Punjab, PAKISTAN: Nutrition International commends the Government of Pakistan for its efforts to prioritize maternal nutrition through various policy initiatives, such as Vision 2025, the National Health Vision 2016–2025, the National Vision for Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition (RMNCAH&N) 2016–2025, the Pakistan Multisectoral Nutrition Strategy (PMNS) 2018–2025, the Pakistan Adolescent Nutrition Strategy (PANS), and the Pakistan Costed Multisectoral National Nutrition Action Plan (2023-2030).

In a significant move towards enhancing maternal nutrition and advancing national and global health goals, the government of Pakistan and key nutrition stakeholders signed the Bhurban Declaration: Advancing Maternal Nutrition in Pakistan. This commitment was formalized at the National Policy Dialogue on the Economic Case for Maternal Nutrition, organized by Nutrition International in collaboration with the Ministry of National Health Services, Regulations and Coordination. The signatories pledged to improve maternal nutrition by ensuring that every woman of reproductive age receives the essential nutrition, healthcare and support required to safeguard her health and the wellbeing of future generations.

Maternal nutrition in Pakistan continues to face notable challenges. Women of reproductive age are grappling with the triple burden of malnutrition, including undernutrition, overweight/obesity and micronutrient deficiencies. The National Nutrition Survey 2018 revealed that 14.4% of women aged 15-49 are underweight, 24% are overweight and 13.8% are obese. Additionally, 41.7% suffer from anaemia, with haemoglobin levels below 11.99 gm/dl, and 22.4% are affected by vitamin A deficiency. These alarming statistics underscore a persistent cycle of malnutrition that urgently calls for investment in maternal nutrition for the implementation of the Pakistan Maternal Nutrition Strategy (PMNS) 2022-2027.

The full text of the declaration follows:

BHURBAN DECLARATION: ADVANCING MATERNAL NUTRITION IN PAKISTAN

On 27^th August in Bhurban, we, the signatories of this declaration, affirm our commitment to advancing nutrition in Pakistan, with a specific emphasis on maternal nutrition.

1. We urge the Government of Pakistan to fulfill its pledges from the Tokyo 2021 Nutrition for Growth (N4G) Summit and to set ambitious, SMART commitments for the 2025 Paris N4G Summit, particularly focusing on the nutrition of women and girls and reducing anaemia.
2. To improve the maternal nutrition situation in Pakistan, we call upon the government and all nutrition stakeholders to accelerate the implementation of the PMNS 2022-2027 and provincial action plans through the following comprehensive actions:

• Formulate a unified maternal nutrition package that spans across pre-conception nutrition to postpartum care. This package should address the nutritional needs of women throughout their reproductive years and expand strategies to reach women who are not currently pregnant or lactating. It should emphasize preventive nutrition measures, such as early supplementation, guidance on dietary diversity, promotion of physical activity, hygiene promotion and mental health over curative approaches.
• Address underlying causes and determinants of maternal malnutrition, including enhancing food security, improving dietary diversity, and ensuring equitable access to healthcare. The Government of Pakistan should prioritize interventions that address key socio-economic factors such as early marriage, adolescent pregnancies, educational attainment, employment and women’s participation in decision-making to break the cycle of malnutrition.
• Ensure that all existing guidelines and protocols for maternal nutrition are aligned with global standards. There is a need to establish a standardized approach for delivering services and counseling to ensure consistency and quality in maternal nutrition interventions.
• Enhance coordination among various sectors involved in nutrition, such as health, agriculture, social protection, WASH and education. We together need to foster a cohesive approach to maternal nutrition by ensuring long-term program sustainability. This is possible by addressing budget constraints, expediting approval processes, building capacity at all levels and improving inter-sectoral collaboration through unified platforms.
• Intensify efforts to provide essential antenatal care, including counseling on nutrition, delivering with a skilled birth attendant and access to family planning, promotion of physical activity, gestational weight monitoring and management, supplementation with essential vitamins and minerals, and deworming prophylaxis in areas with worm infestation. Multiple micronutrient supplementation (MMS) should be provided to all pregnant and lactating women, alongside efforts to improve the nutritional status of women of reproductive age including those at the preconception stage. Promotion of fortified foods, screening for health conditions and mental health support should also be prioritized to improve the health outcomes of nutritionally at-risk women.
• Embed maternal nutrition into existing health services and universal health coverage (UHC) frameworks. In order to improve maternal health indicators and reduce stunting, the life cycle approach should carefully weaved into UHC. This needs integration of nutrition interventions within broader empowerment measures across different sectors, concerted measures to improve the delivery of nutrition interventions across provinces and investments in comprehensive training programs for healthcare providers and community workers.
• Implement comprehensive postnatal care, focusing on nutrition counseling, breastfeeding support, micronutrient supplementation, and care for women who are undernourished, overweight, or anaemic. Mental health support for postpartum women should also be strengthened to ensure their holistic recovery.
• Develop and implement a robust advocacy and communication strategy to promote social behavior change related to maternal nutrition. The strategy should prioritize addressing barriers and challenges through collaborative consultations with both communities and relevant stakeholders, ensuring solutions are grounded in local context and needs
• Ensure that maternal nutrition indicators are integrated into monitoring systems and improve the collection of gender-specific and disaggregated data to guide policy decisions and track progress. Roll out of DHIS2 with the inclusion of maternal nutrition indicators.
• Integrate nutrition in emergencies. This requires a special focus due to the recurrent emergencies and catastrophes faced by Pakistan lately. It is essential to strengthen preparedness and response mechanisms for addressing women’s nutritional needs during emergencies and pandemics. This includes developing strategies to maintain maternal nutrition support and services during crises, ensuring that the nutritional needs of women are prioritized even in the most challenging circumstances and integrating nutrition interventions within disaster response measures.
• Increase and diversify funding sources for maternal nutrition programs. This is possible by ensuring transparent budget allocation and financial management to support long-term sustainability, exploring innovative financing mechanisms including public-private partnerships and impact investing. There is also a need to advocate for dedicated budget lines for maternal nutrition at both national and provincial levels to ensure consistent and adequate funding for this critical intervention.

SIGNATORIES

Ministry of National Health Services Regulations and Coordination

Primary and Secondary Health Care Department, Punjab

Health Department, Sindh

Health Department, Khyber Pakhtunkhwa

Health Department, Balochistan

Health Department, Gilgit Baltistan

Health Department, Azad Jammu and Kashmir

Nutrition International

World Health Organization (WHO)

World Food Programme

UNICEF

Save the Children

Welthungerhilfe

International Rescue Committee (IRC)

Global Alliance for Improved Nutrition (GAIN)

Action Against Hunger (ACF)

Pakistan Medical Association (PMA)

Society of Obstetricians and Gynecologists of Pakistan (SOGP)

PPHI Sindh

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