Experts warn that a long journey lies ahead to implement distribution of fortified rice at government schools and anganwadi centres in 15 States as there is need to bring millers and snack manufacturers on board and improve quality control. However, some are also wary of its nutritional outcomes and caution that fortification of staples such as cereals may hurt local economies.
The government announced earlier this week its plans to expand supply of rice fortified with iron, vitamin B-12 and folic acid on pilot basis from 15 districts to 15 States with the aim to curb anaemia.
“Fortified rice can provide 30-50% of the recommended dietary allowance of iron that adults need to consume daily, based on average Indian consumption,” says Mini Varghese, Country Director - India, Nutrition International, which is one of the organisations partnering with the government to implement a pilot project distributing fortified rice through fair price shops in 15 districts, and expand it to all anganwadis and government schools in 115 districts next year.
Baseline studies
“Trials in a controlled setting, giving 100% RDA of iron through tablets, have shown results within ten months. However, in a programmatic setting, with fortified rice, a minimum of 24 months of constant exposure is needed before we can see the impact,” she said, adding that baseline studies are now being conducted in the 15 pilot districts to measure current levels of anaemia in the population.
The immediate next step requires convincing food manufacturers to use the extrusion machines now used to make snacks such as kurkure or dried pasta shapes to also make fortified rice kernels, enriched with iron and other nutrients. “So far, there are about 15 manufacturers making the kernels, producing a total of 15,000 tonnes per year. The government is talking to other manufacturers and also looking at an expansion in existing capacity, so that the output can be increased to 1.3 lakh tonnes for the 112 districts,” said Suresh Lakshminarayanan, National Program Manager, Food Fortification- India, Nutrition International, who participated in a meeting with the Food Ministry on the subject earlier this week.
Role of millers
The other immediate step is bringing the country’s 28,000 rice millers on board, to install blending machines which can mix the fortified kernels into the normal rice in a 1:100 ratio.
“Millers will have to make the immediate investment, but the government may offer loans or other incentives to create an enabling environment. They are also being promised good return on investment,” said another government partner on condition of anonymity.
Since the fortified kernels look and taste the same as normal rice grains, there is also an urgent need for quality control to ensure that consumers are not being cheated, and FSSAI is in talks with NABL labs to build capacity for such testing, he added. However, the most important step in the long-term will be to create awareness about the benefits of fortified foods to ensure uptake.
“In order to take it to scale there is a need to create demand for fortified rice by ensuring that it is integrated in our food system and implemented in the open market. Its distribution should not just be limited to social feeding programmes such as Mid Day Meals for government schools and anganwadi beneficiaries but expanded beyond by building on the successes of salt iodisation programme,” says Dr. Sheila C Vir, Founder Director, Public Health Nutrition and Development Center. Dr. Vir was closely associated with the salt iodisation programme in the country.
Adverse consequences
Some public health experts also warn of adverse consequences of “the corporatisation of the food system” by insisting on processes that demand a centralisation of food supplies. “Local economies should be protected by decentralising procurement and distribution. Since the impact on anaemia through fortification remains poorly evidenced, such processes may do more harm than good. Micronutrient supplementation can be achieved by many other means, including diversification of diets and providing better quality meals, as well as through supplements that don’t further centralise food systems,” says Vandana Prasad, public health professional associated with the People’s Health Movement, India and the Right to Food Campaign.
Though on the opposite of the debate on the need for fortified foods, both Dr. Vir and Dr. Prasad are critical of the government’s decision to expand the rice fortification programme without conducting an implementation analysis. “Why has the government made a big ticket promise without doing a cost-benefit analysis of implementing such a programme,” asks Dr. Prasad.