The Punjab Multiple Indicator Cluster Survey (MICS) 2014 released recently shows every third child (33.5 per cent) suffers from chronic malnutrition (stunting), says a Punjab Nutrition Progress (2013-2016) Report on children by Unicef.

"4.5 million Punjab’s children are stunted. 66 per cent of Punjab households cannot afford a nutritious diet," the report says.

"There are significant disparities in nutrition between children from rural and urban backgrounds. Also children of educated mothers are less stunted," the report says.

Physical and mental growth of an individual is affected most by the nutrition he/she gets from the moment of conception until five years of age. "In Pakistan, half of the children are not growing fully when healthy life is every child’s right. Malnutrition stunts the body and mind and is irreversible. It is caused by the lack of right minerals and vitamins," says Angela Kearney, Unicef representative in Pakistan, while addressing Punjab Media Workshop on Stunting on January 26.

Stunting can be prevented by improved breastfeeding practices, by washing hands with soap and by giving fortified food. Exclusive breastfeeding in the first two years of life that is first 1000 days can prevent stunting. The damage done to a child’s body and brain by stunting is irreversible. Women need to take fortified food, iron and folic acid during pregnancy. "What is hampering this country’s development is stunting. A stunted child is more likely to have hypertension, diabetes and runs a higher risk of obesity later," says Kearny.

The Unicef report says, "Stunting causes between 22 and 45 per cent reduction in lifetime earnings."

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"Stunting translates into stunted immune systems, stunted brain development, stunted overall life chances and adds up to stunted economic development. It contributes to 45 per cent of preventable deaths. It is responsible for annual GDP losses of 11 per cent in Asia and Africa," says Dr Shehla Zaidi, Director of Health Policy and Management Programme of the Agha Khan University. She has done research on stunting; its reasons, on how to save the population from further damage and the situation in Pakistan. Below are her findings:

"Between zero to five months 17 per cent babies face stunting. From six months to two years is a critical period for them -- it is during this period that humans face maximum stunting. Exclusive breastfeeding in the first two years can prevent stunting but only 37 per cent women in Pakistan do that. Brain development takes place in the first five years of life. Stunting has a cyclical impact on generations. We must worry about stunting because under-performing generations reduce overall life chances."

There is a critical time window for action. It starts before conception. If the mother is weak, has deficiency -- that will pass on to the child. A wide range of women (age 15-49 years) suffers from anemia. Pakistan has the highest rate of anemia in South Asia -- 52 per cent. In Punjab, forty per cent of mothers suffer from Vitamin D deficiency while as many suffer from iron deficiency.

The ratio of stunting is also the highest in Pakistan among South Asian countries. 9.6 million children suffer from stunting. We have made no progress in the last 40 years. In Punjab, nearly one in three children is stunted. The northern districts are performing better as compared to South Punjab where stunting is severe.

Mostly low cost, preventable interventions like iron, iodised salt and folic acid is what women should have during pregnancy. Breastfeeding baby for the first two years has huge advantages. Zinc in breast milk increases immunity. Birth spacing, washing hands with soap, taking Vitamin A supplement and deworming are some good practices that keep us safe. Height and weight of children should be taken routinely uptil five years of age as they are indicators of growth.

To check stunting, we require support from different sectors. Provision of safe drinking water is of utmost importance as germs get into the human body most easily through water.

Sanitation is another important amenity that only 64 per cent Pakistanis have access to which means only as many have access to toilet. Diarrhea is most prevalent among children. The reason is lack of hygiene and sanitation. Children are actually dying from diarrhea. Each time a child falls ill he/she loses weight and it affects the health pattern.

It is also important to promote nutrition sensitive agriculture -- production of nutrient dense and diversified food locally.

The required number of meals is there but they are not diverse. There are seven food groups. Children need at least 4 out of 7 food groups. Though Punjab is considered the food basket from where food is supplied to other provinces of the country, only 17 per cent children get right, diverse diet here.

The Punjab government has approved a child nutrition and stunting reduction programme recently which will be launched in 11 districts in the first phase.

Unicef Pakistan targets to reduce stunting from 44 per cent to 34 per cent, saving 1.9 million children from stunting. Another target is to reduce stunting amongst children under five to below 20 per cent by 2020.

Dr Shabana Haider, Member Health, Planning and Development Department, government of Punjab, says there is 2-10 per cent loss in GDP due to stunting though Pakistan has the 3^rd highest rate of breastfeeding in the world.

She says, "We need to change how people eat -- clear away the confusion around nutrition. We are trying to develop information that is truly helpful -- usable." In this regard, she says, "Fish is a very good source of protein. It can be taken with milk and curd but there is a general misconception that milk and fish cannot be taken at the same time." She asks media to educate people. Unicef is looking into what is a reasonably good diet.