has a negative effect on stunting status in Punjab; the notes do not find effects in the other provinces.<sup>18</sup> To recapitulate, five general results emerge from the available evidence on food consumption in Pakistan. First, although caloric supply is roughly in line with the recommended caloric consumption level, the actual caloric consumption level for most households is below the recommended level. Second, the typical diet of households is not sufficiently diverse, with most calories obtained from cereal consumption. Third, while household demand for most foods is price-inelastic, whether the large increase in food prices in the recent past has had a negative or positive effect on the level and composition of food consumption depends on the location, economic status, and land ownership status of the household. Fourth, while real household consumption spending has increased, caloric consumption has declined in the recent past, particularly for rural households. Fifth, the evidence on the effects of the level and composition of household food consumption, including food insecurity, on child nutrition status is inconclusive.

While we would have liked to discuss the quality of food consumed by households, the available evidence for Pakistan on the nutrient composition of food, and on food adulteration and contamination, is limited to specific food items in highly localized areas (for example, see Ahmad 2016; Waseem et al. 2014; Hassan Ali et al. 2010; Iqbal et al. 2006; and the Pakistan Journal of Nutrition for several articles on the topic). In Section 6, we discuss the share of children under two years of age who benefit from appropriate feeding practices (such as breastfeeding and minimum dietary diversity) in Pakistan, and the available evidence on the effects of such feeding practices on child nutrition status.

# **4. Spatial variation in child undernutrition rates**

We present child undernutrition rates at the national level, followed by spatial differences in undernutrition rates within Pakistan, between urban and rural areas, across provinces and territories, and across districts. Examining how undernutrition rates vary spatially within Pakistan can help identify areas with poorer nutrition status in order to focus research and target interventions. Such an analysis can also help identify areas with better nutrition status (i.e., positive outliers), in order to focus research on those areas, with the intent of drawing insights and lessons to inform interventions elsewhere.

# A. _National child undernutrition rates_

Based on the 2012–13 DHS, the stunting rate in Pakistan is 45%, the underweight rate is 30%, and the wasting rate is 11%.<sup>19, 20</sup> Corresponding statistics from the 2011 NNS fall within two percentage points for the stunting and underweight rates, but the wasting rate is higher, at 15%. Panel A in Figure 1 shows child undernutrition rates for Pakistan based on the 2012–13 DHS,

> 18 Using 2010 PPHS data, Arif et al. (2014) examine the effect of household-reported food shortage in the 12 months before the survey and the effect of reported food insufficiency for household members over the same reference period, in separate regressions. The authors do not find that either indicator is associated with WAZ.

> 19 Based on the same survey, the severe stunting rate for Pakistan is 24%, the severe underweight rate is 10%, and the severe wasting rate is 3%.

> 20 These rates are rated to be either “high” or “very high” in WHO’s classification scheme for the severity of malnutrition.

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