This year, a Unicef report on child mortality revealed Pakistan to have the worst new-born mortality rate. The babies who do survive, face an even greater risk of stunted growth and other health complications due to malnutrition.

Associated with increased risk of morbidity and infections, malnutrition leads to impaired growth and developmental outcomes.

"Stunting means the inability of a child to grow at an appropriate rate and it is usually measured in terms of height," explains Dr. Haleema Saeed, Paediatric Hematologist/Oncologist. "If a child is less than two standard deviations below the average that is expected of their particular age in terms of height, we say the child is stunted."

But it is not just the physical growth of a child which may get affected by this condition. There is a spectrum of issues children with stunted growth face. "It also affects cognition, language skills, resulting in illnesses later in life. Stunting has far reaching consequences," says Dr. Haleema.

While a balanced diet and hygienic surroundings play an important role in the healthy growth of a child, much stress is laid on the overall well being of an expectant mother, since stunting in many cases occurs due to poor foetal development.

Nutrition for women in pre-pregnancy, pregnancy, and over the first two years of the child’s life is of utmost importance for the survival, health and development of mothers and their children. In pregnancy, requirements of energy, protein, and essential micronutrients (vitamins and minerals) are increased not only to maintain the mother’s own health, but to also support optimal physical and brain development in the foetus.

Furthermore, nutrition reserves are built over pregnancy to produce breast-milk for the post-child birth phase. While deficiencies of protein, iron, calcium, iodine, vitamin A and folic acid during pregnancy predispose mothers to maternal complications and even mortality, these also contribute to foetal birth defects, low birth weight, restricted physical and mental potential, and foetal or newborn mortality.

Studies indicate that 51 per cent of Pakistani women of reproductive age are anaemic. A recent health survey acknowledges deficiencies of iron and vitamin A among pregnant and lactating women as a common public health challenge. Despite this, only 22 per cent of women are found to be taking the full 90 day course of iron supplements in pregnancy whilst around 55 per cent took none.

Although the proportion of pregnant women receiving antenatal care from a skilled health provider has increased from 26 per cent in 1990 to 73 per cent in 2013, 3 in 5 pregnant women in Pakistan still do not receive 4 or more antenatal care visits as recommended by the World Health Organisation. These visits are extremely important to prevent and detect health complications, and to reduce the risk of adverse pregnancy outcomes for both the mother and child.

"Sometimes congenital anomalies are detected during visits to gynaecologists," informs Professor Shahida Sheikh, a senior gynaecologist based in Lahore. "In case of the mother suffering from high blood pressure, the growth of the baby is directly affected. Whenever slow growth rate of foetus is detected, its reasons are investigated, often asymmetrical growth is a cause."

While poverty and lack of awareness are major reasons for non access and provision of care to expectant women in Pakistan, societal pressures also play a crucial role. A United Nations report published in February this year showed that over 48 percent of Pakistani women have no say in their health. They also eat less nutritious foods than other members of the family as they give them priority over their own needs. As a result, among women in Pakistan, 14 per cent in the reproductive age-bracket are thin or wasted (with a body mass index less than 18.5 kg/m2).

But then lack of healthy nutrition in women is only one factor resulting in stunted growth of their offspring. "Drug abuse is not uncommon in Pakistan," says Professor Shahida. "In the rural areas, women traditionally consume tobacco in the form of beedis (localised versions of cigarettes) or hookahs (an instrument for vaporising tobacco), while use of cigarettes, cocaine and alcohol prevails among some pregnant women in the cities. This has dire consequences on the growth of the unborn child."

The importance of the well being of a woman for her child persists even after the birth of the baby. Not breast feeding a child has also been noted as yet another reason for stunted growth. In this case too, Pakistan has a worrying situation. In a 2016 report, Unicef stated that Pakistan has the worst breastfeeding indicators in South Asia, and Punjab has the worst breastfeeding indicators within the country. "If children are not appropriately breast fed for the first six months of their lives they may end getting stunted," says Dr. Haleema. "With inappropriate weaning, that means at six months of age if a child does not get appropriate nutrition apart from milk then also stunting may occur."

In the same report, Unicef details a nutrition programme launched by Punjab government’s department of health, which the international organisation supports. This includes "screening children and pregnant and breastfeeding mothers to check their nutritional status, providing micronutrient supplements, conducting awareness sessions on health, hygiene and nutrition, counselling mothers about breastfeeding practices and treating acute malnutrition."

This year, five research studies on different themes of nutrition have been launched in the country with the help of the Australian High Commission, findings of which will be helpful in planning and implementation of nutrition interventions at national and provincial level.

Read also: The governments’ doing

The Punjab Minister for Primary and Secondary Healthcare, Khawaja Imran Nazir, while addressing a seminar in Lahore this month, said the provincial government is committed towards drastically lowering the malnutrition indicators in the province. While inaugurating the session, Muhammad Jehanzeb Khan, Chairman Planning and Development Board, Government of Punjab stressed it was imperative for Pakistan to ensure that there was improvement in mother and child nutrition. "We must lead the call against malnutrition and hunger, for it is not only about establishing food security, but about enhancing future economic growth and sustainable development of the province and ultimately our country," said Khan.