Why food fortification is the answer to India’s malnutrition woes

The Global Hunger Index (GHI) report 2020 placed India at the 94th position out of 107 nations from where sizeable data was available. While GHI considers several other aspects, the percentage of the undernourished population is one of the primary indicators taken into account.

Coming to malnutrition, as per the National Family Health Survey (NFHS)-4 conducted by the Ministry of Health and Family Welfare in 2015-16, 22.9 per cent of women (15-49 years of age) are underweight (BMI less than 18.5 kg/m2). This staggering data, coupled with the number of malnourished children in the country, presents a grim situation. However, the silver lining is the government acknowledges it and is willing to fight it off.

While addressing the nation on the eve of the 75th Independence Day, Prime Minister Narendra Modi said malnutrition is a prominent obstacle in the development of women and children. He announced the country is gearing to take the challenge head-on, and it would fortify all the rice given to the poor under various government schemes, including the rice provided to children under the mid-day meal scheme by 2024.

According to FSSAI norms, 1 kg fortified rice can contain iron (28 mg-42.5 mg), folic acid (75-125 microgram) and Vitamin B-12 (0.75-1.25 microgram). Additionally, rice may also be fortified with micronutrients, singly or in combination, with zinc (10 mg-15 mg), Vitamin A (500-750 microgram RE), Vitamin B1 (1 mg-1.5 mg), Vitamin B2 (1.25 mg-1.75 mg), Vitamin B3 (12.5 mg-20 mg) and Vitamin B6 (1.5 mg-2.5 mg) per kg.

The government initiative, if successful, would result in a mass fortification drive as it would be fortifying rice, which is one of the most commonly consumed cereals in the country. However, we need to understand the what, when, why of fortification to develop a better perspective and know how it can help women and children fight malnutrition.

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What is food fortification?

Fortification is the practice of increasing the content of an essential micronutrient, i.e. vitamins and minerals (including trace elements) in a food item to improve the nutritional quality of the food supply and provide a public health benefit with minimal health risk.

The food fortification process is subject to several defining considerations, such as LmL (Legal Minimum Level) and MTL (Maximum Tolerable Level). Market-driven fortification is another consideration that concerns food manufacturers who take the initiative of adding one or more micronutrients to processed foods, usually within regulatory limits, to attract consumers.

When did food fortification start in India?

While food fortification has been a common practice in developed economies, developing and underdeveloped countries are yet to take full-fledged advantage of these programmes. Iodisation of salt is a relatively common example of food fortification. Way back in 1953, India started with fortification of Vanaspati hydrogenated edible oil with vitamin A and vitamin D. Then later, in the 1960s, the programme for fortification of salt with iodine in India started. However, the total number of Iodine Deficiency Disorder (IDD) cases in the country are still above the government's target of 10 per cent. Fortification is not limited to salt in India; several other consumables undergo the process to enhance their nutrient value. The Food Safety and Standards Authority of India has a distinct resource centre called the Food Fortification Resource Centre to look after issues related to food fortification.

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Why is fortification necessary?

Fortification is necessary to supplement the gaps that can't be fulfilled through regular diets. Micronutrient malnutrition can cause serious health risks. While access to safe and nutritious food is a must to obtain all the essential nutrients, at times, people suffer from malnutrition due to lack of a balanced diet, lack of variety in the diet or unavailability of food. Often, there is a considerable loss of nutrients during the processing of food as well. Furthermore, nutrients are lost during processing and transportation and also during storage and cooking.

How can fortification help in fighting malnutrition?

India has a very high burden of malnutrition caused by micronutrient deficiencies. Women and children suffer from several illnesses like Night Blindness, Goitre, Anaemia and various birth defects due to the deficiency of Vitamin A, Iodine, Iron and Folic Acid. According to the National Family Health Survey (NFHS-4), 58.4 per cent of children (6-59 months) are anaemic, 53.1 per cent of women in the reproductive age group are anaemic, and 35.7 per cent of children under 5 are underweight.

A continued intergenerational cycle of undernutrition persists in India. It is natural for a malnourished mother to give birth to an undernourished baby. Lack of essential nutrients during pregnancy can lead to low-birth-weight babies. This cycle is further aggravated when adolescent teenagers become mothers or when the gap between the children is too less to help the women gain the strength of child-bearing.

Foetal stunting is common among children born to women who had inadequate nutrition before conception and during the first trimester. The stagnant levels of undernutrition in Indian children can be reduced and even eradicated with programmes targeted towards strengthening women during and before pregnancy.

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India can address the problem of malnutrition among women and children by rapidly adopting food fortification. Fortification is a proven complementary strategy to address the supplementation of food that can help improve nutrition and the added nutrients of fortified food can certainly help fight malnutrition.

Driven by science and innovation, DSM has been developing solutions that blend micronutrients with staple foods such as rice, wheat, flour, milk, oil. To that effect, DSM has collaborated with key leading organisations to fight malnutrition globally.

The women and children in India can become healthier with food fortification. With the addition of micronutrients in rice, additional nutrient intake would be possible for women and children beneficiaries of several government initiatives like the targeted Public Distribution System Mid-Day Meal Scheme and Integrated Child Development Scheme (ICDS).

Similarly, other fortified food items may be introduced to women and children to help them avert health crises caused by malnutrition. Through investment in its (bio) science-based innovations, extensive partnerships, and advocacy activities, DSM aims to help deliver change to ensure accessible, affordable, healthy nutrition and livelihoods within planetary boundaries.

Raj Sahetiya, Senior Business Director - HNH, South Asia at DSM

Also read: Global Hunger Index 2021: India slides to 101st rank; behind Pakistan, Bangladesh, Nepal