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 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.
We are working primarily with wheat flour fortification in the state of Haryana. The Haryana State Co-operative Supply and Marketing Federation Limited (HAFED) sells fortified wheat flour in the open market. The government is beginning to provide fortified wheat flour instead of wheat kernels to beneficiaries of the Public Distribution System (PDS). This began in two blocks of Haryana’s Ambala district in March 2018. In June 2018, fortified wheat flour was also distributed in the Integrated Child Development Services (ICDS) in these two blocks. In July 2018, HAFED announced that it would supply fortified food in all PDS shops in Ambala and Karnal, two districts in Haryana, beginning 1 September. State leaders plan to provide fortified wheat flour throughout the state by the end of 2019.
Our work in Haryana included analyzing the wheat supply chain, calculating government costs to supply fortified wheat flour, and evaluating consumer reaction to the fortified product. See this example of media coverage of FFI meetings with Haryana leaders in January 2016.
Most fortified flour in India is distributed in the government’s welfare system, such as the PDS and ICDS systems as well as mid-day meals for school children. We are working with public, private, and civic sector partners to expand fortification to all types of flour in the open market and to expand coverage. We have identified 17 other states that could follow the Haryana model for wheat flour fortification.
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.
Flour and rice can be fortified with multiple nutrients to address several health concerns. Grains are most commonly fortified with iron and folic acid to reduce the prevalence of iron deficiency anemia and birth defects of the brain and spine.
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.
The states in India and the legislative status of grain fortification are listed below. Click on the state name to see more information.