• National Family Health Survey-5 data reported that every second Indian woman has anaemia, every third child is stunted and malnourished and every fifth child is wasted.
• According to FAO (Food and Agriculture Organization) Food Security Report for 2021-
• India ranks 101 out of 116 countries in the Global Hunger Index 2021.
• India has 15.3% undernourished population.
• India has Highest proportion of stunted children (30%).
• India has Wasted children (17.3%).
• Global Nutrition Report 2021 states that stunting among children in India is higher than Asian average of 21.8%.
• World Health Organisation defines ‘hidden hunger’ as a lack of micronutrients from regular diet.
• In this context, India can address the problem of malnutrition among women and children by rapidly adopting food fortification strategies.

Food fortification

• Food fortification is the process of adding nutrients to food during its processing.
• For example- rice and wheat are fortified with iron, folic acid and vitamin B 12.
• Salt is fortified with iron and iodine.
• Vitamin A is added to cooking oil and sugar.

• It is a cost-effective complementary strategy to address multiple micronutrient deficiencies.
• Since 1920s, developed and high-income countries have successfully tackled malnutrition through food fortification.
• 80 countries have framed laws for fortification of cereal flour.
• 130 countries have allowed iodised salt.
• 13 countries have mandated rice fortification.

Need for food fortification

• DALYs for a disease or health condition are the sum of the years of life lost to due to premature mortality (YLLs) and the years lived with a disability (YLDs) due to prevalent cases of the disease or health condition in a population.
• One DALY represents the loss of the equivalent of one year of full health.
• According to the World Health Organization (WHO), Anaemia caused by iron deficiency is responsible for 3.6% of disability-adjusted life years or DALYs in 2006.
• It accounted for a loss of 47 million DALYs.
• According to NITI Aayog, rice fortification budget of ₹2,800 crore per year can save 35% (16.6 million) per year of the total DALYs with no risk of toxicity.

• In India, cost of one DALY lost due to iron deficiency anaemia (IDA) is ₹30,000.
• Cost of averting an IDA related DALY is ₹1,545.
• This is a cost-benefit ratio of 1:18.
• DALYs in India are lower for males as compared to females.
• Rice fortification costs less than 1% of food subsidy bill in 2018-19.
• It has potential to prevent 94.1 million anaemia cases.
• This will save ₹8,098 crore over a five-year period.

Food fortification programmes/initiatives in India

• In India, food fortification began in the 1950s with vegetable oil fortification and salt iodization.
• In 2016 Food Safety and Standards Authority of India (FSSAI) established standards for fortification of rice, wheat flour, edible oil, double fortified salt (DFS) and milk.

Rice fortification

• Pilot projects on the distribution of fortified rice was taken up in Maharashtra (Gadchiroli district).
• Gadchiroli is an aspirational district according to central government.
• It was part of a targeted Public Distribution programme for the masses.
• The programme prevented cases of anaemia — from 58.9% to 29.5% in 2 years.
• After its success, Central government have mandated fortified rice in all its government schemes.
• Some of them are- PDS (public distribution system), ICDS (integrated child development scheme) and PM-POSHAN (PM Poshan shakti nirman).
• Rice is a major staple diet of 65% population and hence fortified rice can prove a cost-effective strategy.

Midday meal scheme

• It is a centrally sponsored scheme that involves provision for free lunch on working days for students in primary & upper primary classes in government aided and local body school.
• It was first launched by Government of India in 1995.
• Funding pattern- Central government -75% and State government- 25%.
• In Gujarat, a study was conducted on multiple micronutrient fortified rice of midday meal scheme for schoolchildren (six-12 years) in 2018-2019. It found-
• Increased haemoglobin concentration.
• 10% reduction in anaemia prevalence.
• Improved average cognitive scores by 11.3%.

Eat Right India’ movement

• It has tagline ‘Sahi Bhojan, Behtar Jeevan’.
• It is aligned with National Health Policy 2017.
• It adopts judicious mix of - regulatory, capacity building, collaborative and empowerment approaches to ensure that food is good for people and planet.
• Its work is coherent with programmes- Ayushman Bharat, POSHAN Abhiyaan, Anaemia Mukt Bharat and Swachh Bharat Mission.

Precautions

• Excess iron overload from fortified rice is dangerous.
• Example- Jharkhand’s tribal population suffered from sickle cell anaemia and thalassaemia.
• As per FSSAI standards fortified rice has:
• Iron levels from 28 mg to 42.5 mg.
• Folic acid from 75 mcg-125 mcg.
• Vitamin B 12 from 0.75 mcg to 1.2 mcg.
• Considering per capita intake in a family of three members with a rice consumption of 60 grams per person, additional intake is 2.45 mg of iron.
• This is more than losses of iron from the body which is 1 mg-2 mg per day.

Challenges to food fortification in India

• Political momentum- Central Government is not able to translate its policy on fortification into uniform State action.
• Lack of policy incentives for the private sector to fortify foods.
• There are small scale and informal producers in the rice, wheat flour, and milk value chains.
• This makes dissemination, coordination, capacity building, and tracking challenging.
• High capital costs of blending machinery with lack of access to affordable finance.
• Low awareness level amongst end-consumers.
• Changes in food tastes is a barrier for low preference of end consumers.
• There are misconceptions about fortified foods that eating fortified foods will result in overdose of vitamins and minerals and harm their health.

Looking ahead

Food fortification has proven efficacy and is cost-effective thus it can help India in reducing micronutrient deficiencies and address overall health benefits of its citizens. The intervention should be carried out with precautions so that it can address malnutrition issue which the nation continues to grapple with.