Naseem Firdous, Program Officer, Nutrition International Pakistan , and Susrita Roy, Regional Program Officer, Maternal, Newborn and Adolescent Health and Nutrition, Nutrition International Asia.

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Breaking down discriminatory gender norms and practices requires us to examine how we understand the impact of gender on our work, and put in place strategies to address these inequities. The primary goal of impactful adolescent nutrition programming is meaningful participation of girls in decisions that affect their lives – to break the cycle of discrimination and violence, and empower them to emerge as agents of change and the spirited, independent women of tomorrow.

With the goal of mainstreaming gender into all aspects of nutrition programming, Nutrition International has developed a Program Gender Equality Strategy aligning with the Sustainable Development Goals, the Global Nutrition Targets 2025 and Canada’s Feminist International Assistance Policy. Two key actions are important in moving towards gender-responsive programming: a sex- and gender-based analysis (SGBA) to systematically understand the gender-based constraints, followed by a gender action planning (GAP) process to respond to the recommendations made in the SGBA.

Over the past 20 years, Nutrition International has successfully worked in partnership with the Government of Pakistan on various programs to improve the health and nutrition status of the country’s women and children. However, to optimize the catalytic impact of nutrition programs, the different attributes pertaining to gender inequality need to be addressed. This is why we have embarked on an intensive process to mainstream gender and ensure that our programs are responding to these norms.

The Pakistan Demographic Health Survey 2017-18 reported that 38% of children in Pakistan are stunted and 17% are severely stunted. The National Nutrition Survey 2018 highlighted that one in eight adolescent girls in Pakistan was underweight, while more than 55% suffered from anaemia. Addressing these health issues requires an in-depth understanding of gender barriers and the practices and perceptions of communities, healthcare providers and organizations.

The SGBA we conducted in Pakistan revealed that adolescent girls were more likely to lack awareness about balanced diets and consumption of packaged snacks. This was due to poor educational status, large family size and early marriage. The case of early marriage was especially highlighted in the SGBA, which indicates that the needs of girls are often neglected. Additionally, due to orthodox values rooted in patriarchy, girls and women are seldom allowed to travel to health facilities, thereby inhibiting their access to health and nutritional services. These practices perpetuate the cycle of malnutrition.

“As soon as a girl is 12-13 years of age, parents only think to marry her. This culture is still followed. That’s the reason girls are unable to get proper medication and face shortage of food. Because of this attitude, both mother and child suffer from iron deficiency.”  – A community woman from Punjab

Due to the COVID-19 pandemic, the vulnerabilities of poorer families increased disproportionately. While this adversely affected all family members, women and adolescent girls suffered more because they were not included in household decision-making.

“During the lockdown, the rich got things but the poor got affected so much that they didn’t even have anything to eat. This is one of the reasons for food deficiency in girls.”  – An in-school adolescent girl from Punjab

Nutrition International’s work on the health of adolescent girls, as well as pregnant and lactating women, has received appreciation and support from government departments as well as the community. To further strengthen the country’s maternal and adolescent health and nutrition services, Nutrition International’s programs are being adapted to focus on addressing gender-based social norms that jeopardize the health and nutritional status of adolescent girls, as well as pregnant and lactating women.

To create and build strong linkages between gender equality and nutrition per the findings from the SGBA, a GAP has been prepared through a consultative process with our country program team, implementing partners and gender mainstreaming experts. As a first step in the process towards gender mainstreaming of programs, capacity building and gender sensitization of Nutrition International’s Pakistan team and implementing partners was completed in February 2022. To support efforts to reduce gender-based barriers, complementary activities will be added to ongoing strategies in routine maternal, child and adolescent programming.

Ensuring an uninterrupted supply of nutritional supplements to pregnant women and adolescent girls, especially in hard to reach areas, is one of the challenges we face. Nutrition International will continue our focus on engaging with frontline health workers as well as health education officers.

More attention will be given to counselling men and women in the target communities, especially among populations in vulnerable situations. Some activities to increase male involvement in nutrition interventions have already begun, including during the Breastfeeding Week celebrations in Jamshoro District, when Nutrition International sensitized expecting fathers about their role in improving maternal and child health and nutrition.

Social and behaviour change strategies and interventions will also be developed to promote practices for better health and nutritional outcomes for both men and women. Stakeholders from different institutions like schools, families, healthcare providers and civil society will also be sensitized and engaged to promote gender equality.

In the words of Dr. Shabina Raza, our Pakistan Country Director, it is both urgent and important to make concerted efforts to alleviate the plight of women in our societies. To achieve that, focusing on the social norms that pose a challenge for nutrition and health is an utmost priority.