The government of India has planned to take accelerated steps to distribute fortified rice through the social safety net schemes of Targeted Public Distribution System, PM Poshan and ICDS in all parts of the country by 2024 in a phased manner. The first leg of this initiative was to implement a pilot scheme, which plans to distribute fortified rice under Public Distribution System in 15 States (one district per State).
Currently, the pilot scheme is being implemented in 11 districts. Given that rice is the staple cereal for 65 per cent of Indians, fortifying rice with micronutrients and supplying it through safety net channels, which cover 800 million people, provides a promising opportunity for plugging the nutritional gaps in dietary requirements of the masses. While achieving dietary diversity should be the ultimate goal, food fortification offers a cost-effective complementary strategy for addressing the problem of undernutrition.
Several countries such as the Philippines, Costa Rica, Nicaragua, Panama, and the US have mandatory legislation for rice fortification, while some low and middle-income countries such as Bangladesh, Sri Lanka, Cambodia and India. are taking the route of social safety nets to target the most vulnerable sections of society.
Various studies provide strong evidence of improvements in nutritional outcomes due to consumption of fortified rice. A review, conducted by Food Fortification Initiative, of 16 efficacy trials indicated that roughly 85 per cent, 64 per cent, 33 per cent and 55 per cent of the trials measuring iron deficiency, ferritin, haemoglobin and anaemia, respectively, recorded a significant improvement in these outcomes in the intervention group. FFI also reviewed five effectiveness studies, of which, four showed an improvement in the nutritional and other related outcomes.
Globally, positive impact from consumption of fortified rice has been observed through programmatic experiences of some countries. The Costa Rican government ramped up its efforts to mandatorily enrich a wide range of staples, including rice, with micronutrients from late 1990s, in response to the problem of widespread micronutrient deficiency, which was flagged by the national nutritional survey.
A comparison of 2008-09 and 1996 National Survey data revealed a reduction in prevalence of anemia by 71.2 per cent among children aged 1-6 years and by 46.8 per cent among women of childbearing age. Although several staples were fortified, given the dominance of rice in overall food basket, its contribution in improving nutritional outcomes could not be overlooked. The success of the Costa Rican rice fortification programme has been mainly ascribed to a centralised rice industry, leveraging of the existing distribution channels, collaborative efforts of private and public sectors and ensuring consumer acceptability, among others.
A study conducted in Bangladesh examined the effectiveness of fortified rice in reducing the prevalence of anaemia and zinc deficiency among vulnerable women, who were recipient of fortified rice through the government’s Vulnerable Group Development programme. Endline evaluation showed that prevalence of anaemia reduced by 4.8 per cent in the group that received fortified rice whereas it increased by 6.7 per cent in the control group. Zinc deficiency also reduced by 6 per cent in the group that received fortified rice.
The Indian experience
In India, several studies have been conducted to examine viability and impact of rice fortification in reducing micronutrient deficiencies. One example is the World Food Programme’s collaboration with the Odisha Government to distribute fortified rice across 1,449 schools in Gajapati district through MDM scheme in 2012.
To evaluate impact, prevalence of anemia, among other key performance indicators, was compared with the control district of Rayagada, before and after the programme. Gajapati’s schoolchildren experienced a reduction of 20 percentage points in the prevalence of anaemia as opposed to 14 percentage points in Rayagada, indicating a reduction of six percentage points that can be attributed to intake of fortified rice.
Another recent study in Gujarat, published in International Journal of Food Sciences and Nutrition (Mahapatra et al., 2021), evaluated the impact on cognitive performance, haemoglobin concentration and anaemia prevalence in children (6-12 years), who were served fortified rice through the MDM scheme. The study found significant improvements in cognitive test scores and haemoglobin concentrations, and reduction in anaemia in the intervention group as compared to the control group.
While such experiences provide evidence in support of cost-effectiveness and impact, the success of scaling up fortification to target the country’s poorest is hinged on various factors including setting up a robust ecosystem, a well-integrated supply chain, and establishing standards to ensure consistency in quality. This should go together with strengthening the quality control and quality assurance mechanisms, creating awareness to enhance acceptability among consumers and monitoring key nutrition indicators.
It is also important to build capacities of stakeholders by incorporating learnings from previous experiences including fortification of salt with iodine and the pilot scheme. Further, collaborations with knowledge and implementation partners would help leverage their expertise in implementation and measuring the impacts of the programme. These measures would help in ensuring a successful national level scale up of the initiative.
Paramjyoti is Monitoring & Evaluation Specialist, and Sonal is Young Professional, NITI Aayog. Views are personal