Youth in Pakistan

Women and girls in Qamber, Shadadkot, north-west Sindh, Pakistan

The practice of child marriage is prevalent in Pakistan, with the highest prevalence in the Sindh province. It disproportionately affects the girl child.[12] Defined as marriage before the age of 18 years, child marriage is widespread in Pakistan and linked to spousal violence.[13] Child marriage occurs most often in rural and low-income households where education is minimal.[13] The Pakistan Demographic and Health Survey conducted from 2012 to 2013 reported that 47.5% of currently married women aged 15 to 24 had been married before the age of 18.[13] Moreover, of those child marriages, one-third of those women reported spousal violence.[13][14][15] Another UNICEF report claims 70 per cent of girls in Pakistan are married before the age of 16.[16] As with India and Africa, the UNICEF data for Pakistan is from a small sample survey in the 1990s.

The exact number of child marriages in Pakistan below the age of 13 is unknown, but rising according to the United Nations.[17]

Another custom in Pakistan, called swara or vani, involves village elders solving family disputes or settling unpaid debts by marrying off girls. The average marriage age of swara girls is between 5 and 9.[16][18] Similarly, the custom of watta satta has been cited[19] as a cause of child marriages in Pakistan.

According to Population Council, 35% of all females in Pakistan become mothers before they reach the age of 18, and 67% have experienced pregnancy – 69% of these have given birth – before they reach the age of 19.[20] Less than 4% of married girls below the age of 19 had some say in choosing her spouse; over 80% were married to a near or distant relative. Child marriage and early motherhood is common in Pakistan.[21]

Malnutrition is one of the most significant public health problems in Pakistan, and especially among children. According to UNICEF, about half of children are chronically malnourished.[31] National surveys show that for almost three decades, the rates of stunting and acute undernutrition in children under five years of age have remained stagnant, at 45 percent and 16 percent, respectively.[32] Additionally, at the “national level almost 40% of these children are underweight...and about 9% [are affected] by wasting”, diseases where muscle and fat tissues degenerate as a result of malnutrition.[33] Similarly, women are also at risk, with about half suffering from anemia, which is commonly caused by iron deficiency.[34]

Depression often starts at a young age and affects women more commonly than men.[35] One or two mothers out of 10 have depression after childbirth. Depression also limits a mother's capacity to care for her child, and can seriously affect the child's growth and development. A study showed that exposure to maternal mental distress is associated with malnutrition in 9‐month infants in urban Pakistan.[36]

A child receives the oral polio vaccine (USAID).

Pakistan is one of the two remaining countries[37][38] in the world where poliomyelitis (polio) is still categorized as an endemic viral infection,[39] the other one being Afghanistan.[37] As of 20 July 2020, there have been 60 documented cases in Pakistan in 2020, and 146 documented cases in Pakistan in 2019.[40][41] The total count of wild poliovirus cases in Pakistan in 2018 was 12.[42] By 1991, only 83 percent of Pakistani children had been vaccinated.[43] Research by the Center for Disease Control (CDC) in April 1998 cited a failure to vaccinate, vaccine failure, and inadequate immunization strategies as causes for the continued incidences of polio in this time.[44] Reasons for under-vaccination included the population being uninformed, considering vaccination unimportant, and having to travel long distances to vaccination sites.[44]

In March 2001, about 27 million children were vaccinated across the country in the hope that Pakistan could be virus-free by the end of that year.[45] As of 2004, when there were 30 million children in Pakistan under five, about 200,000 health workers were required for a vaccination campaign that was carried out eight times a year.[46] A documentary, Polio True Stories, was aired on several television channels to make people aware of the problems facing people affected by the disease.[47] In August 2015, the country launched an injectable polio vaccine intended to treat four million children and bring Pakistan closer to its goal of eradication by 2016.[48] While the new vaccine is pricier than the traditional oral polio vaccine (OPV) and requires that a doctor or nurse administer it, the injection needs only one dose, not repeated doses, to generate immunity.[48]

It has been shown that low parental - specifically, maternal - literacy and knowledge regarding vaccines and immunization schedules, poor socioeconomic status, and residence in rural areas all are attributable to decreased rates of immunization completion.[49] Parental education is one of the most important determiners of whether children will complete their vaccinations. In a study of two-parent households in Pakistan, it was shown that the father's knowledge about health most impacted immunization decisions, with an effect so large that some researchers contend improving education will improve health more than even the provision of health services.[50] Widespread malnutrition in Pakistani children is a factor in lowered resistance to disabling diseases and reduced efficacy of the polio vaccine.[51]

Polio has had drastic effects on the health of the population of Pakistan and on the nation's healthcare infrastructure and economy. The WHO estimates that 65–75% of polio cases in developing countries occur in children under 3 years of age, with 95% of all cases occurring in children under 5 years of age.[52] Researchers at the School of Public Health at Johns Hopkins University quantified the disease burden of various diseases in Pakistan; in the year 1990, a Pakistani person with polio averaged a loss of 1.13 healthy life years to the disease.[53] The duration of disability of polio, averaged over 1000 people, was 81.84 years, the equivalent of diseases including diphtheria, childhood meningitis, and measles.[53]