India has made impressive progress in reducing stunting and anemia among children over the last decade. However, anemia still impacts more than one in two children and women. The WHO has declared anemia among women and children as a “severe” public health problem, demanding immediate attention. Rice fortification is an effective, preventive and cost-efficient complementary strategy to address the nutrition problem within a short period. However, ensuring access to and affordability of healthy and diverse diets would be the key to a sustainable long-term strategy.
Recent statistics indicate rise in anemia levels amongst among women and children in 16 and 18 of 22 States/UTs respectively (NFHS-5). Iron deficiency-anemia is the biggest cause of disability for the past 10 years and contributed 20 per cent direct and 50 per cent associated maternal deaths in India. Its economic burden is equivalent to about 4 per cent of GDP. Apart from iron, deficiency in micronutrient like vitamin B12, vitamin A, folate and zinc also contribute to rising anemia levels. Evidence suggests vitamin B12 deficiency impacts one in six pre-school children and one in three adolescents; folate deficiency in one in three school-aged children and one in four adolescents.
What is Food Fortification?
Fortification is the practice of deliberately increasing the content of one or more micronutrients (i.e., vitamins and minerals) in a food or condiment to improve the nutritional quality of the food supply and provide a public health benefit with minimal risk to health. Fortification is the addition of key vitamins and minerals such as iron, iodine, zinc, Vitamin A & D to staple foods such as rice, milk and salt to improve their nutritional content. These nutrients may or may not have been originally present in the food before processing.
Fortification of Rice
According to the Food Ministry, fortification of rice is a cost-effective and complementary strategy to increase vitamin and mineral content in diets. According to FSSAI norms, 1 kg fortified rice will contain iron (28 mg-42.5 mg), folic acid (75-125 microgram) and Vitamin B-12 (0.75-1.25 microgram). In addition, rice may also be fortified with micronutrients, singly or in combination, with zinc, Vitamin A, Vitamin B1, Vitamin B2, Vitamin B3 and Vitamin B6. Fortifying rice involves grinding broken rice into powder, mixing it with nutrients, and then shaping it into rice-like kernels using an extrusion process. These fortified kernels are then mixed with normal rice in a 1:100 ratio and distributed for consumption.
Need for Fortification
India has very high levels of malnutrition among women and children. According to the Food Ministry, every second woman in the country is anemic and every third child is stunted. India has slipped to 101st position in the Global Hunger Index (GHI) of 116 countries, from its 2020 position of 94th. The deficiency of micronutrients or micronutrient malnutrition, also known as “hidden hunger”, is a serious health risk. Rice is one of India’s staple foods, consumed by about two-thirds of the population. Per capita rice consumption in India is 6.8 kg per month. Therefore, fortifying rice with micronutrients is an option to supplement the diet of the poor.
Rice fortification is the most viable and welcome, preventive and complementary intervention to solve the problem of anemia in a short period of time. Historically, India has tested this idea of fortification by mandating iodized salt in 1962. Interestingly, CNNS Report 2016-18, subtly hinted the success of universal fortification of salt by revealing iodine to be the only exception to micronutrient deficiencies in the tested sample.