Partners Celebrate 10 Years of Flour Fortification Progress

24 October 2012

In the past decade, the number of countries requiring wheat flour fortification with at least iron or folic acid has more than doubled from 33 to 75, and the proportion of industrially milled flour being fortified has risen from 18 to 30 percent. Advocates say this progress is due to leaders in the public, private, and civic sectors working together to improve health through fortified flour.

Regional strategies led to widespread flour fortification in the Middle East and the Americas before 2002, but there was no global movement to promote this cost-effective means of improving nutrition. A “Policy Planning Forum” on 24 October 2002 led to creation of the Flour Fortification Initiative (FFI) as a network of partners working together to make fortification standard practice in industrial mills.

Fortification adds vitamins and minerals to flour as it is milled. Seventy countries with fortification requirements include both iron and folic acid in wheat flour. Many countries include zinc plus other B vitamins; some include vitamin A and vitamin D as well.

The combined population of the 75 countries requiring wheat flour fortification now is 2.09 billion. Women and children who consume foods made with the fortified flour are the primary beneficiaries.

Studies of flour fortification’s effect among specific populations in China, Iran, Venezuela, Fiji and Oman have each shown an improvement in iron status. Because iron deficiency usually has no visible symptoms, it is considered “hidden hunger.” A more tangible measure of fortification’s success is the reduction in neural tube defects, such as spina bifida and anencephaly, when flour is fortified with folic acid, a B vitamin.

By 2008 it was estimated that 22,000 neural tube defects a year are prevented annually due to flour being fortified with folic acid. That is an average of 60 birth defects prevented worldwide every day. In addition, eight sub-national studies showed an overall reduction of 46 percent in these birth defects after fortification began.

The 2002 “Policy Planning Forum” was in Mauritius in conjunction with a meeting of the Association of Operative Millers. The forum was initiated by Glen Maberly who was then a professor at Emory University in Atlanta, Georgia, USA. It was co-hosted by the Micronutrient Initiative based in Canada and the U.S. Centers for Disease Control and Prevention (CDC).

By 2003, the Association of Operative Millers was renamed the International Association of Operative Millers (IAOM). In May that year, the IAOM Board of Directors passed a resolution in support of flour fortification worldwide. By June, partners had grown to include the Australian Wheat Board, U.S. Wheat Associates, American Ingredients Company, the Wheat Foods Council, the United Nations Children’s Fund (UNICEF), the Global Alliance for Improved Nutrition (GAIN), and the Fleishman Hillard public relations agency among others.

As fortifying flour with folic acid to prevent birth defects has proven effective, civic groups focused on birth defect prevention have joined the partnership. Organizers have agreed for FFI to remain a network to support national partnerships rather than to become a traditional organization.

“We refer to flour fortification as a ‘public-private-civic sector investment’ because successful fortification requires each of these groups to work together for the well-being of people,” said Scott J. Montgomery who became the FFI Director in 2011 after 30 years experience in the private sector. One of the eight Millennium Development Goals adapted in 2000 is to develop a global partnership for development.

“The FFI experience as a network of partners committed to a common mission indicates that developing global partnerships could very well lead to the accomplishment of the remaining goals,” Montgomery added.

FFI has historically focused on wheat flour. Plans are underway for the emphasis to expand to include maize and rice fortification. These three cereal crops are the most commonly consumed grains worldwide, and the fortification of each represents tremendous opportunities to improve global health.

Wheat Flour Fortification Progress
20041 20071 20122
Number of countries with mandatory requirements to fortify wheat flour with at least iron or folic acid  33 57 75
Percent of flour fortified in industrialized mills worldwide 18 27 30

1 Trends in Wheat Flour Fortifcation with Folic Acid and Iron – Worldwide, 2004 and 2007, Morbidity and Mortality Weekly Report, US Centers for Disease Control and Prevention, January 11, 2008.
2 Flour Fortification Initiative database, October 2012