Presentation by Haris Gazdar at the Seminar on 'Food security, hunger & nutrition' hosted by the Planning & Development Department, Sindh and EU PFM-SPP

1. Food Security, Hunger and
Nutrition in Sindh:
Concepts, Situation and Policies
Haris Gazdar
14 February 2018

2. Overview
• Concepts
• Indicators
• Situation
• Linkages between Food Security, Hunger and Nutrition
• Policy

3. Concepts
• Hunger
• Experience of hunger and vulnerability
• Discounted because ‘subjective’, but critically important, I will argue
• Food Security – FAO definition
• ‘a situation that exists when all people, at all times, have physical, social and economic access to
sufficient, safe and nutritious food that meets their dietary needs and food preferences for an
active and healthy life’
• Nutrition – WHO definition
• ‘Nutrition is the intake of food, considered in relation to the body’s dietary needs. Good nutrition
– an adequate, well balanced diet combined with regular physical activity – is a cornerstone of
good health. Poor nutrition can lead to reduced immunity, increased susceptibility to disease,
impaired physical and mental development, and reduced productivity.’
• Historical associations
• Famine and starvation deaths – preventing these is part of legacy of statecraft
• Shortages, price spirals, hoarding – preventing these is current ‘social contract’ in Pakistan
• Need to go beyond these if not addressing food security, nutrition, and hunger

4. Concepts
• Focus on individual wellbeing
• In place of national, provincial, or community
• Emphasis on situation of households, and what happens within households
• From output to consumption
• Whether, to what extent, and how, food needs are met
• Own production, market, welfare, charity
• From consumption to nutritional outcomes
• Physical wellbeing – depends on dietary adequacy AND (public) health
• Framing food security as ‘right to food’
• Making policy responsible for expansive definition of food security

5. Indicators and data
• Food intake
• Household or individual
• Recall data in household surveys
• Dedicated dietary intake surveys
• Subjective experience of hunger and food insecurity
• Anthropometrics
• Measurement of physical attributes
• Weight, height, mid-upper arm circumference (MUAC)
• Blood sample examination

6. Energy deficiency
Daily caloric intake
up to 2005-06 2007-08 2010-11 2011-12
1500 kcal 10.9 10.2 7.0 9.2
1800 kcal 24.9 25.5 20.9 24.2
2000 kcal 36.7 38.0 33.9 39.1
2150 kcal 46.3 48.3 44.6 50.7
2500 kcal 66.3 69.2 67.5 72.5
Distribution (per cent) of population by daily energy intake
– kcal per adult equivalent
Source: Author’s calculations based on HIES, several rounds

7. Total Cereal Non-cereal N
All 2,232 1,178 1,054 15785
Urban 2,072 1,008 1,064 6729
Rural 2,312 1,263 1,049 9056
All (poorest) 1,751 1,056 695 1578
Urban (poorest) 1,652 986 666 672
Rural (poorest) 1,715 1,042 673 905
Energy intake by found source (kcal per adult equivalent per day)
for various population groups, 2011-12
Source: Author’s calculations based on HIES, 2011-2012
Poverty and Energy Intake, Dietary Diversity

8. Subjective Experience of Hunger and Vulnerability
to Hunger
• Qualitative research
• “Hungry days”: days when adults or adults as well as children have gone
hungry
• “Nothing to eat”: literally no food; only roti; roti with black tea; roti with
chillies chutney; roti with milk/lassi
• “Good days”: potatoes; other vegetables; lentils; meat
• Various indices based on recall
• Not just actual experience of hunger, but also experience of fear of going
hungry

9. Food security status by province (per cent)
Source: National Nutrition Survey 2011
Self-Reported Food Insecurity
Food secure
Food
insecure
without
hunger
Food
insecure
with
moderate
hunger
Food
insecure
with
severe
hunger
Pakistan 42.0 28.4 19.8 9.8
Punjab 40.5 32.2 18.5 8.8
Khyber Pakhtunkhwa 68.5 21.0 6.0 4.5
Balochistan 36.5 33.9 18.0 11.5
Sindh 28.0 21.1 33.8 16.8

10. Policy and Food Economy of the Poorest
National framework
• Focus on some essential foods –
primarily wheat
• Producer incentives
• Ensure market availability and
price stability
• No concept of a right to an
adequate diet
Hunger vulnerable population
• Livelihood revolves around
acquisition of main staple
• Non-producers
• Non-market sources of food
• ‘Right to food’ interpreted as
‘who deserves to be fed?’ –
men, women, children

11. Hunger and Nutrition – naïve view
FOOD
AVAILABILITY
FOOD
CONSUMPTION
NUTRITION
Sectors implicated:
• Agriculture

12. Hunger and Nutrition – realistic view
ECONOMIC
OPPORTUNITY
FOOD SECURITY
NUTRITION
PUBLIC ACTION
HEALTH+
CARE+
WOMEN’S
EMPOWERMENT
FOOD
ABSORPTION
Sectors implicated:
• Agriculture
• Health
• Social Protection
• Women’s
Development

