Sohail J. Malik Hina Nazli Asma Shahzad Amina Mehmood April 15, 2015

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1 Food Consumption Patterns and Nutrition Sohail J. Malik Hina Nazli Asma Shahzad Amina Mehmood April 15, 215

2

3 Plan of Presentation Food security and Consumption Patterns Food prices and cost of calories Nutritional status and hidden hunger women children Determinants of malnutrition in Children Policy implications and Recommendation

4 Food Security Food Security and Resilience Availability Production + Stocks Imports-exports Income Accessibility Prices Income Poverty Consumption Utilization Water, sanitation and Hygiene (WASH) Nutritional status Nutritional status Sustainability Variability in availability, accessibility, utilization Resilience

5 Source: GoP (213). Agriculture Statistics of Pakistan Per capita availability (kg/annum) declining or stagnant Per capita availability (kg/annum) of Wheat and Milk Per capita availability (kg/annum) of Other Food Items Wheat Milk Rice Pulses Edible oil/ghee Meat

6 Calories/adult equivalent/day Average Supply of Calories per adult equivalent per day has increased over time and is higher than the recommended allowance of Source: GOP (214), Economic Survey

7 Food Accessibility in Pakistan

8 Kilograms of Flour per daily wage (Kgs) Decreasing ability to access: Kilograms of Wheat Flour that one Day s Wages can Buy declining Skilled Isamabad Skilled Karachi Skilled Lahore Unskilled Islamabad Unskilled Karachi Unskilled Lahore Source: GOP (214), Economic Survey

9 Calories per capita per day Calorie consumption is lower than calorie supply Available Consumed Government of Pakistan (211). Change in the cost of Food Basket Nutrition Cell, Planning Commission

10 SHARE OF FOOD EXPENDITURE (%) On Average more than 7% of food expenditure is spent on Dairy, Wheat, Fats, Sugars, and Meats (21-11) 3 25 Overall Non-poor Poor Dairy Wheat Oils Sugars Meats Pulses Fruits & vegs Other Source: HIES 21-11

11 kg/capita/month Differences in the Consumption Patterns of Agricultural and Non-agricultural households (Rural Pakistan 21-11) Milk Wheat Fruits & vegetables Agricultural households Sugar Rice Fats Meat Pulses Non-agricultural households Source: HIES 21-11

12 % households Share of Food expenditure of Poor Households is High and Food Expenditures are Rising Botton quintile Highest quintile Source: HIES (various issues)

13 SHARE OF FOOD EXPENDITURE (%) SHARE OF FOOD EXPENDITURE (%) SHARE OF FOOD EXPENDITURE (%) Poor Spend more on wheat and non-poor on Dairy (21-11) 3 25 Pakistan Non-poor Poor 2 Source: HIES Dairy Wheat Oils Sugars Meats 3 25 Urban areas Non-poor Poor 3 25 Rural areas Non-poor Poor Dairy Wheat Oils Sugars Meats Dairy Wheat Oils Sugars Meats

14 Limited Dietary Diversity in Rural Pakistan: (% households reporting type of food items consumed in last 24 hours PSSP 214) Other cereals Other fruits Fresh meat Dark green leafy vegetables Poultry Eggs Vitamin A-rich fruits Rice Vitamin A-rich vegetables Pulses Roots and tubers (potatoes, turnip) Tomato, onion, egg plant etc. Dairy products Sugar Ghee/butter/oil Spices, condiments Wheat flour Source: RHPS (214) % households

15 % SHARE IN TOTAL CALORIES Wheat is the major source of energy Wheat Oils Dairy Sugars Meats Overall Non-Poor Poor Source: HIES 21-11

16 Rs/kg Trends in the Prices of Food Items Wheat flour Basmati rice Moong Sugar Milk Source: GOP (214), Economic Survey

17 Rs/KG Sharp Increase in the Price of Wheat since Source: GOP (214), Economic Survey

18 Rs/1 calories Calories consumed and the cost of calories (21-11) Calories cost Overall Food excluding wheat (Rs) 1 Calories cost Wheat (Rs) Rural Poor Rural Non-Poor Urban Poor Urban Non-Poor Source: HIES 21-11

19 Econometric Estimates indicate that Increase in Wheat Price has possible adverse implications for other essential Human Development Indicators An increase in the price of wheat may not result in substitution with other food items (low own and cross price elasticity) substitution with non-food items is possible A substitution with health and education may worsen the already low human development indicators adverse effect on already high levels of poverty in the country Serious implications especially for current nutritional status and productivity of future generation A further reduction in the purchasing power of the wage earners can aggravate this situation further Source: Authors estimates using HIES data and applying LA-AIDS model

20 Dietary patterns impact on nutritional status

21 % WOMEN (15-49 YEARS) Malnutrition among Women (BMI) Over 47 % are Malnourished Pakistan Urban Rural Underweight (<18.5) Normal ( ) Overweight ( ) Obese (>29.9) Source: NNS 21-11

22 % WOMEN (15-49 YEARS) % WOMEN (15-49 YEARS) % WOMEN (15-49 YEARS) Hidden Hunger: Micronutrient Deficiency among Women (21-211) 6 5 Pakistan Source: NNS (21; 21-11) Prevalence of Anemia Vitamin A Deficiency Zinc Deficiency 6 5 Urban areas Rural areas Prevalence of Anemia Vitamin A Deficiency Zinc Deficiency Prevalence of Anemia Vitamin A Deficiency Zinc Deficiency

