Is grain fortification the only way to meet India's nutritional challenge?

Some experts say fortified grain is a wasteful expenditure with no tangible results, and advocate balanced diet instead. Others cite the success of fortification in other South Asian countries.

(This report has been updated with latest figures. The report, originally published on August 11, is being republished in view of the latest announcements by Prime Minister Narendra Modi in his Independence Day speech.)


As the Centre presses ahead with its plan to distribute fortified rice through the public distribution system, in order to fight chronic anaemia and malnutrition, critics have raised questions on the strategy with some alleging that the entire programme is ‘unnecessary’ and will cost the exchequer around Rs 2,600 crore a year without delivering tangible results.

They instead advocate a different approach of meeting the nutritional deficiency challenge, which is through diversification of dietary habits and including more nutrition-rich victuals in food habits and in PDS.

Before moving forward on the pros and cons of both the approaches and arguments, let’s look at the current status of fortification of grains in India.

Status check

In a recent reply in Parliament, the Centre had said it is running a pilot scheme to fortify rice and distribute it through the PDS for a period of three years starting 2019-20, with a total outlay of Rs 174.64 crore.

The Central government is funding 90 per cent of the scheme for the north-eastern and hilly states, and 75 per for the rest of India.

The pilot focuses on 15 districts across 15 states, preferably one district per domain. 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 in their selected districts.

Four more states have completed the requisite processes to start distribution of fortified rice under the pilot, 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 and other related issues.

It said that as on date, nine states and UTs have constituted steering Committees under the chairmanship of respective chief secretaries for better coordination and monitoring and effective implementation of the pilot scheme in the state.

It added that due to continuous efforts, the availability of FRKs has gone up from around 7,250 tonnes to 60,000 tonnes during the last two years and rice mills with blending capacity for fortified rice have risen to 3,292 from less than 50 initially.

FCI, which is responsible for the procurement and supply of fortified rice for ICDS and mid-day meal programmes, has so procured 0.80 million tonnes of fortified rice.

The naysayers

Though the Central government has been propagating rice fortification for PDS as a very effective way to fight malnutrition in children and adults alike, some experts said it is a wrong approach that entails wasteful expenditure.

Recently, around 18 sectoral experts in a paper argued that the programme of fortification ignores the central role of a balanced and diverse diet in addressing a variety of nutritional problems of India.

Advocating extreme caution while going ahead with the programme, the authors said that 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 H P S Sachdev, one of the key authors of the paper, said in a statement that the fortification of only the rice delivered through the social safety networks will cost the public exchequer about Rs 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 reason for the fortification programme, Dr Anura Kurpad, the lead author of the paper said that it is 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 a 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.

Firstly, it said 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.

“Experience from Bangladesh, Bhutan, India and Sri Lanka shows that banking on social protection programmes, just as India is doing with its ongoing pilot on distributing fortified rice through PDS, offers a great setting for piloting and take up,” it said.

The report said secondly, fortification programmes are most successful when driven by partnerships and trust between the public- and private-sector actors, with a final public health objective.

“Multisectoral collaboration between various ministries--agriculture, education and health in particular--as well as with academia and local and international NGOs helps create an enabling environment for rice fortification, with each stakeholder contributing their individual expertise and sphere of influence,” the WFP said.

Finally, it said that the private sector should be provided with adequate incentives to build robust supply chains of fortified rice.

“Embarking on rice fortification through social protection programmes should be seen as a critical first building block towards creating a favourable environment towards progressive, nation-wide take up,” the WFP said.

Thus, though there is ample evidence on the benefits of fortification to meet nutritional challenges, whether it is the only way available is a million-dollar question which policy makers and experts need to explore.