Moniza Inam examines how malnutrition is not only a medical issue, it is closely related to human rights.

Women may belong to different ethnic groups and socio-economic classes, but undernourishment remains the common denominator between them.

Saima, aged 25, resides in Lahore; she belongs to an affluent but conservative family, where girls are perceived as a liability. Being the third daughter, her birth wasn’t treated as a blessing. Her father tried his best to deprive her of basic entitlements such as education, healthcare, job opportunities, nutritious food and recreation. Consequently, she grew into a malnourished woman without any formal education or income-generating skills. Married at a young age, she gave birth to five underweight children who are more susceptible to diseases and suffer from stunted growth.

Another victim of malnutrition, Nazeeran, lives near the Cholistan desert in Punjab. Life is hard for everyone but for women it is even harsher. Belonging to a nomadic tribe her family lives and works on a farm of a local landlord. Due to tough climate and rain scarcity, the farm productivity is very low and there is not enough to eat. Unfortunately, even in households, there exists a disparity in distribution of resources and men’s nutritional needs are given priority.

Women in the family have to work double. Apart from the back-breaking work in the fields they have to do household chores and bring water, fodder and fuel from long distances. Nazeeran was married at a young age and due to repeated pregnancies and other gynae-related problems, her health has deteriorated a lot and she appears to be much older than her age. Her children are also malnourished and underweight.

The above-mentioned examples clearly drive home the point that like gender, malnutrition is also a cross-cutting issue and not merely a medical or nutritional problem. Rather it has its genesis in gender inequality and discrimination which is prevalent in our society, culture and country.

Women, opposed to men, are nutrition-deficient from early childhood. Daughters are considered an economic liability as they will get married and go to someone else’s house. This attitude legitimises the family to invest less in their diet, nutrition, education, etc. Traditionally, they often lack access to adequate healthy food and eat smaller portions due to cultural practices within families, but they tend to work harder than men.

Poverty also plays an important role, as it promotes discrimination in distribution of food. When food is scarce, often the women are expected to sacrifice their own dietary intake, so that men can eat more. Early marriage and childbearing further depletes the body’s nutritional resources and multiple childbirths may result in early death. Women, particularly of childbearing age, are disproportionately affected, and so are their children, as health of a newborn is so closely linked with that of his or her mother.

Food security is also an important factor, as its unavailability affects women detrimentally. The three central pillars of the food security equation are: food availability, economic access to available food and nutritional security and quite often women face enormous social, cultural and economic constraints in obtaining food.

Dr Abid Suleri, executive director of the Sustainable Development Policy Institute, explains the phenomenon. “Women in rural areas have been playing an active role to curb malnutrition and food insecurity through kitchen gardening, poultry and dairy husbandry, and their active participation in agricultural sector. Their role can be further strengthened by sensitising them about clean drinking water and basic health and hygiene practice, lack of which would adversely affect food absorption. We should keep in mind that malnutrition is not always about physical availability of food, it is also about eating balanced and nutritious food.”

There is no denying the fact that malnourishment reigns highest in Pakistan in young girls and women, which is yet another manifestation of unequal gender relations and a strong patriarchal society. According to one research, among children living in urban slums, girls are nearly three times more likely to be stunted than boys (Food Nutrition Bulletin, 2006).

Dr Sadiqa Jaffery, president of the National Committee for Maternal and Neonatal Health, explains: “During my long practice as a gynaecologist, I have observed that malnutrition is rampant in all socio-economic sections but women from the lower classes are especially vulnerable due to extensive poverty which in turn affects their kids’ lives and health who are more likely to suffer from cognitive impairment, short stature, lower resistance to infections and a higher risk of disease and death throughout their lives.”

For society to progress beyond the existing norms, it is all too important that we realise that malnutrition in not only a medical issue, it is closely related to human rights. Malnutrition in women leads to economic losses for families, communities and countries since it reduces their ability to work and can create ripple effects that stretch through generations. On the policy level, strengthening women’s power, influence and decision-making roles within the family and community can be an effective strategy.

Unlike their male counterparts, women are more likely to spend their income on the welfare of their families and it is important to increase their access to land and control of physical and financial assets. This will not only improve agricultural production but also display a marked improvement in overall health and nutritional intake of their children. For these reasons, it is imperative that the political will and commitment which addresses the gender angle of this issue exists to overcome the problem.