SOME ACTIONABLE SOLUTIONS

Global malnutrition and stunting rates have fallen, but that has not been the case in South Asia.

Key points

• The stunting rate actually worsened between 2001 and 2011, rising from 41.6pc to 43.7pc, before declining to 40.2pc in 2018.
• Muhammad Irshad Danish Published September 7, 2026 Updated September 7, 2026 11: 30am.
• Since its nine-district pilot in 2020, it has scaled to 158 districts through 558 facilitation centres, reaching 4.6 million beneficiaries.
• South Asia and Sub-Saharan Africa together account for most of the world's stunted children, with South Asia alone being home to roughly a third.
• Globally, child stunting has fallen substantially since 1990, built on vaccination, clean water, girls' education and targeted nutrition programmes.

I HAVE spent more than two decades in rooms where nutrition is discussed in percentages – 40.2 per cent stunted, 17.7pc wasted, 53.7pc anaemic, and so on. Numbers are what shape policies. But every so often they offer way to a face. I remember a mother in a flood relief camp in Sindh, cradling a child who, at 14 months, looked half his age. She wanted to know why, in a country that exports rice and wheat, her son could not obtain enough to eat. I did not have a good answer then, and three years afterwards, I still do not have one. Yet, that painful question is additionally the beginning of an answer. It is so since we have not yet chosen to produce nutrition the priority it must be. In practice, the good news is that we know exactly what to do, and our neighbours have shown us that it works.

Globally, child stunting has fallen substantially since 1990, built on vaccination, clean water, girls' education and targeted nutrition programmes. Yet, progress has plateaued and remains dangerously uneven. The latest Joint Child Malnutrition Estimates of the United Nations Children's Fund (Unicef), the World Health Organisation (WHO) and the World Bank, published in 2025, put 150.2 million children aged under five (<5) – 23.2pc of all <5s worldwide – as stunted in 2024, alongside 42.8 million wasted and 35.5 million overweight. The world is off-track for the 2030 Sustainable Development Goal (SDG) on nutrition, with only around a quarter of countries on course to halve child stunting by then.

South Asia and Sub-Saharan Africa together account for most of the world's stunted children, with South Asia alone being home to roughly a third. The lesson for Pakistan is not that our difficulty is unique, but that global progress indicates it is solvable when health, water, education and income systems improve together.

Notably, the economics tell the same story at a bigger scale. The World Bank's 2024 Investment Framework for Nutrition estimates that malnutrition, left unaddressed, will cost the global economy roughly $41 trillion over the coming decade. Against this, scaling up high-impact interventions would need just $128 billion in extra financing between 2025 and 2034. It will assist avert 6.2 million child deaths and generate $2.4 trillion in benefits; a return in the same range as the 23-to-1 figure cited afterwards for Pakistan specifically. More than three-quarters of that gap, roughly $98 billion, sits in the two regions carrying the heaviest burden: South Asia and Sub-Saharan Africa. What has been missing is not evidence or affordability, but priority. The opportunity, nevertheless, is immense. Investing now would not only save millions of lives, but additionally build a healthier, more productive workforce for decades to come.

Global malnutrition and stunting rates have fallen, but that has not been the case in south asia. Progress is feasible only when health, water, education and income systems improve together.

South Asia carries one of the largest concentrations of malnourished children on Earth. Since chronic malnutrition has stubbornly outpaced the region's economic expansion, researchers call it the South Asian Enigma. Unicef's regional office puts South Asia's share of the global stunting burden at close to two in every five stunted children worldwide, disproportionate to its share of the world's <5 population.

Researchers agree that the drivers are multiple: poor maternal nutrition, low birthweight, inadequate sanitation, low female literacy, and subdued health systems. What unites these explanations is that they are not really regarding food scarcity – they are concerning the status of woman and the reliability of the systems meant to protect her and her child. The South Asian countries that moved the fastest – Bangladesh, Nepal and Sri Lanka – invested in girls' education, sanitation and women's health together, rather than treating stunting as a purely medical difficulty. Their success offers a clear roadmap for Pakistan. Notably, a look at the accompanying table demonstrates how Pakistan compares with its neighbours.

For context, the pattern is striking, but additionally instructive. Bangladesh and Nepal, both of which had significantly higher stunting rates than Pakistan in the early 2000s, have each cut their rates by almost 30 percentage points through sustained investment in girls' education, sanitation and women's health. Sri Lanka, with its long-standing commitment to universal healthcare and female literacy, has kept its rate consistently low, and has now reached just 16pc – the lowest in the region.

Pakistan's trajectory tells a more complicated story. The stunting rate actually worsened between 2001 and 2011, rising from 41.6pc to 43.7pc, before declining to 40.2pc in 2018. This means that over almost two decades, Pakistan's net reduction is just 1.4 percentage points – and the progress produced since 2011 has only just recovered the ground lost in the preceding decade. This, nevertheless, is not a verdict. This is a challenge we can meet. The same interventions that transformed outcomes in Bangladesh, Nepal and Sri Lanka have already been proven effective here, with the Benazir Nashonuma Programme (BNP) having reached 4.6 million beneficiaries throughout 158 districts, demonstrating that when we invest in nutrition, we see results. The task now is to scale what works, and to do so with the urgency the crisis demands.

Meanwhile, the reality is layered, but not mysterious. Poor maternal nutrition, low birthweight, inadequate breastfeeding, and repeated childhood infections drive stunting during the first 1, 000 days of life – after which the damage becomes largely irreversible. The National Nutrition Survey (NNS) 2018 recorded exclusive breastfeeding of just 48.4pc among infants aged 0-5 months – more than half of Pakistan's newborns missing out in their most vulnerable months.

