The malnourished children of 2018 are teenagers now. Why?

In 2018, Pakistan produced the widest survey in its history on how much nutrition its people were getting. The NNS or National Nutrition Survey was the fifth such epic exercise to be undertaken since 1965, and the first ever to show us the numbers from the districts. It was the most comprehensive data-gathering effort in Pakistan’s history and is regularly cited today in policymaking.

The NNS results painted such an alarming picture at the time that the government should have declared a national emergency. Instead, I find myself writing this seven years on with a question as Finance Minister Muhammad Aurangzeb tables an estimated Rs17.1 trillion federal budget for fiscal year 2026-27: What did Pakistan’s budget-makers do with the population nutrition evidence?

No prizes for guessing the answer was scant little. What we got instead is a story of policy documents without funding to see through on the ground, bodies meant to coordinate without the mandate or teeth, and a government that continues to treat nutrition as a humanitarian footnote rather than the country’s economic foundation it actually is.

The FY2025–26 federal budget offered a clear indication of where nutrition stood among national priorities. Health spending was reduced by 16 per cent, while no dedicated nutrition allocation was included in the federal budget architecture.

Quiz: Is this child malnourished, stunted or wasted?

Look at the photo carefully, then choose your answer below.

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Image: UNICEF Pakistan

This poll accompanies Prism's reporting on childhood malnutrition in Pakistan. Stunting, wasting and malnutrition are clinical conditions defined by measurement — height-for-age, weight-for-height and weight-for-age respectively — and cannot be reliably diagnosed from a single photograph. This exercise is intended to illustrate how easily these conditions are misread by sight alone, not to diagnose any individual child.

What the survey told us

The 2018 National Nutrition Survey was an extremely big deal in health and policy circles. It was done by the Ministry of National Health Services that teamed up with the Aga Khan University and Unicef to survey over 115,600 households and, for the first time, drill down into district-level breakdowns, adolescents, and water quality. The data it produced was both authoritative and devastating.

Four out of every 10 children under five years in Pakistan were stunted or too short for their age. This means that about 12 million children were suffering from chronic malnutrition.

Four out of every 10 children under five years in Pakistan were stunted or too short for their age. This means that about 12 million children were suffering from chronic malnutrition.

Wasting was 17.7pc, the highest recorded in Pakistan’s history and well above the WHO’s 15pc emergency threshold.

Wasting was 17.7pc, the highest recorded in Pakistan’s history and well above the WHO’s 15pc emergency threshold.

More than half of children aged six to 59 months were anaemic.

More than half of children aged six to 59 months were anaemic.

Among women of reproductive age, 42.6pc were anaemic and 46.9pc of pregnant women were iron-deficient.

Among women of reproductive age, 42.6pc were anaemic and 46.9pc of pregnant women were iron-deficient.

A staggering 81.2pc of pregnant women were vitamin D deficient.

A staggering 81.2pc of pregnant women were vitamin D deficient.

Meanwhile, the country was simultaneously confronting the other end of the malnutrition spectrum: overweight prevalence had nearly doubled in seven years, and 13.9pc of women of reproductive age were obese.

Meanwhile, the country........

© Dawn Prism