Grain fortification drive: Experts question nutritional efficacy
The Centre’s decision to go ahead with its plan to distribute fortified rice through the public distribution system (PDS) to fight chronic anaemia and malnutrition has raised questions on its efficacy, with critics saying the “unnecessary” programme will cost the exchequer about ~2,600 crore a year without delivering tangible results.
These people advocate a different approach to meeting nutritional deficiency by diversifying dietary habits and including more nutrition-rich victuals in food habits and in the PDS.
However, fortification also has several backers who believe that it does help in improving nutrition intake.
Status check
In a recent reply in Parliament, the Centre said it was running a pilot scheme to fortify rice and distribute it through the PDS for three years starting 2019-20, with a total outlay of ~174.64 crore. The government is funding 90 per cent of the scheme for northeastern and hilly states, and 75 per for the rest of India.
The pilot project focuses on 15 districts across 15 states. So far, six states, namely, Andhra Pradesh, Gujarat, Maharashtra, Tamil Nadu, Chhattisgarh and Uttar Pradesh have started distribution of fortified rice under the pilot scheme.
Four more states have completed the requisite processes to start distribution, the Centre said.
The Centre claimed that the government has, through its development partners, evaluated the effectiveness of rice fortification and it has been found to be useful. It added that slow distribution of fortified rice by states is primarily due to lower availability of Fortified Rice Kernels (FRK), blending infrastructure among other related issues.
It added that the availability of FRKS has gone up from about 7,000 tonnes to 50,000 tonnes in the past few years and rice mills with blending capacity for fortified rice have risen to 3,292 from less than 50 initially. In its reply, the Centre also said that FCI, which is responsible for procurement and supply of fortified rice for ICDS and mid-day meal programmes, has procured 0.66 million tonnes of it.
The naysayers
Though the central government has been saying rice fortification for PDS is an effective way to fight malnutrition among children and adults alike, some experts said it was a wrong approach that entails wasteful expenditure.
Recently, about 18 experts in a paper argued that the programme ignores the central role of a balanced and diverse diet in addressing a variety of nutritional problems of India. The authors said the new nutrient recommendations of the Indian Council of Medical Research and National Institute of Nutrition (NIN) show that a diverse natural diet is adequate to meet the normal micronutrient needs of the population.
“Therefore, fortification of rice with iron without diversifying the diet will make very little difference, if at all,” the paper said.
The paper titled ‘When the cure might become the malady: The layering of multiple interventions with mandatory micronutrient fortification of foods in India’, was published in the American Journal of Clinical Nutrition on July 28, 2021.
Professor HP SS a ch dev, one of the key authors, said that the fortification of only the rice delivered through the social safety networks will cost the public exchequer about ~2,600 crore annually.
This, he said in the backdrop of the already ongoing public health initiatives of iron supplementation,
represents an avoidable and wasteful expenditure with no palpable benefits. On the contrary, it carries the risk of harm.
On the prevalence of chronic anaemia, which has been elaborated as one of the main reasons for the programme, Dr Anura Kurpad, the lead author of the paper, said it was magnified because of the use of inappropriate haemoglobin cut-offs to diagnose the malady in children and pregnant women.
“It creates an ongoing perception of stagnant or worsening anaemia prevalence. However, it does not reflect the true nutritional status of the population,” Kurpad said in the statement.
The backers
Not all feel that fortification is unnecessary and a wasteful expenditure, though.
The United Nations World Food Programme (WFP), in a cross-country mapping of the rice fortification programme done in Bangladesh, Bhutan, India and Sri Lanka, found that it is possible to improve the diet of millions of vulnerable people with fortified rice.
The premier global agency, in a report released a few months back, suggested three key interventions by the national governments to make the programme a real success. First, the operationalisation of fortified rice distribution channels to reach groups that can benefit most from the consumption of the grain is key to providing necessary incentives for production and supply in the initial phase. Second, fortification programmes are most successful when driven by partnerships and trust between the public- and private-sector actors, with a final public health objective. Finally, it said the private sector should be provided with adequate incentives to build robust supply chains of fortified rice.