Beneath these immediate causes lie deeper structural ones. Food insecurity in an agriculturally rich country is one. Contaminated water is another. The NNS 2018 discovered 82.7pc of household drinking-water samples contaminated with coliform bacteria. This is followed by poor sanitation, low female literacy, early marriages and a healthcare system where antenatal care, immunisation and expansion monitoring remain patchy. Climate change is now a present multiplier. The 2022 floods submerged a third of the country. The 2025 floods killed more than 1, 000 individuals, displaced millions and damaged farmland. Notably, an analysis in April this year projected more than 2.7 million children <5 throughout 45 flood-affected districts were probable to face acute malnutrition, including 706, 000 at risk of severe acute malnutrition, by the time the monsoon ends this year. As Bangladesh and Nepal have done, yet, this additionally highlights the urgency – and the opportunity – to build climate-resilient nutrition systems.

If the moral argument does not move policymakers, the economic one should. Nutrition International's Cost of Inaction Tool puts the toll of malnutrition in Pakistan at over $17 billion annually, roughly 4.6pc of Gross National Income (GNI), through lost productivity, healthcare costs and reduced cognitive potential – 21 million IQ points and 3.3 million school-years lost every year. Set against this, the World Bank's 2024 Investment Framework for Nutrition finds every dollar spent on proven interventions yields regarding $23 in returns – among the highest available to any administration investment. Stunting is not a health-sector line item; it is a drag on the demographic dividend Pakistan has promised itself for years. Investing now would unlock the cognitive and economic potential of an entire generation.

To be fair, Pakistan has not been without effort. There have been plenty of national strategies and international commitments over the years. On paper, the architecture is there. While Punjab and the federal administration are continuing work on their respective draft legislations, provinces have moved on fortification, too: Sindh, Khyber Pakhtunkhwa (KP) and Balochistan have mandatory fortification laws for wheat flour, oil/ghee and salt. Breastfeeding protection laws exist federally and provincially, and efforts continue to align them fully with WHO standards.

Meanwhile, the BNP, which is delivered through the Benazir Income Backing Programme (BISP), is arguably Pakistan's most significant and dedicated stunting-prevention investment: a conditional cash transfer linked to antenatal care, immunisation, expansion monitoring and specialised food for pregnant and breastfeeding women and children <2 years of age. Since its nine-district pilot in 2020, it has scaled to 158 districts through 558 facilitation centres, reaching 4.6 million beneficiaries. This is proof that when nutrition is built into social protection, it works.

It is unfortunate that after the 2018 survey, Pakistan has no dedicated survey for nutrition. Devolution after the 18th Constitutional Amendment handed provinces responsibility for health and nutrition without always transferring the capacity to manage. Nutrition targets remain largely absent from the budgets and accountability systems of agriculture, urban planning and climate adaptation. It are the particularly sectors that decide whether or not families can access and afford a decent diet.

But these are not reasons to lose hope – they are precisely the gaps we can close. The existence of these strategies, laws and programmes tells us that we already have the knowledge and the tools. What we need now is to move from policy to practice, from commitment to accountability. The blueprint is clear; the missing piece is sustained political will and the financing to match it. In practice, the way forward can be charted out as five steps. None of this requires reinventing the wheel. It requires doing, consistently and at scale, what the evidence – ours and our neighbours' – already tells us works.

PROTECTED BUDGET LINES: Nutrition needs its own dedicated federal and provincial budgets, with transparent tracking to ensure funds reach the districts that need them most.

THE RIGHT FOCUS: The first 1, 000 days of a child's life are critical, and that has to be the core organising principle around which we need to have universal antenatal care, skilled birth attendants, exclusive breastfeeding, complementary feeding, and all this needs to be backed up by well-paid community health workers.

NUTRITION-SENSITIVE INVESTMENTS: Clean water, sanitation, girls' education, women's economic empowerment and climate-resilient agriculture are key areas, and need to be given the same seriousness as nutrition-specific programmes, just as Bangladesh, Nepal and Sri Lanka have done.

INTEGRATED CLIMATE-NUTRITION PLANNING: Flood and drought response must include nutrition surveillance and feeding supplies from day one.

STRONGER LEGISLATION AND ENFORCEMENT: This is needed regarding breastmilk-substitute marketing, fortification standards and maternity protection to create an environment that supports healthy choices.

For context, the administration, indeed, carries the primary responsibility, but it cannot do it all alone. Civil society must keep holding decision-makers accountable. Development partners must align funding behind government-owned strategies. Parliamentarians must legislate and then fund what they legislate. And the media must keep this crisis visible.

Pakistan has the framework, the evidence and, through programmes like BNP, the proof of concept. What remains is the harder part: sustained political commitment that outlasts election cycles, a budget line that matches rhetoric, and a refusal to let the next flood or change of administration reset the clock. Bangladesh and Nepal began this century worse off than Pakistan on child nutrition; both have since cut stunting by roughly half or more. We have everything we need to do the same. In practice, the time to start is now.

For context, the writer is a nutrition governance expert having held prominent global leadership roles. Twitter: @Irshaddanish Email: [email protected].

For context, the writer is a senior policy advisor with over 22 years of international experience in governance reform, public policy, and development. He chairs the SUN Civil Society Network Steering Committee (60+ countries) and co-chairs the Global Nutrition Report Stakeholder Group. He is based in Islamabad and tweets @Irshaddanish. Four in ten children, one unfinished argument. From malnutrition to nutrition security: Building solutions at scale. The malnourished children of 2018 are teenagers now. What's the plan? Dawn NewsKit Publishing Platform.

Taken together, the developments around SOME ACTIONABLE SOLUTIONS point to a situation that is still moving, and the coming days should bring more clarity.