Socio-Cultural Determinants of Malnutrition and its Health Implications on Mother and Child in Punjab, Pakistan

Abstract

Maternal and child malnutrition remains a critical public health challenge in Pakistan, with Punjab province exhibiting paradoxically high malnutrition rates despite agricultural abundance. This study examines socio-cultural determinants of malnutrition and their health implications for mothers and children in Punjab, Pakistan. A cross-sectional mixed-methods study was conducted in 2022-23 across three districts (Faisalabad, Rawalpindi, and Multan). The quantitative component included 600 mothers (aged 18-40 years) with children under five, equally distributed between rural and urban settings. Data encompassed socio-demographics, household characteristics, and anthropometric measurements. Eight focus group discussions (FGDs) with 6-8 mothers each provided qualitative insights. Chi-square tests examined bivariate associations, while thematic analysis coded qualitative data. Nearly half (46.7%) of mothers were underweight, while 31.8% were overweight, indicating a double burden of malnutrition. Over one-third of children exhibited stunting. Maternal nutritional status showed significant associations with spousal education (χ²=77.3, p<0.001), household income, maternal education, and age at marriage. Qualitative findings revealed persistent food taboos, patriarchal decision-making patterns, and gender-biased food distribution practices that disadvantage women and girls. Malnutrition in Punjab stems from complex socio-cultural dynamics rather than food scarcity alone. Integrated interventions addressing gender inequality, education, poverty, and early marriage are essential to breaking the intergenerational cycle of malnutrition.