Are Pakistan’s richest children really stunted?

We Gallup Pakistan Digital Analytics looked at household surveys (MICS and PDHS) for children under 5.

On the WHO growth standard, stunting is 27% in Punjab and 48% in Sindh. Even among the richest 5% of families it is 13–23%, where a healthy group would show about 2%.

That raised a question about the yardstick, not only the children.

India has been debating this for years:

• The Indian children in the WHO study came from well-off South Delhi families.

• Genetics and mothers’ height may not be fully allowed for.

• A 2022 Lancet analysis found stunting of 24% on an Indian reference against 33% on WHO.

• Others reply that location explains little of height differences, and that a lower bar could hide real undernutrition.

Out of curiosity we tried the Indian method on Pakistani data. Using urban, better-off children with educated mothers, we got a Pakistani reference. It would cut stunting to roughly 4–14%, depending on assumptions.

We hold these numbers loosely. A reference built from the best-off children will show few of them as stunted by design, so lower figures describe the yardstick, not healthier children.

The poorest fifth stays far behind under every yardstick.
Our references are approximations and we may have got things wrong. We would welcome corrections from nutrition experts.

This is a preliminary analysis. Purpose is that figures which are so widely consumed ought to be critically reviewed.