**Background:** Undernutrition is a major challenge in low- and middle-income countries, linked to approximately half of deaths among children under 5 years. While a large literature documents an income–health gradient (wealthier is healthier) and evidence of son preference in South Asia, little attention has been given to gender differences in the income–nutrition gradient. This paper uses Pakistan as a case to investigate whether higher household income translates into better nutritional outcomes and health inputs for both male and female children aged 0–5 years in rural areas.
**Methods:** The study uses the 2014 round of the Pakistan Rural Household Panel Survey (PRHPS), which collected anthropometric measurements and dietary recall data for about 900 children under 5 years. Height and weight were measured by the survey team, and HAZ, WAZ, and WHZ z-scores were calculated using WHO 2006 child growth standards. Stunting, underweight, and wasting were defined as z-scores < −2. Household income was measured as log per capita consumption expenditure (mean Rs. 20,986/year, about $210 in 2014). Dietary diversity was captured by a count of food types (cereals, meat, milk, eggs, pulses) consumed in the last 24 hours. Vaccination count (mean 8.87, range 5–13) and vitamin A supplement intake in the last two weeks (15% of children) were also recorded. The authors used OLS regressions for continuous outcomes (HAZ, WAZ, WHZ), probit regressions for binary outcomes (stunting, underweight, wasting, individual food items, vitamin A), and negative binomial regressions for count outcomes (food diversity, vaccines). All models controlled for household size, age of household head, mother’s and father’s education, child’s age and gender, and district fixed effects. Regressions were run for the full sample and separately for boys and girls, with Wald tests for gender differences. Standard errors were clustered at the household level.
**Key Results:** In the full sample, a log-point increase in per capita income was associated with a 0.357 increase in WAZ (p < 0.01) and a 0.403 increase in WHZ (p < 0.05), but no significant association with HAZ. For boys, the income coefficient for WAZ was 0.470 (p < 0.05) and for WHZ was 0.427 (p < 0.05); for girls, the coefficients were 0.171 (not significant) and 0.266 (not significant), respectively. Wald tests confirmed that the gender difference was significant for WAZ (χ² = 10.04, p = 0.006) and WHZ (χ² = 7.96, p = 0.018). In probit models, a 10% increase in income was associated with a 1.8% reduction in the likelihood of being underweight (p < 0.10) and a 4.4% reduction in wasting (p < 0.01). For wasting, the elasticity was −0.416 for boys (p < 0.10) and −0.342 for girls (not significant). For dietary diversity, a 10% increase in income was associated with a 1.7% increase in the count of food items consumed (p < 0.05); the elasticity was 0.235 for boys (p < 0.05) and 0.148 for girls (not significant). A 10% increase in income was associated with an 8.1% increase in the likelihood of egg consumption (p < 0.01), with the coefficient for boys (1.16, p < 0.05) nearly three times that for girls (0.414, not significant). Meat consumption increased by 11.5% per 10% income increase (p < 0.01), more equally distributed. For vaccines, a doubling of income was associated with a 9% increase in the likelihood of an additional vaccine (p < 0.10); the elasticity for boys (0.156, p < 0.10) was four times that for girls (0.044, not significant). No significant relationship was found between income and vitamin A supplement intake.
**Clinical Implications:** The findings demonstrate that income gains improve child nutrition but that benefits are skewed toward boys in rural Pakistan, consistent with son preference. The lack of association with HAZ (stunting) likely reflects the cross-sectional design, as stunting reflects long-term growth faltering. The results suggest that cash transfer programs alone may be insufficient to close gender gaps in nutrition; combining transfers with behavioral interventions that promote equitable intrahousehold allocation, dietary diversity, and healthcare seeking may be more effective. Programs such as the Tawana Pakistan Project, which combined school meals with girls’ enrollment, have shown promise. Longer-term societal change through female empowerment and expanded control of resources by women is needed to address underlying discrimination.