Millions of Africans Gain Access to Health Benefits of Fortified Flour

19 countries now fortify at least 75% of their industrially milled wheat flour

23 April 2013

In the last two years 15 million Africans - and perhaps as many as 82 million - have gained access to more nutrition in their staple foods due to increased amounts of wheat flour being fortified with essential vitamins and minerals, according to estimates by the Flour Fortification Initiative (FFI). The Africa assessment was a highlight of the FFI Executive Management Team (EMT) meeting in Atlanta 16-17 April.

“Fifteen million is a very conservative estimate as it only includes people living in urban areas,” said Scott Montgomery, FFI Director. “The combined population of countries in Africa where flour fortification is standard milling practice now is 443 million. In 2011, it was 361 million. The health benefits of food made with fortified flour are probably reaching somewhere between an additional 15 million and 82 million people now than in 2011.”

With information from public, private, and civic sector partners, FFI conducted an exhaustive analysis of opportunities in Africa in 2011. At that time, seven countries were fortifying at least 75 percent of their domestically produced wheat flour with at least iron and folic acid. Now 19 countries have reached that level of fortification.

Where flour fortification is standard milling practice and the transportation infrastructure allows country-wide distribution of commercially processed foods, most people have access to fortified flour and foods made with fortified flour. In Africa however, the lack of extensive transportation systems in many places means that the urban population is more likely than the rural population to consume foods made with fortified flour. In 2011, the urban population of the seven countries which fortified flour was 175 million. In 2013, the urban population of the 19 countries which fortify flour is 190 million, for an increase of 15 million people.

Africa’s total urban population is expected to increase from 414 million to over 1.2 billion by 2050, according to the 2011 Revision of the World Urbanization Prospects, produced by the UN Population Division of the Department of Economic and Social Affairs (DESA). A UN Development Account project noted that migration to cities “has created very dense informal settlements where 30 to 40 percent of the urban population lives in abject poverty and dismal conditions.”

In some regions, fortified flour is available beyond urban areas. Eleven of the 15 member countries of the Economic Community of West African States (ECOWAS) now have mandatory legislation for fortifying wheat flour. Helen Keller International (HKI), a leader of fortification activities in the region, estimates that 72 percent of women of reproductive age in the region have daily access to fortified wheat flour and that 90 percent of the overall population has access.

Flour is commonly fortified with iron, folic acid, and other B vitamins. People need iron for physical activity and work productivity, and iron is essential for children’s development and healthy pregnancies. Folic acid reduces the risk of children being born with serious birth defects such as spina bifida. A 2008 study estimated that fortifying flour with folic acid prevented 22,000 of these birth defects in one year.

Flour fortification is usually part of a combination of strategies to prevent nutritional deficiencies among specific populations, said Ronald Afidra, FFI’s Africa Network Coordinator. To reach people who do not access commercially processed foods, countries may distribute vitamin and mineral supplements or micronutrient powders for example.

Flour fortification progress in Africa “reflects the value of the partnerships on the ground,” Afidra noted. His role is to work with multi-sector leaders in countries and regions then identify ways that FFI can complement their work.

FFI works in Africa as part of the Smarter Futures partnership for fortification which began in 2009 and was scaled up in 2012. Smarter Futures has helped strengthen quality control systems and reinforce other capacities to fortify wheat flour. Smarter Futures includes the Ministry of Foreign Affairs of the Netherlands, AkzoNobel, FFI, HKI, and the International Federation for Spina Bifida and Hydrocephalus (IF).

Some of the additional partner organizations working in Africa include government ministers, industry leaders, civic sector volunteers, the Global Alliance for Improved Nutrition (GAIN), Micronutrient Initiative (MI), Project Healthy Children, US Agency for International Development (USAID), US Centers for Disease Control and Prevention (CDC), the World Bank, and UN agencies such as UNICEF, World Health Organization, and World Food Program.

The next step in Africa is to train country leaders to monitor fortification programs. A new tool called the Fortification Monitoring and Surveillance System (FORTIMAS) will help track trends in household coverage of quality fortified flour and foods made with fortified flour as well as expected health outcomes. The tool uses existing data from easy-to-reach target populations with high access to quality fortified foods. It will be applied in two African countries later this year. A quality assurance / quality control workshop in northern Africa, a cost benefit analysis workshop for southern Africa, and an advocacy event for central Africa are also planned this year.

Globally 76 countries require fortification of industrially milled wheat flour with at least iron or folic acid, and at least half of the flour in seven countries is fortified through voluntary efforts. FFI estimates that 31 percent of the world’s industrially milled wheat flour is fortified through these mandatory and voluntary efforts. The combined population of the mandatory and voluntary countries is 2.26 billion.