percent of households in Pakistan used biomass as cooking fuel, slightly down from 67% in 2006– 07. In Bangladesh, 82% of households used biomass to cook.

_Underlying factors:_ Poor nutrition status among mothers is associated with greater risks of obstructed labor, babies with low birth weight, low-quality breastmilk, and morbidity for mothers and their babies (NIPS/ICF International 2013). As primary caregiver for the child, a mother’s education level and employment status may influence child’s food consumption, disease environment, and health service use. More-educated mothers may have better knowledge about health, nutrition, and childcare practices, and may provide more sanitary and safer environments for their children (Christiaensen and Alderman 2004; Webb and Block 2004; Glewwe 1999; Berrera 1990). The effect of mother’s employment status on child nutrition status is ambiguous, given the trade-off between the potential positive effect of increased household income and increased maternal control over household resources and the potential negative effect of reduced time of the mother in home food production and childcare (Crepinsek and Burnstein 2004; Lamontagne, Engle, and Zeitlin 1998; Desai and Jain 1994; Abbi et al. 1991; Engle 1991).

In 2012–13, 14% of ever-married Pakistani women were thin (body mass index [BMI] below 18.5) and 40% were overweight or obese (BMI at or above 25). Forty-two percent of ever-married women had at least a primary education, roughly double the 20% rate in 1990–91. Twenty-nine percent of mothers were employed, an increase from 17% in 1990–91. In comparison, Bangladesh had a lower share of ever-married women who were overweight or obese (24% in 2014), and greater shares of ever-married women who were thin (19%), and who had at least a primary education (75%). It also had a higher share of mothers who were employed (36%).

Children in larger families may have poorer nutrition status because they receive a smaller allocation of limited family resources (Montgomery and Lloyd 1996). Pakistan’s total fertility rate was four children in 2012–13, a decrease from five in 1990–91. WHO (2005b) advises that births should be spaced by at least two years to reduce the risk of adverse health outcomes for the mother and child.<sup>32</sup> Sixty-three percent of births were in line with this recommendation in 2012–13, compared to 68% in 1990–91. The risk of death is greater among children born to mothers who are young (under 18 years of age), or old (over 34 years of age), children that are too closely spaced together, and those born to mothers with more than three children (Rustein and Winter 2014). Fifty-eight percent of births were high risk in 2012–13, compared to 55% in 1990–91. In comparison, Bangladesh had both a lower total fertility rate (two children) and a lower share of high-risk births (37%), whereas the share of births spaced by at least two years was higher (89%).

Pakistani households have registered large gains in terms of the use of maternal and child health services. Between 1990–91 and 2012–13, the share of births for which mothers received antenatal care from a trained medical professional nearly tripled from 27% to 73%, the share of births for which mothers had four or more antenatal checkups increased from 14% to 37%. The share of births in hospitals increased from 13% to 49%, and the share of births attended by trained medical professionals rose from 35% to 52%. In comparison, in Bangladesh, shares for these indicators were similar or lower in 2014.

> 32 Short birth intervals may prevent women from restoring depleted nutrition before the next pregnancy (National Research Council Committee on Population 1989). Short birth intervals are associated with greater risks of preterm delivery, fetal death, and low birthweight or small–for–gestational–age infants (WHO 2005b).

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