23 Undernourished Females Implications for Future Generation A malnourished woman is at higher risk of giving birth to an anemic or an underweight child (less than 2.5 kg) such children have five times the risk of death in the first year and high risk of growth failure during childhood Low birth weight may result in greater chronic diseases as an adult Severe iron deficiency anemia causes deaths during pregnancy and childbirth Iodine deficiency in pregnancy causes the birth of mentally impaired children Human and economic potential can be at risk due to malnutrition Source: World Bank (26)

24 Pakistan: Child malnutrition Results in Child mortality Low birth-weight babies (31.6% of live births in 27) rank 3 rd highest in 183 countries Under five mortality rate (86 per 1 live births, ) ranks 26 out of 194 countries Infant mortality rate (74 per 1 live births, ) Neonatal mortality rate (55 per 1 live births, ) Disability About 2.65 % population was disabled in 212 (based on the projections on 1998 Census), 2.54% was in 1998 Of these, 43% are children (1-15 years) Of total disabled, 8.2% are blind, 7.5% deaf, 14% mentally retarded, 8.3% have multiple disabilities Probability of falling sick, loss in work days and income Source: PDHS Source: UNICEF, State of the World's Children, Childinfo, and Demographic and Health Surveys by ICF International Source: Helping Hands for Relief and Development (212). Persons with Disabilities (PWDs) Statistics in Pakistan 212

25 % children Malnutrition (PEM) among Children (under 5 years of age) Underweight Stunted Wasted Source: NNS 21-11

26 % children How reliable are the data? Variations in the estimated malnutrition indicators based on different national surveys for the same year Underweight Stunted Wasted National Nutrition Survey 21 Pakistan Socio-Economic Survey 21 Pakistan Rural Household Survey 21

27 % CHILDREN % CHILDREN % CHILDREN Hidden Hunger: Micronutrient Deficiency among Children (21-211) 7 Pakistan Source: NNS (21; 21-11) Prevalence of Anemia Vitamin A Deficiency Zinc Deficiency Urban areas Rural areas Prevalence of Anemia Vitamin A Deficiency Zinc Deficiency Prevalence of Anemia Vitamin A Deficiency Zinc Deficiency

28 Percentage Low Levels of Mothers Knowledge about Child Nutrition Iron deficiency Iodine Rich Food Drinking Water Treatment Source: RHPS (212)

29 % CHILDREN High and Variable Prevalence of Malnutrition (< 2SD) by Province and Rural Pakistan (213) Underweight Stunting Wasting All Pakistan Punjab Sindh KPK Source: Authors estimates using RHPS, Round 2 (213)

30 Determinants of Malnutrition: Results of Logistic Regression Mother s education improves the general state of nutrition among children under five Improving hygienic conditions appear important to reduce long term malnutrition (toilet facility and safe drinking water) Access to health care services plays a significant role in reducing the short-term nutrition (LHW) Incidence of malnutrition among children under five is highest in Sindh The prevalence of malnutrition is high across all income groups Poverty and malnutrition are determined by the same variables Nutritional status is a more direct measure of household welfare Source: Authors estimates using RHPS, Round 2 (213)

31 Summing up High prevalence of malnutrition in the country: Poverty - Lack of resources at the household level to maintain the minimum daily allowance of essential nutrients; limited diversification because cost of non wheat calories significantly higher Lack of awareness about balanced diet and maintaining good health Focus of previous research on estimating numbers only Food Security not fully understood or integrated into policies Little work on understanding the linkages between food security, consumption behavior and nutritional outcomes and variations across socio-economic groups and regions Need re-prioritization and evaluation of any previous policies and programs

32 Summing up The consumption of micronutrient rich foods is very low (vegetables and fruits) Average calorie consumption is lower than the recommended level of 235 and unbalanced in terms of micro-nutrients Wheat is the main source of calories, carbohydrate and fiber Food policy to date focused on availability of wheat tonnage through production and import. Little diversification away from four major crops. Lesser focus on accessibility, sustainability and safety. Wheat consumption is price inelastic (implications for dietary diversity and household expenditures on education, health care, etc.)

33 Results Indicate the Need for: Massive nutrition awareness campaigns and education Provision of safe drinking water Improvement in sanitation facilities Expansion in health care coverage (e.g., lady health workers) Promotion of kitchen gardens Food fortification and bio-fortification Special attention to the mother s nutritional status through proper medical care, adequate food, and iron, folic acid, and multivitamin supplementation

34 Recent Global Initiatives to address Malnutrition Global Alliance for Improved Nutrition (GAIN) (22) United Nation s Millennium Development Goals First goal eradicate extreme poverty and hunger. Undernourishment and malnutrition are amongst the indicators for this goal United Nation s Sustainable Development Goals (212) Replacement of MDGs United Nation s zero hunger challenge (212) Elimination of stunting is the first goal United Nation s Scaling up nutrition (SUN) movement (29) The First 1 Days Initiative The Copenhagen Consensus 212

35 Recent Nutrition Initiatives in Pakistan National Zero Hunger Program, launched in 212 Pakistan s draft Agriculture and Food Security Policy 213 aims to address the food and nutrition insecurities Pakistan Integrated Nutrition Strategy (PINS), launched in 213, aims to address the underlying causes of malnutrition (food diversification, WASH, school feeding, etc.) Scaling Up Nutrition (SUN) program, launched in 213, aims to identify the hurdles in access to food and address the issue of malnutrition

36 Needed Steps Improve identification of malnourished population based on scientific method Sustained political commitment and government ownership Institutional and sectoral coordination and collaboration Sufficient resource allocation to strengthen implementation Massive awareness campaigns Enhancing zero hunger program, PINS, SUN Ensuring synergies - no overlaps Monitoring and evaluation system to improve real-time program implementation and effectiveness

37 Thank you so much

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