A child does not have to go hungry to be malnourished.

In Pakistan, a child may eat every day and still lack the protein, micronutrients, clean water and healthcare needed for healthy growth. A mother may have enough food but enter pregnancy already anaemic or undernourished. A family may have food on the table but not enough money to make that food nutritious.

That is the quieter face of Pakistan’s malnutrition crisis.

Around four in ten children under five are stunted. The consequences are not confined to childhood. Poor nutrition can affect learning, productivity, household incomes and the country’s economic future.

But there is an important question hidden inside Pakistan’s national numbers: What can we learn from the places where progress has been made?

One answer comes from Khyber Pakhtunkhwa.

Research published in the American Journal of Clinical Nutrition in 2025 found that KP recorded the largest decline in stunting among Pakistan’s provinces between 2011 and 2018. The improvement was associated with wider socioeconomic changes, social protection and investments in health and nutrition — not with a single miracle programme.

That distinction may be the most important part of the story.

KP has not solved malnutrition. But it has shown that the trajectory can change.

The first 1,000 days

At the centre of the province’s approach is the first 1,000 days — from conception through a child’s second birthday.

It is a narrow window, but one with consequences that can last a lifetime. Maternal nutrition, antenatal care, breastfeeding, complementary feeding, immunisation, sanitation and protection from infection all shape a child’s development during this period.

KP has established a Nutrition Cell at the Directorate General Health Services to coordinate nutrition........

© Dawn