2019 Pakistan: United Nations Maternal and Child Stunting Reduction Programme in three target Districts in Sindh, Pakistan

Executive Summary

Childhood Stunting Causes and Consequences:

Childhood stunting is the consequence of maternal and child inadequate dietary intake (poor maternal health and nutrition, inadequate infant and young child feeding practices, micronutrients deficiencies), repeated bouts of infections and/or combination of both. Underlying these immediate causes are socio-economic factors including poverty, gender inequalities, food insecurity, inadequate care of mothers and children, low women literacy and poor availability and quality of water, sanitation, hygiene and health services. The consequences of stunting are clear; however, its causes are more complex. It is one of the most significant impediments to human and economic development and accurate reflection of children‘s well-being and gender inequalities. It impacts quality of life through increased susceptibility to infections, reduced stature in adulthood, compromised physical growth, increased risk of maternal, perinatal, and neonatal mortality, and increased risk of chronic diseases in adulthood. Stunting is also associated with impaired cognitive development and school performances in children and reduced lifetime earnings. There is a general acceptance that stunting occurs in the first 1000 days of life, from conception till age 2, which is largely irreversible, hence, this period constitutes the key window of opportunity to reduce stunting. In addition to vulnerable points in the life‐cycle, gender inequities substantially influence poor maternal and child feeding practices and under-nutrition. These inequities stem from inadequate attention to the needs and roles of women, resulting in inadequate care for pregnant and lactating women and other socio-economic gender disparities. This highlights the need that women and girls should be kept at the centre of the nutrition-specific interventions and nutrition-sensitive approaches and viewed them as the key agents in the fight against under-nutrition rather than passive victims of malnutrition who are in need of assistance. In order to unleash their potential as change agents, they need to be empowered so that they can make decisions about their own and their children health and wellbeing including participation in the community-led activities.

Programme (Object of Evaluation) Overview:

The nutritional status of the children and women in Pakistan denotes both a chronic long-term problem and an acute on-going emergency. A large proportion of Pakistan‘s children are stunted (one in every three children), which represents an estimated 6% of the global stunting caseload. Sindh is the worst hit province in Pakistan in terms of malnutrition and food insecurity, with a prevalence of 49.9% for stunting, 16.1% for wasting and 4.4% for severe wasting. In the given context of Sindh province, UNICEF with support of USAID designed and implemented integrated nutrition-specific and nutrition-sensitive programme to complement Government of Sindh (GoS) efforts in stunting reduction. The programme implementation began in May 2016 and continued until December 2018 with a no cost extension for one year. UNICEF signed contracts with Implementing Partners (6 NGOs, one Government Line Department and a Consulting Firm) on varying dates. Hence, they became operational on ground on roll-on basis. USAID provided $20 million while the 6 NGOs contributed $1.1 million as part of the PCAs requirements. The programme revolved around to address systemic, human and geographical needs and vulnerabilities through creating an enabling environment for the improved service provision and policy environment. To this end programme prioritized both upstream and downstream interventions to garner households, community, service delivery and policy/institutional level changes under a strategic objective and three intermediate results. In order to translate the programme theory of change (ToC) into action, the programme deployed gender-responsive integrated implementation approach to address the immediate and underlying causes of under-nutrition and preventing repeated bouts of infection in Ghotki, Khairpur and Nausheroferoz districts in Sindh province.