(P17-034-23) Exemplars in Stunting Reduction: Pakistan Sub-National Case Study

Objectives: From 2001 to 2018 stunting prevalence in Pakistan has only slightly declined (41.5% in 2001 vs. 40.2% in 2018) despite relatively steep increase in GDP per capita. This study aims to investigate the gaps and challenges in Pakistan that have prevented reduction in stunting. Additionally, this study examines both exemplary and counterfactual regions within Pakistan to study the barriers and facilitators at a subnational level.

Methods: Case study methodology included 5 broad research activities: 1) a review of existing literature, 2) Geospatial, equity, and growth curve analysis to examine distribution of stunting across the country and between population subgroups; 3) Time-series analyses and regression-based analyses based on individual-and household-level data to understand the major predictors of stunting decline; 4) interviews with national and subnational experts and focus groups with community stakeholders; and 5) a review of policy, program, financing, and health system.

Results: In exemplary regions, Khyber Pakhtunkhwa, Northern Punjab, and Southern Punjab, direct and indirect nutrition interventions have led to gains in child growth over the last decade. Improved economic conditions, social safety net coverage targeting women, better maternal nutrition, and reduced diarrhea were among the most important factors driving change in these regions. In general, the absolute number of nutrition-related programs, as well as the better integration and coordination of health and nutrition post-devolution, has led to improvements. In addition, improvements to the Lady Health Workers program increased utilization and accessibility of health services at the community and household level. In non-exemplar regions, risk factors for stunting were varied but vulnerable mothers and non-responsive leadership consistently arose.

Conclusions: The results from the Pakistan case study highlight the importance of leadership and prioritization of commitments to improved nutrition. Specific effort should also be placed on reaching the poorest, least educated, and rural populations and reducing rates of maternal undernutrition and high fertility rates. The adoption of a multisectoral approach is critical to facilitate the implementation of nutrition efforts across diverse sectors and stakeholders.

Funding Sources: The Bill and Melinda Gates Foundation