Demographic liability

There are more than 34 million children in Pakistan who can be deemed as malnourished, or 33 percent of the country’s population of children, more than 44 percent of whom are less than five years old and are stunted, and 15 percent of the same are wasted – suggesting that roughly 12 million children are stunted. The decently conducted population census suggests a population growth rate of 2.48 percent, which is amongst the highest globally. As the population continues to grow at a rapid pace, the state continues to fail in enabling access to basic nutrition to its most vulnerable population segment. Even education takes a backseat at this stage, when access to affordable nutrition is not guaranteed, or not made available.

A country can never achieve sustainable economic growth, if it cannot feed large swathes of its population. A demographic dividend, which is a function of the country’s youth bulge is rapidly turning into a demographic liability, as the state has failed to address critical areas of malnutrition and stunting. Economic growth is a function of labor, capital, and productivity. An economy like Pakistan can capitalize on its population base to enable broad-based economic growth. However, if the same population base is not trained, or educated, it cannot effectively contribute, or benefit from that broad-based growth.  

More importantly, if a significant portion of that population is malnourished, or stunted, it cannot even be educated, or trained, such that any long term gains productivity can be realized through education, or human capital development. Simply put, the physiological need of hunger needs to be addressed first for survival, before education can be imparted.

Food inflation in the country has exceeded 50 percent on a year-on-year basis, making access to nutrition more difficult. Millions of children are already out of school, and more are expected to leave school, as budget constraints can either allow for access to nutrition, or education. Even when food is available, it may not be dense in nutrition required for the development of children.

According to the School Age Children, Health and Nutrition Survey (SCANS), 2030, more than 90 percent of children have inadequate quantity of iron in their diet, with iron deficiency being among the most critical reasons for malnourishment for children aged less than five years.  

Similarly, more than 80 percent of children do not have sufficient intake of calcium, zinc, and Vitamin A relative to recommended intakes, in their diets. In the case of macronutrients, almost two-thirds of children have inadequate protein intake, relative to the Acceptable Macronutrient Distribution Range (AMDR).

Given a rapid increase in food prices, particularly protein, the macronutrient, and micronutrient intake will decrease, further affecting millions of children across the country, further increasing the incidence of malnutrition, and stunting in the country. Absence of a coherent agricultural policy that prioritizes access to nutrition, and optimized macronutrient, and micronutrient intake is pushing the country towards a demographic disaster. Recovery from such a disaster would be extremely difficult, or impossible if we subject a full generation of children to malnutrition.

Malnutrition has direct medical, and indirect economic costs. Direct medical costs include greater hospitalization, and greater stress on an already fragile healthcare system. Having the right interventions in place can relieve the burden on the healthcare system. Indirect economic costs include restricted physical and cognitive development of children, which hinders their ability to acquire education, while restricting them from acquiring more advanced education at the same time thereby hindering productivity gains, not just at individual, or household level, but also on a macro level.  

Pakistan is going through a polycrisis right now, from political, to economic, to energy, and so on. All of these can be fixed with the right interventions, and fixed in a relatively short period of time. A demographic crisis is an existential crisis. It is a crisis that pushes millions of children towards a darker future, if the right interventions are not made today. This is a crisis that can pose an existential threat to the country.

A coherent national nutrition policy needs to be in place, that enables access to affordable nutrition, whether that be animal protein, vegetables, or other grains, etc. – in a manner that makes access affordable, rather than being subject to price volatility.  Fixing agricultural supply chains and incentives is crucial in enabling the same.

On a more accelerated level, it is critical that food is fortified for early childhood intake, such that nutritional quality of available food can be improved, and micronutrient deficiencies can be addressed. These are minor, low-hanging, and low-cost interventions that can generate high value outcomes. The state has continued to fail in successive generations. As the population increases, so does the scale of that failure. It is extremely important that the state starts caring about nutrition and its effect on future generations, else we will have successive lost generations, with only ourselves to blame.