Why Fortify? Economic Progress

The economic benefits a country experiences as a result of improving nutrition are tremendous. Each dollar spent on reducing chronic undernutrition has a $30 payoff, according to the 2012 Copenhagen Consensus.

In a review of the World Bank report An Investment Framework for Nutrition, consultant Julia Dayton Eberwein noted that investing $10 per child per year above current spending for nutrition-specific interventions would have ‘enormous impacts.’ She wrote that  “Every dollar invested in this package of interventions would yield between $4 and $35 in economic returns, making investing in early nutrition one of the best value-for-money development actions."

The nutrients most commonly used in grain fortification are iron and folic acid. The economic benefits associated with these are below.


Fortification yields $84 for every dollar spent on reducing iron deficiency anemia prevalence [1].

The mental capacity that is undeveloped when children are iron deficient is never regained. That affects their academic performance and future earnings potential. Consequently childhood anemia is associated with a 2.5% drop in wages in adulthood [2].

The median value of annual physical productivity losses due to iron deficiency is $2.32 per capita, based on illustrative calculations for 10 developing countries [2]. Median total losses which include both physical and cognitive losses are $3.64 per capita [2].

These estimates of economic loss from iron deficiency do not include the social costs of maternal deaths due to iron deficiency or healthcare costs of treating infants born prematurely because their mothers were iron deficient.

Folic Acid

Healthcare expenditures are averted when neural tube defects (NTDs) are prevented by fortifying with folic acid. The most common of these birth defects is spina bifida. These children have varying levels of paralysis and loss of bowel and bladder control. They undergo a lifetime of surgeries and treatments which take a toll both emotionally and financially.

Total lifetime costs for patients with spina bifida in 2002 was US $620,484, according to one literature review. That included medical care, development services and indirect costs.

The following countries have compared the cost of fortifying with folic acid and the healthcare savings from preventing NTDs:

  • Chile calculated one year of costs of surgical treatment and rehabilitative services for people with spina bifida who were less than 22 years old. The results represent a net savings of 2.3 million international dollars [3].

  • South Africa estimated the costs of treating infants with spina bifida and reported a net savings of 40.6 million rand [4].

  • The United States included the lifetime costs to care for people with spina bifida plus the value of the time required for others to care for the children. The annual net savings is 603 million US dollars [5].

Economic ImpactModeling Tool

A tool to help estimate the benefit:cost ratio for your country is available. A locked version has been filled with data from an imaginary country called “Fortifitopia” to illustrate how the spreadsheet works. An unlocked version can be adapted on a country-by-country basis. First download these indicators then follow these directions. The tool was presented during a workshop in 2013. For more information, please contact info@ffinetwork.org

For more information please see:

Costs for wheat and maize in Frequently Asked Questions

Costs for rice industry in Frequently Asked Questions

[1] Hunt, J., Reversing Productivity Losses from Iron Deficiency: The Economic Case. The Journal of Nutrition. 2002. vol. 132 no. 4 794S-801S.

[2] Horton, S., and Ross, J, The Economics of Iron Deficiency. Food Policy. 2003, 28: 51-75.

[3] Llanos, A., et. al., Cost-effectiveness of a Folic Acid Fortification Program in Chile. Health Policy 83 2007:295-303.

[4] Sayed, A., et.al., Decline in the Prevalence of Neural Tube Defects Following Folic Acid Fortification and Its Cost-Benefit in South Africa. Birth Defects Research 82 2008:211-216.

[5] Grosse, Scott, et. al., Retrospective Assessment of Cost Savings From Prevention. American Journal of Preventive Medicine , 2016. 

A World Bank analysis shows that food fortification in Tanzania could generate 8,220 shillings in net savings for every 1,000 shillings spent on fortification.

See presentation made by Dominic Haazen of the World Bank in 2010 >>

"Our measured costs, despite being considerable, represent the tip of the iceberg."

- Pediatric spina bifida inpatient treatment at Wellington Regional Hospital: a cost analysis of sequential patients


Based on a 10-year projection, Indonesia could see a return of US$8 in program benefits for every US$1 of estimated costs to fortify flour with iron, folic acid, and other nutrients.