Food Fortification in India – Why is it Necessary?

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The Union Budget 2019-20 saw an increased focus on food fortification. India is currently suffering from nutrition insecurity despite the progress made in food production capacity and food security. Regardless of all the poverty alleviation and food security schemes, currently, 38% of children under 5 years are stunted, 36% are underweight and 21% are wasted (too thin for their height). This is a sign of acute under-nutrition. Furthermore, 59% of women and 53% of children are anaemic. The government’s intervention to address this issue is a need of the hour.

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What is food fortification?

  • Food Fortification is the strategy of adding certain micronutrients (vitamins and minerals) into food to address the nutrient deficiency in the nation.
  • It involves the addition of iron, zinc, vitamin A and D to staple foods like rice, wheat, oil, milk, etc., to improve the nutrient contents of the food.
  • These nutrients may or may not be present during the processing or may have been lost during the food processing.

Why is it necessary?

  • Micronutrient Deficiency or micronutrient malnutrition, also known as “hidden hunger” is a serious health risk that is plaguing the developing nations.
  • Access to safe and nutritious food is essential for the improvement of the health and performance of the nation.
  • Due to the lack of availability or affordability to a balanced diet, people do not get adequate micronutrients.
  • Also, there are even cases of the loss of micronutrients during the various stages of food processing.
  • Food Fortification substitutes other ways to improve the nutrient intakes like diversification of diet and increased consumption of food.
  • The majority of the Indian population has a very high deficiency of micronutrients like Vitamin A, Iodine, Iron and Folic Acid.
  • Hence, there is a high probability of them suffering from night blindness, goiter, anaemia, and various birth defects.
  • According to the National Family Health Survey:
    • 4% of children (6 to 59 months) are anaemic.
    • 1% of women in the reproductive age group are anaemic.
    • 7% of children under age 5 are underweight.
  • Food Fortification is an internationally recognized and cheap method to address the micronutrient deficiencies in the population.

What are the advantages of food fortification?

  • Food Fortification has a high benefit-to-cost ratio: Copenhagen Consensus had estimated that every 1 rupee spent on food fortification can lead to benefits up to 9 rupees to the economy.
  • It initially requires high investments to purchase both the technology and the vitamin and mineral premix. However, the overall cost is very cheap.
  • Even when all of the program costs are passed on to the consumers, the price increase is approximately up by 1% to 2% – less than the normal price variation.
  • Wide Coverage at a short period: Adding micronutrients to the staple foods can improve the health of a large portion of the population in a short span of time.
  • Safe: It is a safe method that is used to improve the nutrition of the people. It does not pose a health risk to people. The quantity of micronutrients added is regulated to be kept under the Recommended Daily Allowances (RDA).
  • It is a cost-effective intervention that does not require any change in the eating habits or food habits of the population.
  • It is a socially and culturally accepted means to deliver the nutrients to the people.
  • The governments have taken measures to not to alter the food’s taste, aroma or texture to make it more acceptable to the consumers.

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What are the limitations of food fortification?

  • The fortified food is often rich in a particular micronutrient. However, developing nations’ citizens may often require multiple micronutrients. Hence, they may not benefit from the consumption of the fortified food that is rich in particular micronutrients.
  • The population groups who consume relatively small amounts of food, like infants, young children and the elderly are less likely to be benefited from food fortification.
  • There are technical issues related to food fortification with regards to the appropriate levels of nutrients, the stability of the fortified foods, nutrient interactions, physical properties as well as the acceptability of the consumers.
  • More research is needed to understand the impact of interactions among the nutrients. For example, the presence of a large amount of calcium can hinder the absorption of iron from fortified food while the presence of vitamin C has the opposite effect as it can increase the iron absorption.
  • Though it is often more cost-effective than other strategies, there are nevertheless high costs associated with the food fortification process. The costs range from start-up costs and costs of conducting trials for micronutrient levels, physical qualities, and tastes, to a realistic analysis of the purchasing power of the probable beneficiaries.
  • It is argued by many that low levels of addition of micronutrients through food do not address the deficiency and that supplementation is the best method to address this issue.

What are the measures taken by the government with regard to food fortification?

  • India’s National Nutritional Strategy, 2017 has listed food fortification as one of the interventions to address anaemia, vitamin A and iodine deficiencies, apart from supplementation and dietary diversification.
  • The Union Budget 2019-20 saw progress in the food fortification strategy.
  • Under the Centrally Sponsored Scheme on Fortification of Rice and its distribution under Public Distribution System 2019-20, a total of Rs.42.65 crore has been budgeted.
  • This is a part of Rs.192, 240.39 crores allocated to the department of food and public distribution, an increase from the Rs.14,159.10 crore budgeted in 2018-19.
  • The Food Safety and Standards Authority of India (FSSAI) made standards for the fortification in Food Safety and Standards (Fortification of Foods) Regulation, 2018 for five staples – wheat, rice, oil, milk and salt.
  • The Union Ministries of Women and Child Development, Human Resource Development and Consumer Affairs and Public Distribution have mandated the distribution of fortified wheat flour, rice, oil and double fortified salt in their schemes Integrated Child Development Services (ICDS) and Mid-Day Meal (MDM) and Public Distribution System (PDS) respectively.
  • The government has targeted 11.8 crore children through MDM, 10.3 crores children, adolescents and women through ICDS and 81.34 crores through PDS.
  • The use of fortified wheat, rice, oil, and salt are to be made mandatory in the ICDS and MDM by December 2019 while the same is planned to be made mandatory in the PDS by January 2020.
  • In this setting, the Union Minister of Consumer Affairs, Food and Public Distribution, had recently announced the distribution of fortified rice under PDS on a pilot basis in a district in each of the 15 states – Maharashtra, Kerala, Gujarat, Uttar Pradesh, to name a few.
  • The standards are given for the fortification of rice and wheat with iron, folic acid, and vitamin B12, the deficiency of which can cause
  • Folic acid intake can prevent neural tube disorders.
  • Besides this, other B vitamins are added – niacin can prevent pellagra, thiamine can prevent beriberi, pyridoxine can prevent nerve disorders and riboflavin can provide healthy metabolism.
  • Apart from these, standards are also provided for milk and oil fortification with vitamin A and Vitamin D, the deficiency of which can cause night blindness and rickets respectively.
  • Standards are also given for the fortification of salt with iron and iodine to prevent goiter.
  • The companies that wish to add micronutrients to these staples have to follow the standards set by FSSAI. If the product is fortified as per the standards, the package will carry an F+ label.

What can be the way forward?

Few essential aspects should be taken into account while planning for large-scale fortification are as follows:

  • Obtaining the evidence that these micronutrients are deficit across the population and that their addition at the suggested level would help those who are in need of it without risking unnecessary exposure to those who are not in need of it. Example: Vitamin A deficiency is localised and is not as common as anaemia.
  • These schemes may hurt dietary diversification, agricultural practices, and biodiversity.
  • There are chances of diets becoming rice and wheat-centric and the benefits of millets would remain untapped. The government must take measures to diversify the diet of the population to ensure the full success of these schemes
  • The government must also assess the impact of this move on small players like millers of rice and wheat in the food supply chain and on the local procurement of food.
  • Due to the technical and financial barriers, the small players in the food supply chain may get side-lined. The government must ensure that the needed assistance is provided for them to compete with the bigger players in the market.

Conclusion

Malnutrition is a pressing issue that is affecting the population in India, especially women and children. The government’s intervention to address this issue is a step in the right direction.

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