gender Gap Index (2024), with only 36 percent of women participating in economic activities and just 23 percent part of the workforce, highlighting the extent of gender inequality. A recent report indicates that among Pakistan’s out-of-school children aged 5 to 16, nearly 53 percent are girls. The lack of education not only limits their personal growth but also increases the likelihood of early marriage and unplanned pregnancies. The prevalence of teenage pregnancy in Pakistan is 42.5 percent, with one in eight adolescent girls being underweight and more than half (56.6 percent) suffering from anaemia. Research consistently shows that child mortality rates are significantly lower among children of educated mothers compared to those with no formal education. Education enhances a mother’s knowledge of nutrition, hygiene and healthcare-seeking behaviours, directly improving child health outcomes. Furthermore, children born to teenage mothers, who are often physically and emotionally unprepared for motherhood, are at a higher risk of low birth weight, stunting and malnutrition. Further, a study in 36 LMICs by Smith et al estimated that if women and men had equal household decision-making power, the prevalence of underweight children under three years would decrease by 13 percent in South Asia and 3 percent in Sub-Saharan Africa. This underscores the strong correlation between women’s empowerment and child nutrition.

Addressing child malnutrition in Pakistan, therefore, requires a holistic approach that not only improves healthcare and nutrition services but also prioritises women empowerment. Pakistan must integrate policies that support mothers at different stages of the first 1,000-day cycle, including pre-pregnancy, pregnancy and post-natal phases. These steps include:

Prioritising and ensuring universal access to quality education for girls as this can significantly reduce early marriage, teenage pregnancies and maternal malnutrition.

Investing in maternal healthcare infrastructure, including prenatal care, skilled birth attendance and post-natal support.

Expanding microfinance initiatives, vocational training and job opportunities which enable women to make autonomous decisions about their family’s well-being.

Strengthening social safety nets and food fortification programmes to ensure that vulnerable mothers and children receive adequate nutrition.

Enforcing maternity leave policies, workplace breastfeeding support and childcare facilities to help working mothers.

Raising awareness about nutrition, family planning and gender equality to create awareness regarding harmful cultural norms and promoting healthy dietary practices.

Quaid-i-Azam Muhammad Ali Jinnah had said: “No nation can ever be worthy of its existence that cannot take with them their women.” This statement underscores the urgent need to break the cycle of malnutrition by empowering women with education, healthcare and economic opportunities. Tackling child malnutrition is not just a health issue, it is a socio-economic imperative as well. By investing in women’s empowerment, Pakistan can build a healthier, more productive future, ensuring that no child suffers from preventable malnutrition. Prioritising our daughters, sisters and mothers is not just a moral obligation but also a critical strategy for national development and economic prosperity.

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

Dr Rozina Nuruddin is an associate professor in the Department of Community Health Science at Aga Khan University.