Wheat Flour and Rice Fortification Status in India
Food fortification is gaining momentum in India to address the alarmingly high prevalence of vitamin and mineral deficiencies among India’s 1.3 billion people.
In March of 2018, the Haryana state government began distributing fortified atta in two blocks of one district, reaching approximately 177,000 people with iron, folic acid, and vitamin B12. Haryana’s government plans to scale up to eventually reach 12 million people across the entire state. See our 2016 analysis of the potential in Haryana.
This success means fortifying wheat flour through appropriate market channels could be replicated in 17 states in India to reach 400 million people who are highly vulnerable to vitamin and mineral deficiencies. We are working with public, private, and civic sector partners to expand fortification to appropriate market channels. We have identified 17 other states that could follow the Haryana model for wheat flour fortification.
Atta is whole-wheat flour used to make chapati and roti. Fortifying these commonly consumed foods with folic acid should greatly reduce the number of babies with brain and spine birth defects and the number of children and women with nutritional anemia.
In 2016, multiple stakeholders led by the Food Safety Standards Authority of India (FSSAI) issued a joint declaration noting that “food fortification is a realistic and sustainable complementary strategy to food supplementation and dietary diversification to eliminate micronutrient deficiencies.” Foods to consider for fortification, according to the declaration, include milk, edible oil, rice, salt, and wheat flour.
Fortifying salt with iodine is mandatory in India. The country has standards for the nutrients and nutrient levels to include in fortified edible oil, rice, and wheat flour, but fortifying these products is not mandatory. In May 2017, FSSAI recognized food fortification early adopters.
To have the greatest health impact, grain fortification in India must consider both wheat flour and rice. The amount of rice and wheat in India's food supply is almost equivalent, according to the Food and Agriculture Organization of the United Nations. In 2013, the most recent year for which data are available, the amount of milled rice in the national food supply was 190 grams per person per day; the amount of wheat was 166 grams per person per day.
Fortified rice is available through social safety net programs in the states of Odisha and Karnataka. Also, fortified rice is being distributed in two research trials in India – one in Tamil Nadu and one in Gujarat.
Twenty-four Indian states report anemia prevalence between 26 to 65% among married women; the average is 50%. The World Health Organization calls anemia prevalence over 40% a “severe” public health concern. Anemia can result from many things in addition to nutritional deficiencies. Regardless of its cause, anemia leads to debilitating fatigue, lowers productivity, limits cognitive development in children, and contributes to maternal deaths.
In India, 45 of every 10,000 births (live births and stillbirths) have a defect of the brain or spine. With 25.6 million annual births, this equates to 115,390 birth defects of the brain or spine every year. Adequate intake of folic acid (a form of vitamin B9) could lower the prevalence to 6 per 10,000 live births. These mostly preventable birth defects are also called neural tube defects.
Wheat flour and rice fortification is voluntary in India. Voluntary means the country has a standard for the nutrients and the amount of each nutrient to include if grains are fortified, but fortification is not mandatory. Maize is not widely consumed in India.