13. Source: Pakistan Demographic and Health Survey 2012-2013
Stunting and wasting in children under 5 years
Stunting
Height-for-age
Wasting
Weight-for-height
Pakistan 44.8 10.8
Punjab 39.8 9.5
Khyber Pakhtunkhwa 41.9 12.0
Sindh 56.7 13.6
Urban 46.1 12.8
Rural 63.3 14.0
Anthropometrics

14. Source: Pakistan Demographic and Health Survey 2012-2013
Infant and young child feeding practices
Among breastfed
children 6-23 months,
percentage fed:
Among non-breastfed children 6-23
months, percentage fed:
4+ food
groups
Minimum
meal
frequency
Milk or
milk
products 4+ food groups
Minimum
meal
frequency
Pakistan 19.7 55.3 74.7 29.5 84.6
Punjab 19.3 48.8 83.7 29.3 87.2
Khyber Pakhtunkhwa 17.9 61.5 40.3 35.5 77.6
Balochistan 8.8 61.3 63.4 10.1 73.3
Sindh 23.7 63.8 70.8 29.1 84
Urban 26.2 69.7 82.3 33.5 89.3
Rural 22.2 60.1 59.1 24.7 78.6

15. Stunting Wasting
Overall 45.33 12.36
Cotton picking Yes 53.75 15.28
No 42.03 11.26
Nutritional status of children by mother’s work
Source: Women’s Work and Nutrition survey, CSSR and LCIRAH, 2016
The relationship between women’s
work in agriculture and mother-child
nutrition
Findings from WWN survey
Women’s work and nutrition is a longitudinal study for LANSA (Leveraging Agriculture for Nutrition in South
Asia) research in Pakistan which investigates the impacts of women’s work in agriculture on their own and their
children’s nutrition in rural areas of Sindh. The survey was conducted with over 1,000 mother-child dyads, in
canal-irrigated areas of Sindh province.
Leveraging Agriculture for Nutrition in South Asia is a multi-country research consortium funded by the Department for International
Development (DFID) UK; however, the views expressed do not necessarily reflect the UK Government’s official policies.

16. Source: Pakistan Demographic and Health Survey 2012-2013
Nutritional status of women
Total normal
BMI (18.5-
24.9)
Total thin
(BMI <18.5)
Total over-weight
or obese
(BMI ≥25.0)
Pakistan 45.9 13.9 40.2
Urban 38.2 7.4 54.3
Rural 49.9 17.1 33.0
Punjab 43.6 13.9 42.5
Khyber Pakhtunkhwa 43.4 6.3 50.3
Balochistan 55.9 9.0 35.1
Sindh 51.0 19.6 29.4
Double Burden of Malnutrition

17. Cycle of Hunger and Undernutrition – Rural Sindh
Leveraging Agriculture for Nutrition in South Asia is a multi-country research consortium funded by the Department for International
Development (DFID) UK; however, the views expressed do not necessarily reflect the UK Government’s official policies.
POVERTY
LOW BIRTH WEIGHT
HOUSEHOLD
FOOD
INSECURITY
LOW
MATERNAL
BMI
WOMEN’S
WORK –
LONG
HOURS
LOW PAY
CHILD
UNDERNUTRITION
Over 40%
children
already
stunted at
baseline –
more whose
mothers
were cotton
workers
Over 60%
stunted at
endline
WWN – baseline children aged 0.5-3 months – endline same children 10-12 months
60% mothers worried
about family not having
enough to eat in the last
month – 12% for over 10
days in a month Need to break cycle of hunger,
work, low BMI, child
undernutriition
Over 80% women worked
while pregnant, over 30%
in strenuous jobs like
cotton harvesting

18. Conclusions
• Hunger remains a major issue, as
well as food insecurity
• Food security needs to be
framed with primary focus on
individual vulnerability
• Much broader issue than that of
food availability
• Rural women bear the burden of
food insecurity – cycle of hunger
and undernutrition
• Existing policy framework too
narrowly-focused on output and
preventing price volatility
• Needs rights-based approach
and placing women at the centre
of the policy paradigm

19. Ways forward
National
• Right to food framework in place of
present social contract around
price stability
• Embedding food security into
social protection system rather
than only agriculture
• Reform of government
intervention in wheat economy,
starting with acknowledgement
that it does not ensure food
security
Provincial
• Incorporate more nuanced
understanding of linkages between
hunger, food insecurity and
nutrition
• Use existing platforms such as AAP
to identify and break cycles of
hunger of malnutrition
• Recognition of women agricultural
workers and provincial legislation
and programmes for their rights
and wellbeing