Inequality of opportunity in early childhood development and health among children under five in Pakistan: a multidimensional analysis using MICS data

Early childhood development is central to long-term well-being and mobility, yet Pakistani children face persistent disparities rooted in socioeconomic, geographic, and household conditions. Despite national commitments to the Sustainable Development Goals, inequities remain pronounced, particularly among disadvantaged regions. This study evaluates inequality of opportunity in developmental and health outcomes for children under five. Guided by distributive justice and equality-of-opportunity principles, the study applies the Human Opportunity Index framework, which distinguishes between effort-based outcomes and those shaped by circumstances beyond a child’s control—an essential consideration given minimal agency in early childhood. Using Pakistan Multiple Indicator Cluster Survey data (2017–2020) across four provinces, the analysis covers seven outcomes, including literacy, socio-emotional development, nutritional status, and morbidity. Circumstances include socioeconomic status, gender, province, disability, household environment, and exposure to violence. Inequality is measured through the Human Opportunity Index, Dissimilarity Index, and Shapley decomposition. Socioeconomic status is the dominant contributor to inequality, particularly in literacy and undernutrition. Children with disabilities and those exposed to harsh discipline show significantly poorer outcomes. Structural disadvantages drive early-life inequality, necessitating targeted investments in equitable early education, nutrition, and health services.