Pakistan fights devastating malnutrition with mass food-fortifying programme

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A new programme of fortification of everyday foods such as bread and oil is being rolled out in Pakistan in an attempt to tackle chronic and widespread malnutrition.

The food fortification programme, which is backed with $48m (£36m) of funding from the UK’s Department for International Development (DfID), will see nutrients added directly to wheat flour, edible oils and ghee at source in mills and factories.

Lucy Palmer, a health policy adviser at Mott MacDonald, the leading partner implementing the project, says: “This is the first time that they will be fortifying a staple food in Pakistan across the whole country. It’s a mass-scale intervention.”

Pakistan has some of the worst rates of child malnutrition in the world, with more than 40% of children suffering from stunting and 30% underweight. Stunting is a result of malnutrition in the first two years of a child’s life, and limits height as well as emotional, social and cognitive development.

The programme is aimed mainly at changing the health of women and children. Palmer says this is because of the disastrous long-term impact of poor health in mothers. “Stunting is inter-generational. If you are poor and your mother is stunted, it could take a few generations to iron out, which perpetuates inequalities.

“Recurrent and early childbearing reduces a woman’s nutritional status and there are taboos around women eating certain food. For example, they might be told they can’t eat much eggs or meat in pregnancy, which are foods that are rich in protein and iron that they need. Women may eat less nutritious food than other family members and they often can’t access healthcare.”

Joel Spicer, president of Micronutrient Initiative, which is working with Mott MacDonald, says the high levels of malnutrition are having a devastating impact on Pakistan’s development.

“Our work is taking place in the context of a malnutrition crisis in Pakistan, where nearly half of children are stunted and won’t be able to participate in the economy,” he says. “Stunted kids are at a disadvantage cognitively as well as often being the height of a child two or even four years younger. If a child doesn’t get [enough] nutrition in the first 1,000 days, their brain and immune system don’t develop.

“When these children become adults they are more susceptible to communicable diseases, they are generating less money for their families – and the overall net effect on GDP is 3% a year for Pakistan. So it is a much cheaper problem to fix than to allow to continue.”

Fortification of cereals directly at source, where they are produced, is done in almost 90 countries worldwide. Similar tactics have been used successfully in Jordan and Iran in recent years.

Spicer says the project is an ambitious one. “We are aiming to work with over a thousand mills directly as well as around 100 oil producers. That is why [this project] is so exciting – it will reach 57% of the population through wheat flour and 72% through ghee, in a country with some of the highest rates of malnutrition in the world.”

Spicer believes the world could do more to tackle the issue of child malnutrition.Globally, one in four children still suffers from stunting even though levels of hunger have fallen by a third in the past 15 years.

“We estimate that $2bn a year in funding would prevent 50 million children from stunting. But the world spends $14.5bn a day on energy subsidies, so you have to conclude that malnutrition is a political choice.”

In June, Save the Children warned that little progress has been made on curbing malnutrition, particularly in sub-Saharan Africa and south Asia.Rates have actually increased since 2000 in 13 countries, including Papua New Guinea and Eritrea.

Launching the project, the head of DfID Pakistan, Joanna Reid, said: “Food fortification is a safe, cost-effective way of decreasing micronutrient deficiencies. That is why the British people, through UK aid, are investing in the food fortification programme. We believe that this programme will benefit millions in Pakistan.”

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