Media's Role Critical in Tackling Pakistan’s Undernutrition Crisis

As Pakistan plans to hold general elections in a few weeks, one critical development issue has received little attention: undernutrition. Almost half of Pakistan’s children are chronically malnourished, and 70% have deficiencies of essential vitamins and minerals. These hard-hitting facts were laid out in a seminar on “The Role of Media in Highlighting Nutrition” to mainstream nutrition in the national development discourse, organized by the Pakistan Nutrition Development Partners Group (which is chaired by the World Bank) in Islamabad and attended by media professionals.

The two speakers were Professor Dr. Zulfiqar Bhutta, Founding Director of the Center of Excellence in Women and Child Health at the Aga Khan University, who presented about the nutrition situation in Pakistan; and Mr. Adnan Rehmat, Executive Director of Intermedia Pakistan, speaking about how to get the media to highlight the issue.

Malnutrition is a source of poverty around the world, and it needs to be seen as an entry point into development, rather than simply an outcome of economic growth. There are 165 million stunted children globally, which puts them at significantly higher risk than other children of dying from simple diseases. In fact, 45% of child mortality in the world can be attributed to underlying undernutrition as a cause.  Malnutrition during pregnancy and in the first two years of life reduces brain development and learning ability, thus reducing learning ability and productivity during adult years.

Dr. Bhutta, who was the principal investigator of the 2011 National Nutrition Survey (pdf), laid out the magnitude of the undernutrition problem in Pakistan, along with the opportunities to improve it.

Based on nationally representative data, there has not been much improvement in the nutrition situation in Pakistan over the past two decades, with some indicators remaining near levels found almost 50 years ago. From maternal anemia rates, stunting, to children being underweight, Pakistan is trailing, even falling behind Sub-Saharan Africa. Beyond the impact on individual families and thousands of avoidable deaths, it is estimated undernutrition costs Pakistan 3% of GDP growth per year through losses in productivity.

There are vast regional differences in undernutrition in Pakistan, Dr. Bhutta illustrated, using maps created with district-level data. The provinces of Sindh and Balochistan, as well as the southern part of Punjab, lag behind the rest of the country in almost all childhood nutrition indicators.

These same regions also lag behind in maternal health indicators, showing the inter-generational relationship between nutrition, health, and poverty. The data shows that severely stunted children also have mothers who are significantly shorter than other women. Further, half of stunting in children in Pakistan happens by six months of age, underlying the need to make investments in nutrition early. While the poorest are the most adversely affected, even among the richest fifth of Pakistanis, there is 25-30% stunting, showing that undernutrition is a society-wide problem.

There are many known interventions, such as exclusive breastfeeding, which have been successful globally that could save hundreds of thousands of lives, Dr. Bhutta said. Good data exists which can be used to improve Pakistan’s situation. The role of the media is critically important in making this issue part of the public discourse and catalyzing political ownership in tackling undernutrition, which so far has been lacking, he said.

“Where you have an intervention the government implements and monitors, you see a result,” Dr. Bhutta said, talking about the highly successful government efforts to improve iodine deficiency through fortification of edible salt in the country over the past decade.

Citing the examples of Bangladesh and Brazil, Dr. Bhutta also stressed that civil society needs to be heavily involved in tackling the issue and creating political will. Resources spent to tackle this issue should not be seen as an expenditure, he said, but as an investment in the future of Pakistan.

Mr. Rehmat explained why nutrition gets uneven attention as a function of the dynamics of media evolution in Pakistan. The areas with the least media density are also the regions with the highest malnutrition rates.

Further, the structure of Pakistan media has become to sell consumers to their advertisers and to report events rather than investigate issues. There is no purposeful decision not to cover these stories by editors and owners, Mr. Rehmat said, but a lack of realization of their importance as a public interest issue and a lack of resources.

Despite there being 700 health reporters in Pakistan, there is little professional media training on health issues, thus few journalists are properly qualified to understand and contextualize often heavily technical reports and research.

Some reporters among the audience said that when they have tried to cover these issues, they face financial and time constraints in traveling to the most-affected regions, and editors often do not publish or air their stories.

The development sector needs to also have an institutional emphasis on engaging with the media on this topic, Mr. Rehmat said. They could provide information, access to experts, as well as media training. “The media is not an expert on issues. It can become an expert on reporting issues,” he said. Opportunity also exists in the country’s rapidly growing local language radio stations. While television reaches about 60 million Pakistanis, radio reaches 160 million.

The panel was joined by the caretaker Federal Minister for Education and Training, Science and Technology, and Information Technology Dr. Sania Nishtar, herself a longtime expert on public health in Pakistan. She provided concluding remarks, asking for the media’s support. The media, she said, are among the most powerful actors in the country to bring the type of societal transformation required to tackle undernutrition in Pakistan, and save lives.