Ever since 1948 when its first office was established in Pakistan, the United Nations Children’s Fund (UNICEF) has been committed to the aspiration that one day, each and every child in the country, no matter where they live, or their family circumstances, will be guaranteed the right to survive. We do not stop there – the right to life is ineffectual if ill-health, ignorance, violence or exploitation deny a child his or her right to thrive. For this reason, we envision a day when all children everywhere get a fair chance in life, and avail of meaningful opportunities to reach their full potential, unhampered by discrimination, bias, or favouritism.
This conviction underpins our work in Pakistan. Working in partnership with government at every level from the local to the provincial and federal, alongside committed donors, NGOs, CSOs and private organizations, we celebrate important achievement while recognizing that there is a long way to go before we can achieve the dream of a world fit for children.
Through the equity strategy, which emphasizes the most excluded and disadvantaged children, we translate our commitment to child rights into action. We are guided by key documents such as the Core Commitments for Children in humanitarian situations, and the Convention on the Rights of the Child (CRC) to which Pakistan is a signatory, as well as the aspirations of first the Millennium Development Goals (MDGs) and now the Sustainable Development Goals (SDGs). We focus on increasing access to services and opportunities by women and girls in all facets of life, and promote gender-sensitive action as a core priority.
This year, under government leadership to eradicate polio, we saw the number of cases plummet and geared up for a final push to end a disease which has brought disability and heartbreak to millions. We celebrated Pakistan’s National Vision for Coordinated Priority Action to Address the Challenges of Reproductive, Maternal, Newborn, Child Health and Nutrition (2016–2025) which created a new framework for health care, and new strategies to help caregivers learn how to ensure that all children get the right nutrition at the right age.
We helped bring children to school and investigated alternative streams for those left behind by the formal education system. We successfully piloted innovative ways of helping to register children at birth, and assure them of an identity.
Pakistan is prone to both natural and man-made disasters. We continued helping displaced and returning families in Khyber Pakhtunkhwa (KP) province and the Federally Administered Tribal Areas (FATA). Recognizing the importance of preparing for future disasters, we supported training in disaster risk reduction, climate change adaptation and disaster risk management.
This year, we celebrated Pakistan’s achievement of its sanitation target under MDG 7. Our Pakistan Approach to Total Sanitation was a key contributor to this success.
In 2016, UNICEF begins efforts to help Pakistan achieve the SDGs – an opportunity to advance the rights and well-being of every child. Meaningful success will depend on renewed and effective partnerships at every level, from the federal government down to communities where our work has the most tangible impact. It requires high quality data and research, and innovative ways of addressing challenges. It requires an equity-based approach, so those who are traditionally excluded also benefit. As part of Pakistan’s One UN II programme and Delivering as One, we join our United Nations peers in helping Pakistan’s governments meet this pressing challenge.
• Of every 1,000 Pakistani children born, 89 – nearly one in ten – die before they reach five years of age. Pakistan ranks 23rd in the world for under-five deaths.
• Over half, 55, die in their first month of life. While child mortality declined slowly since 1990, newborn mortality has actually risen.
• Wide disparities exist between rural and urban areas, regions of the country, and differing socio-economic profiles.
• In Pakistan, only 52 per cent of deliveries take place in the presence of a skilled birth attendant, declining to 14 per cent in rural Balochistan province.
• Almost half of children do not receive a full course of vaccinations, with large variations in coverage across provinces, characterized by geographical and wealth inequities.
• Although HIV prevalence is low in Pakistan, the epidemic is concentrated in key populations such as people who inject drugs (27.2 per cent) and transgender sex workers (5.2 per cent).
• Many Pakistani children are faced with long term nutritional deprivation, due to poverty, food insecurity, poor health services, illnesses linked to hygiene such as diarrhoea, and improper feeding practices.
• About 44 per cent of Pakistani children – 58 per cent in FATA – suffer from stunting, indicating chronic malnutrition.
• At 15 per cent, the proportion of children who suffer from wasting, indicating acute malnutrition, exceeds the international emergency threshold.
• A fifth of pregnant women and children under five have severe Vitamin A deficiency, and 62 per cent of children under five are anaemic.
• Infant and young child feeding (IYCF) practices are poor. Breastfeeding is initiated within an hour in only 18 per cent of births (the lowest rate in South Asia), while only 38 per cent of children are exclusively breastfed for the first six months of life.
• Pakistan’s persistent food insecurity has been exacerbated in recent years by conflict and displacement, and repeated natural disasters such as floods and drought has meant that support perforce addresses immediate needs rather than prevention.
• Diseases related to water, sanitation and hygiene (WASH) account for 110 deaths of children under-5 every day.
• Inadequate sanitation is estimated to cost Pakistan 3.94 per cent of GDP.
• Open defecation – a challenge to health, equity and dignity – is prevalent among 25 million people - 13 per cent population of Pakistan.
• Lack of sanitation facilities in schools is deterring children, particularly girls, from enrolling and staying in school. Girls’ menstrual hygiene needs are rarely accommodated in schools, serving as a further deterrent.
• Only 9 out of 10 have access to Water, and more than 3 out of 10 do not have access to Sanitation.
• Nearly a third of South Asian children who are out of school (OOSC) live in Pakistan – more girls than boys.
• Recent enrolment drives decreased the number of out of school primary aged children to 6.16 million in 2013–2014, but there is insufficient data on whether these children actually remain in education.
• Quality of education is a concern, especially for girls: only 14 per cent of the poorest girls can read a story in Urdu, Sindhi or Pashto, compared to 22 per cent of the poorest boys.
• Quality of education is also affected by lack of infrastructure and teaching materials and weak teacher training and assessment systems.
• Only 20 per cent of girls from poor rural households are in school, compared to 81 per cent of those from rich urban households. Poor rural girls receive on average only one year of education.
• Only 33.6 per cent under-5 children are registered in Pakistan. Among the unregistered children, 59.3 per cent are in urban areas and 22.8 per cent are in rural areas.
• Around 14 per cent of girls aged 15-19 are currently married: in rural areas these figures are even higher. (Source: PDHS 2012-2013)
• Data on child labour is out-of-date – real figures are likely to be higher than those commonly quoted. The largest percentage of child labour is to be found in the agriculture sector - yet child labour in the agriculture sector is not addressed within applicable legislative frameworks in Pakistan.
• The matter of the marriage of girls between 15 and 17 requires targeted interventions in Pakistan.
• Along with Afghanistan, Pakistan remains one of the only two countries left on polio-endemic nations list. It shares more than half of the global polio burden.
• Polio cases in Pakistan continue to decline: in 2015 Pakistan recorded 82% fewer cases than in 2014. The number of children paralyzed by polio at the end of June 2016 has been reduced by 60% when compared to a similar period in 2015 (June 15 to June 16).
• However, the virus remains active in three core reservoir zones – the Khyber-Peshawar corridor, Karachi and the Quetta block as well as areas outside of the core reservoirs zones like northern Sindh and Bannu district in Khyber Pakhtunkhwa.
• The strategic shift from measuring immunization coverage to measuring missed children has been a game changer for the programme. Building on the achievements made in the last low season to reach all children, particularly those who have been continuously missed by vaccination.
• Pakistan has set itself a determined goal: to stop transmission of polio in 2016 and sustain interruption in 2017. Guided by the National Emergency Action Plan and implemented by a committed network of Emergency Operation Centres, Pakistan is building its strongest ever defence against polio with stronger surveillance, fewer unvaccinated children and fewer strains of the virus.