Context

• When it comes to nutrition, or more specifically micronutrient malnutrition, there is an urgent need to address the maladies that poor nutrition can inflict on the masses, especially given the diverse populations in India.

Data on Malnutrition 

• Malnutrition exacerbates the magnitude of the public health crises we face, and is India’s most serious challenge and concern. 
• As in National Family Health Survey-5 data, every second Indian woman is anaemic, every third child is stunted and malnourished, and every fifth child is wasted. 
• According to the Global Hunger Index 2022, India ranks 107th out of 121 countries with a score of 29.1.

Food Fortification 

• Since the 1920s, developed countries and high-income countries have successfully tackled the issue of malnutrition through food fortification. 
• Of late, the low-and middle-income countries, such as India, have pursued food fortification as one of the strategies to tackle micronutrient malnutrition. 
• Fortification is the practice of deliberately increasing the content of one or more micronutrients (i.e., vitamins and minerals) in a food or condiment to improve the nutritional quality of the food supply and provide a public health benefit with minimal risk to health.
• For instance, rice and wheat are fortified with iron, folic acid and vitamin B 12, and salt fortified with iron and iodine. Iodised salt has been in use for the past few decades.

Rice Programme & Anaemia

• Pilot projects on the distribution of fortified rice have been taken up in select States, including Maharashtra (Gadchiroli district) as part of a targeted Public Distribution programme for the masses. 
• The programme has been a success in terms of preventing cases of anaemia — from 58.9% to 29.5% — within a span of two years, prompting the central government to declare the scaling up of the distribution of fortified rice, the major staple diet of 65% of the population, through the existing platform of social safety nets such as the PDS and ICDS.
• Experiences from the different States on the fortified rice project, so far tally with the results of global programmes that use fortified food as a cost-effective strategy. 
• The government aims to provide fortified rice under all the state-run food schemes in three stages by 2024 to improve nutritional outcomes.

Noon Meal Scheme in Gujarat

• In Gujarat, an eight-month long study on multiple micronutrient fortified rice intervention for schoolchildren (6-12 years) in 2018-2019, as part of the Midday Meal Scheme, found increased haemoglobin concentration, 10% reduction in anaemia prevalence, and improved average cognitive scores (by 11.3%).
• Iron deficiency anaemia is a major public health concern, because it is responsible for 3.6% of disability-adjusted life years or DALYs (years of life lost due to premature mortality and years lived with disability) according to the World Health Organization (WHO) – i.e., a loss of 47 million DALYs, or years of healthy life lost due to illness, disability, or premature death (2016). 
• According to NITI Aayog, a rice fortification budget of around ₹2,800 crore per year can save 35% of the total or 16.6 million DALYs per year with no known risk of toxicity, resulting in a cost-benefit ratio of 1:18. 
• Rice fortification, which costs less than 1% of the food subsidy bill, has the potential to prevent 94.1 million anaemia cases, saving ₹8,098 crore over a five-year period.

Need for Precautions

• Despite the programme’s proven efficacy, activists have expressed concern that excess iron overload from fortified rice has been dangerous for Jharkhand’s tribal population suffering from sickle cell anaemia and thalassaemia. 
• In some instances, fortified rice packets were distributed without any mandatory labels. According to the Food Safety and Standards Authority of India, state-run food agencies and commercial manufacturers of fortified food must carry the “+F” logo along with a health warning on packaging for people with blood disorders such as sickle-cell anaemia and thalassaemia.

Way Forward

• Food fortification is a cost-effective complementary strategy to address multiple micronutrient deficiencies. 
• Thus, given its proven efficacy and cost-effectiveness, food fortification can help us in reducing micronutrient deficiencies and address overall health benefits. 
• The intervention, carried out with precautions, is the key to the malnutrition issue which the nation continues to grapple with.