Malnutrition in Pakistan is a major and pervasive public health issue. Every four under five
children in our country are reported to be stunted, with a mighty prevalence of 40.2%
stunting as reported in the National Nutritional Survey of Pakistan 2018. Pakistan also
shares one of the highest burden of low birthweight (LBW) where 19% babies in urban and 32%
in rural are born with weight <2500 grams. LBW babies have a higher risk of death compared to
full term babies and contributes to 60-80% of all neonatal deaths.
The first 1000 days of life, the time from conception to 2 years of age, is a critical
period, providing a window of opportunity for interventions to improve maternal and child
nutrition and health outcomes including stunting and other nutritional markers. Availability
and access to primary healthcare and nutrition services during pregnancy and the first two
years of life can help prevent undernutrition and reduce infections in early life, helping
reduce maternal and infant mortality, and preventing the lifelong and intergenerational
consequences of malnutrition. Evidence-based nutrition interventions, especially the
combination of BEP and small quantity lipid nutrient supplements have been shown to be
effective in improving birth outcomes and reducing child stunting.
BNP is a health and nutrition CCT programme, with the aim to address stunting in children
under 23 months of age. The CCT and Specialized Nutritious Food (SNF) are provided to Benazir
Income Support Programme (BISP) participating women during pregnancy and lactation up to 6
months and to children aged 6-23 months contingent on their participation in and adherence to
BNP interventions. In addition to the programme components, the pre-existing standard of care
interventions including antenatal and postnatal care, childhood immunizations, growth
monitoring and behavior change communication (BCC) activities, i.e., awareness sessions on
health, nutrition and hygiene.
The primary study objectives are to assess the impact of intervention (BNP) on:
The secondary objectives related to maternal outcomes are to assess the impact of
intervention on:
Dietary diversity of women
Mean nutrient intake including energy in kilo calories.
Prevalence of iron deficiency anemia among lactating women.
Proportion of pregnant women using reproductive health services.
The secondary objectives related to newborn and infant outcomes are to assess the impact of
the intervention on:
Prevalence of wasting among infants at 6 and 12 months of age.
Incidence of anemia among infants at 6- and 12-months of age
Infant and child feeding practices among infants at 6 and 12 months of age.
Neurodevelopmental outcomes (cognitive, language and motor development) using Bayley
Scales of Infant and Toddler Development (BSID-IV) at 6 months, and 12 months of age
among children.
Other objectives include following:
To measure receipt and utilization of BEP supplementation among pregnant and lactating
women enrolled in BNP.
To measure receipt and utilization on BEP supplementation among children under 12 months
of age enrolled in BNP
Household food insecurity status (using the Food Insecurity Experience Scale).