Pakistan is currently grappling with interconnected challenges of rising poverty, growing food insecurity, escalating undernutrition, and increasing ‘hidden hunger’ — deficiencies of essential micronutrients (vitamins and minerals) in diets.

Globally, over two billion people are affected by hidden hunger. Driven primarily by poverty, these individuals rely on energy-dense but nutrient-poor diets consisting mainly of low-cost staples like rice and wheat. Their diets lack the nutrient diversity that comes from dairy products, meat, eggs, fruits, vegetables, and nuts. Unlike overt hunger, hidden hunger does not necessarily result in weight loss but can lead to severe long-term health impacts on both adults and children.

In adults and the elderly, nutritional deficiencies of calcium, iron, and vitamins B and D are linked to bone health problems, chronic fatigue and weakness, and cognitive decline. In children, these deficiencies have an even more profound impact on growth and development. Stunted growth, weakened immune systems, and cognitive impairments in children are often the result of inadequate intake of vitamins A and C, iron, and zinc. Furthermore, early-life deficiencies of these micronutrients may also serve as predictors of chronic diseases in adulthood.

Hidden hunger is becoming an increasingly pressing issue in Pakistan. With a poverty rate of over 40 per cent in FY24 (World Bank data), countless families struggle to provide adequate food for their children, let alone a nutritious diet. According to the United Nations Food and Agriculture Organisation, 37.5 million people in Pakistan are deprived of proper nourishment, resulting in an annual loss of 3pc of the country’s GDP (around $7.6 billion).

Food fortification could help low-income individuals at risk of serious long-term health issues due to nutrient-poor diets

Furthermore, the National Nutrition Survey 2018 revealed alarming statistics: 40pc of children under five years are stunted, 17.7pc suffer from wasting (low weight for height), and 33pc are underweight (low weight for age).

In the given context, the country needs comprehensive policy measures encompassing both nutrition-specific and nutrition-sensitive interventions that could address the immediate and underlying causes of malnutrition, respectively. Developing countries have typically sought to combat hidden hunger through various approaches, such as food fortification, dietary diversification, supplementation (nutrient pills), and crop biofortification.

Pakistan also launched a five-year “Food Fortification Programme” in 2016 to combat micronutrient deficiencies, with the support of the United Kingdom’s Department for International Development. The programme primarily aimed to enhance the nutritional quality of wheat flour by adding essential micronutrients (iron, folic acid, vitamin B12, and zinc) during the grinding process at flour mills. Additionally, edible oil and ghee were fortified with vitamins A and D during the production process in oil and ghee mills.

Several countries have implemented school-based interventions to address malnutrition, particularly hidden hunger. In India, initiatives such as the mid-day meal scheme and the distribution of iron and folic acid tablets during school hours have been noteworthy. Likewise, Bangladesh introduced a school feeding programme, providing fortified biscuits containing iron, zinc, and vitamin A. In the Philippines, fortified milk was distributed to school children to improve calcium and vitamin D. Other countries, including Brazil and Uganda, have also opted for school-based feeding programmes with similar objectives.

About 37.5m people in Pakistan are deprived of proper nourishment, resulting in an annual loss of 3pc of the country’s GDP, says FAO

Recently, following the suit of other countries, the Punjab government launched the “School Nutrition Programme” aimed at providing daily nutrition-rich milk packs (175ml) to 0.4m primary school children across three districts in South Punjab (Muzaffargarh, Rajanpur, and Dera Ghazi Khan), which are among the most affected by malnutrition.

Despite its prohibitively high per capita cost, this initiative is a commendable step in the right direction. It has been rolled out in the face of historically limited budgetary allocations for primary education, ongoing privatisation of government schools to cut provincial expenditures, and the alarming reality that 7.7m children aged five to 16 are out of school in Punjab.

Another viable approach is crop biofortification, which is widely recognised as a sustainable and cost-effective solution to hidden hunger. It is particularly relevant in contexts like Pakistan, where cost constraints significantly limit the outreach, impact, and viability of other options.

Biofortification increases the concentration of essential nutrients in crops through conventional plant breeding, biotechnology, or improved agricultural practices. Golden rice (enriched with vitamin A), zinc-enriched wheat, high-iron lentils, and quality-protein maize are some of the global examples of biofortified (nutritionally enhanced) crops. Notably, Pakistan introduced a zinc-enriched wheat variety — Akbar 2019 — a few years ago, which has gained remarkable acceptance among farmers.

The success of such initiatives highlights that biofortified crops can provide a wide range of essential minerals and vitamins directly while eliminating the need for nutrient addition later during crop processing or food preparation.

In Pakistan, hidden hunger continues to rise. Despite the immense potential of biofortified crops to address it, the country has largely overlooked their development and promotion. Nevertheless, we can still prevent the worst from happening. By investing in agricultural research, strengthening extension services for farmers, and raising public awareness, the country can unlock the full potential of biofortified crops to enhance the availability, affordability, and consumption of nutritious foods.

Khalid Wattoo is a farmer and a development professional, and Dr Waqar Ahmad is a former Associate Professor at the University of Agriculture, Faisalabad.

Published in Dawn, The Business and Finance Weekly, January 6th, 2025