Figure 3 shows district child undernutrition rates in Punjab (Panel A) and Sindh (Panel B), respectively, based on the 2014 MICS. In both panels, districts (shown on the x-axes) are ordered from left to right in terms of ascending stunting rates, and the districts with the highest and lowest child undernutrition rates are indicated.

Child undernutrition rates differ substantially across districts in Punjab and Sindh. Across Punjab’s 36 districts, stunting rates vary from 18% to 51%, wasting rates from 11% to 23%, and underweight rates from 19% to 49%. Across Sindh’s 28 districts, stunting rates vary from 24% to 67%, wasting rates from 7% to 33%, and underweight rates from 26% to 69%.<sup>22</sup> As can been discerned by visually inspecting the association between stunting and underweight rates in the two panels, tests indicate that the three nutrition indicators are significantly associated with each other across districts in both provinces. That is, districts with poorer nutrition status measured through one indicator tend to also have poorer nutrition status measured through the other two indicators.

While district-representative data are unavailable for other provinces and territories in Pakistan, the World Bank provincial nutrition status notes and Di Cesare et al. (2015) estimate district child undernutrition rates across the country by applying a Bayesian spatial model to the 2011 NNS data. The studies find that the districts with the highest child undernutrition rates are concentrated in Balochistan, KPK, and Sindh; that, within Punjab, the southern districts tend to have higher child undernutrition rates than the northern districts; and that the district variation in child undernutrition rates overlaps with the district variation in other indicators of individual and household socioeconomic welfare.

# **5. Trends in child undernutrition rates**

To begin, we examine the trends in child undernutrition rates for the period of the 1990s and 2000s, using the 1990–91 to 2012–13 DHS rounds, as well as the subperiod of the 2000s using the 2001 and 2011 NNS rounds. The DHS rounds indicate that stunting, underweight, and wasting rates have declined over the 1990s and 2000s (see Figure 4, Panel A). The NNS rounds for the subperiod of the 2000s indicate that stunting, underweight, and wasting rates have either increased slightly or stagnated (also see Figure 4, Panel A). The flat trend for Pakistan’s stunting rate over the 2000s is relatively unique in South Asia; most of the other countries in the region have experienced a decline in the stunting rate (see Figure 4, Panel B). Both the 1990–91 and 2012–13 DHS rounds provide child undernutrition statistics at the province level for KPK, Punjab, and Sindh. Over the 1990s and 2000s, the stunting rate declined in KPK and Punjab, and stagnated in Sindh; the underweight rate declined in all three provinces; and the wasting rate increased in KPK and Sindh, while stagnating in Punjab (see Figure 4, Panel C).

How sensitive are child undernutrition rates to economic growth and poverty reduction in Pakistan? Results from cross-country regressions consistently suggest that national child undernutrition rates decline with national economic growth. Estimates of the effect of a 10% increase in national income on the stunting rate varies between 2% to 7%, depending on the number of countries and observations, the specific empirical strategy, and the time frame (for

> 22 At the time the 2014 Sindh MICS was designed and administered, Sindh had 28 districts. It currently has 29 districts.

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