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A group of health experts in India have raised concerns about the country’s strategy to fight malnutrition through food fortification. They argued for “extreme caution” in implementing new chemical interventions to address micronutrient deficiencies.
Before proceeding further, let us first understand few details about fortification and the need for it.
What is fortification?
Fortification is the addition of key vitamins and minerals such as iron, iodine, zinc, Vitamin A & D to staple foods such as rice, milk and salt to improve their nutritional content. These nutrients may or may not have been originally present in the food before processing.
Need of fortification
- According to the National Family Health Survey (NFHS-4):
- 58.4% of children (6-59 months) are anemic
- 53.1% women in the reproductive age group are anemic
- 35.7% of children under 5 are underweight
- Also, It is estimated that 50-70% of these birth defects are preventable. One of the major causes is deficiency of Folic Acid.
Thus, fortification is necessary to address deficiency of micronutrients or micronutrient malnutrition, also known as “hidden hunger”, a serious health risk. Unfortunately, those who are economically disadvantaged do not have access to safe and nutritious food. Others either do not consume a balanced diet or lack variety in the diet because of which they do not get adequate micronutrients. Often, there is considerable loss of nutrients during the processing of food.
One of the strategies to address this problem is fortification of food. This method complements other ways to improve nutrition such as such as diversification of diet and supplementation of food.
Fortification in India
Currently government is promoting fortification in following 5 food items:
- Rice, salt, edible oil, milk and wheat.
Rice: Department of Food & Public Distribution (DFPD) has been running a “Centrally Sponsored Pilot Scheme on Fortification of Rice & its distribution through Public Distribution System”. The scheme was initiated in 2019-20 for a three-year pilot run. This scheme will run till 2023 and rice will be supplied to the beneficiaries at the rate of Re 1 per kilogram.
- For rice fortification, Ministry of Consumer Affairs, Food and Public Distribution is the nodal agency
Wheat: The decision on fortification of wheat was announced in 2018 and is being implemented in 12 states under India’s flagship Poshan Abhiyaan to improve nutrition among children, adolescents, pregnant mothers and lactating mothers.
Edible oil: Fortification of edible oil, too, was made compulsory across the country by FSSAI in 2018.
Milk: Fortification of milk was started in 2017 under which the National Dairy Development Board of India (NDDB) is pushing companies to add vitamin D.
Benefits of fortification
- High benefit-to-cost ratio: Food fortification has a high benefit-to-cost ratio. The Copenhagen Consensus estimates that every 1 Rupee spent on fortification results in 9 Rupees in benefits to the economy. While an initial investment to purchase both the equipment and the vitamin and mineral premix is required, the overall costs of fortification are extremely low.
- Also, fortification ensures a threshold level of nutrition at a very low cost—just 15 paisa to fortify a litre of oil and 2 paisa for a litre of milk.
- No socio-cultural barriers: Fortification does not require any changes in food habits and patterns of people. It is a socio-culturally acceptable way to deliver nutrients to people
- No alteration of food characteristics: It does not alter the characteristics of the food like the taste, aroma or the texture of the food
- Quick implementation: It can be implemented quickly as well as show results in improvement of health in a relatively short period of time.
- Wide reach: Since the nutrients are added to widely consumed staple foods, fortification is an excellent way to improve the health of a large section of the population, all at once.
Issues with fortification
A flawed approach to malnutrition: When it comes to malnutrition in India, the problem is calorie insufficiency, protein inadequacy and a severe lack of dietary diversity as a result of monotonous cereal-based diets.
- Problem with excess iron: Wrt anaemia, haemoglobin synthesis doesn’t happen with just iron alone; many other elements are required in far larger quantities, especially good quality protein, vitamin B and C, folic acid, among others. Adding more iron will only succeed in increasing ferritin—an iron storage protein, but won’t lead to haemoglobin synthesis, or treatment of anaemia.
Loading the system with iron has its own problems. Iron has oxidative properties and it can react with intestinal mucosa, which could become damaged by existing infections, which are widespread in India. Tuberculosis, malaria and other infections become uncontrollable when iron is given at the acute phase of these infections. New evidence shows that high ferritin is associated with diabetes, especially during pregnancy.
- Loss of natural protective substances: Sometimes, fortification can have the opposite effect. Natural foods contain protective substances such as phytochemicals and polyunsaturated fat that are adversely affected by the process of blending micronutrients.
- Market-driven solution: The researchers are worried that the push towards fortification is more to help the industry than the people and is an international market driven solution and without any scientific logic.
- Mandatory fortification will create markets that will be hard to withdraw when we have achieved the target of reduced micronutrient deficiency.
- Moreover, globally, scientific studies have shown that fortification programmes lead to increased market share for larger formal players, and reduce market share of the informal sector.
- High cost: The fortification expenditure of only the rice delivered through the social safety networks will cost the public exchequer about Rs 2,600 crores annually.
- Impact on small industries: Fortification creates an assured market for multinationals. It could threaten the livelihoods of small units across India. Like, in case of rice and oil processing. Although the FSSAI claims that medium and large rice millers will be incentivised to fortify rice, the process itself is expensive and prohibitive for small players. An indicative cost of setting up rice fortification infrastructure for a medium-sized mill is Rs 3.2 crore, according to the government.
- No direct link b/w anaemia & iron deficiency: There is no direct link between anaemia and iron deficiency. Anaemia is high among poor children in the rural areas but iron deficiency is more among the urban and rich across the country.
|Also Read: Status of malnutrition in India – Explained|
- A diverse and quality diet is more helpful: Instead of fortification, the quality of diet should be improved. Increasing the intake of foods from animal sources and fruits would be more helpful. National Institute of Nutrition, too, recommended that a diverse natural diet is required to meet the normal population need of micronutrients in its Nutrient Requirements of Indians released 2020.
- School meals programmes should look to enhance dietary diversity by adding animal and plant protein like eggs, dairy, pulses along with vegetables and fruit.
- Food can be grown through Amrut Krishi, an organic farming technique that would lead to an increase in food nutrition.
- Another solution was breast feeding with proper latching techniques. It could make critical impacts on nutrition deficiency in the critical first 1,000 days.
- Kitchen gardens: A study in Maharashtra has shown that vegetables grown in organic kitchen gardens increase haemoglobin levels.
- Include less processed or unpolished rice in the public distribution system. This would make sure that rice bran, a rich source of various micronutrients reached people.
- Connect local communities, farmers, micro, small and medium processors and others with local nutrition programmes. They can supply the raw materials as well as any locally prepared food-to-food fortificants such as syrups, biscuits, porridge, powders and various products made from local ingredients like starchy foods, vegetables, fruit, flowers, nuts, oils, and animal products. Studies show that such food fortificants greatly improve nutrition, while supporting local livelihoods.
Instead of pushing food fortification, the money will be better spent on alternative diet based sustainable solutions and improving the access to quality healthcare in the public sector.
Note: Biofortification differs from conventional fortification as biofortification aims to increase nutrient levels in crops during plant growth rather than through manual means during processing of the crops.