Tue Nov 21

A year after Pakistan's floods, 44% of children have stunted growth. What can be done about it?

Written by Michael Toole, Associate Principal Research Fellow, Burnet Institute

The extensive flooding in Pakistan ^[1] in August 2022 submerged one-third of the country. This affected 33 million people, half of them children. Some 9.4 million acres of crops ^[2] were destroyed, and more than 1.1 million farm animals perished.

One year later, the rate of child undernutrition ^[3] has increased by 50% and an estimated 44% of children ^[4] under five are now stunted, meaning they have a low height for their age.

A recent assessment ^[5] of 43 rural districts in the three provinces most affected by floods found 29% of the population was experiencing high levels of hunger and weren’t consuming enough energy.

Food prices remain high in both urban and rural areas of Pakistan and achieving food security will remain a challenge for many families. So what’s being done to address this crisis?

What is undernutrition?

There are three types ^[7] of child undernutrition: wasting, which reflects recent weight loss and greatly increases the risk of early death; stunting, which reflects long-term food deprivation; and underweight, which is a combination of the two. The type most common in Pakistan is stunting.

Stunting ^[8] is irreversible – you cannot regain lost height. It leads to more illness, premature death, poor school outcomes, lower employment opportunities and may increase the risk of chronic diseases.

A girl who is stunted is also more likely to give birth to a low birth weight baby ^[9] when she grows into an adult.

How big is the problem, worldwide?

In 2022, 9.2% of the world’s population ^[10] experienced what is called undernourishment, or low energy intake, compared to 7.9% in 2019.

Almost 600 million people are projected ^[11] to be chronically undernourished in 2030.

Worldwide, food insecurity is more likely to affect women and people living in rural areas. Food insecurity affected 33.3% of adults living in rural areas in 2022 compared with 26% in urban areas.

Food insecurity disproportionately affects people in rural areas. zeljkosantrac/Getty Images ^[12]

Globally in 2022, an estimated 148.1 million children under five years of age (22.3%) were stunted and 45 million (6.8%) were wasted.

The stunting rate has declined ^[13] from 33% in 2000 but the pace of decline has slowed.

Only about one-third of all countries are on track to halve the number of children affected by stunting by 2030, a goal of the Sustainable Development Goals ^[14].

Who is most at risk?

A large population study in India ^[15] looked at the contribution of 15 known risk factors. The five leading factors were: the mother’s short stature, the mother having no education, the household being in the lowest wealth quintile, poor dietary diversity, and the mother being underweight. These five were causal factors in two-thirds of stunted children.

Other studies have found the critical age of vulnerability ^[16] to stunting is six to 24 months and is associated with poor breastfeeding practices, nutritionally poor food (given in addition to breast milk after the age of six months) and repeated infections, which may be due to poor water quality and sanitation.

What’s being done to address undernutrition?

The main global initiative to address child undernutrition is the Scaling Up Nutrition ^[17] movement, which was launched in 2010 and has 66 member countries, including Australia.

The Scaling Up Nutrition movement strategy and roadmap is the product of a collaborative dialogue between member countries, the UN and donor agencies and other international and national non-governmental organisations and businesses. It promotes a focus on the first 1,000 days of a child’s life when they are most likely to develop stunting.

It also encourages a dual approach of nutrition-specific interventions (which address the immediate causes of undernutrition) and nutrition-sensitive interventions, such as agriculture, water and sanitation, and gender equality.

Australia was initially an enthusiastic supporter ^[19] of Scaling Up Nutrition and during the previous decade (2010-2019) made nutrition a priority in its international aid program. The Australian government’s 2014 development policy identified ^[20] early childhood nutrition as “a critical driver of better development outcomes”.

Nutrition in the first 1,000 days can affect children’s growth as they get older. SM Rajfiq Photography/Getty Images ^[21]

A nutrition strategy ^[22] was developed in 2015 and a broad-ranging evaluation ^[23] of the aid program’s impact on nutrition was commissioned by the now-defunct Office of Development Effectiveness.

However, that enthusiasm has disappeared since 2020.

How can Australia help?

So far in 2023, record floods ^[24] have been recorded in Libya, Somalia, Kenya, India, Italy, Rwanda and South Sudan. Deadly storms have raged in western Europe. We’ve seen cyclones in Myanmar and southern Africa, devastating landslides in Cameroon and a powerful hurricane in Mexico. Wildfires ^[25] have spread in Greece, Argentina, Canada and Hawaii, and Asia has experienced a stifling heatwave.

Computer modelling of real data ^[26] shows the frequency and intensity of these events are influenced by climate change.

The most obvious long-term strategy is to accelerate efforts to control carbon emissions and decelerate the momentum towards global warming.

In the short-term, the government must reinstate nutrition as a priority in the Australian aid program.