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Chew on this: rice fortified with iron -Ananya Sengupta
-The Telegraph

New Delhi: The Narendra Modi government wants to fortify not just mid-day meals in school for children, but many other staples that Indians eat.

The government, after proposing to supply fortified ready-to-eat packaged meals for children in anganwadi centres, is now mulling a plan for mass fortification of several staple food items on the lines of iodine-fortified salt.

Prime Minister Modi last week heard a presentation from secretaries of the ministries of agriculture, food and public distribution, commerce, health and the women and child development, which has proposed mass fortification across the country.

The proposal, officials said, would be to add certain essential micronutrients to rice, wheat, milk and edible oils, and distribute such food items through the public distribution system to address malnutrition.

"The idea is to begin small by supplying such fortified products in mid-day meals and anganwadi centres. The next step would be to take it further for use in the public distribution system. The last phase would be to take it to every citizen," said an official of the women's ministry, which is spearheading the project.

According to the proposal, wheat would be fortified with iron, rice with iron and Vitamin D, milk and edible oils with Vitamin A, and salt - fortified for over three decades with iodine - will now be double-fortified with iodine and iron.

Child health and nutrition specialists have, however, questioned the rationale for the proposal, saying the government appears to be rushing into some mass fortifications whose public health benefits have yet to be adequately demonstrated.

"There is no scientific evidence in India to show that some of these fortification proposals have any functional benefits. For example, fortification with iron should show benefit for those with anaemia. Except for iodine and folic acid, no micro-nutrient has shown to have any public health benefit. There is no third example," said Umesh Kapil, professor of nutrition at the All India Institute of Medical Sciences, New Delhi.

The group of secretaries, officials said, are likely to have another round of meetings before a final decision is taken, after which the Food Safety Standard Association of India (FSSAI) - which is under the ministry of health - will notify the standards.

After the FSSAI notification, all producers and those packaging the products will have to follow the norms prescribed. Some child specialists fear mass fortification will do little to address the long-standing challenges of water, poor nutrition and sanitation.

"In the absence of basics like water, food and sanitation, boosting food items with micro-nutrients will not address malnutrition. Fortification is not the route to follow in a country where basic nutrition is absent. In most districts in the country, even supplementary nutrition under the Integrated Child Development Scheme is absent," said Vandana Prasad, a community paediatrician and the founding secretary and national convener of the Public Health Resource Network.

Worldwide, around 84 countries supply fortified food to their citizens to address nutritional loss in transit from harvesting to milling to packaging to distribution, and also due to excessive use of chemicals. "To introduce large-scale fortification, the government also has to ensure there is no increase in cost of the food. There is no point if the cost of food for the poor increases because of the micro-nutrients," Kapil added.

In India, pilot projects on fortification are already underway at the National Institute of Nutrition, Hyderabad, and the Centre's department of biotechnology in Delhi.

"These two institutions have the requisite technology and can start production in nine months to a year," said the WCD ministry official.

Rice fortified with iron is already available and is distributed in around 1449 schools in Odisha's Gajapati district, while IIT Kharagpur has a project running on similar lines. Many commercial manufacturers are already offering varieties of fortified wheat flour.

Both Prasad and Kapil say that a decision to fortify staples should be taken only after careful and prolonged consultation with experts as in many cases fortification - like in the case of wheat - may lead to adverse effects on the diet.

Activists also say that technological interventions in food for reducing hunger and malnutrition should be protected from commercial interests. The changes should be carried out through public institutions, based on transparent processes, public debate and scientific evidence, with extensive safeguards against profit motives and conflict of interest.

"The problem is that the government is showing a lack of focus in getting the basics sorted out. We can only deduce that these strategies (fortification) are being created for corporates to get into the fray. Fortification is a centralised process with debatable impact on micronutrient deficiencies. This becomes a centralised process of production and distribution where people have no control or ownership over what they eat," Prasad said.