“Food fortification is one of the most cost-effective and sustainable interventions with an unparalleled ability to reach entire populations with essential nutrients, particularly those who might not otherwise have access. The COVID-19 pandemic has further emphasized the value of fortification and the importance of scaling up, so that more people will get the nutrition they need – not just to survive – but to reach their full potential.”
Dr. Noor KhanDirector
Food Fortification Programme (2.0) Pakistan
For every person on the planet, access to essential vitamins and minerals – like iron, folic acid, zinc and vitamin A – can be the difference between life or death, surviving or thriving. These micronutrients are essential for brains to develop fully, bodies to grow properly and immune systems to function effectively.
Globally, more than two billion people, especially women, girls and children, do not get the nutrition they need. The impacts of micronutrient deficiencies are devastating for individuals, families, and entire countries. The right nutrition at the right time is the foundation for every individual to contribute towards building a stronger, more equitable world.
Fortifying foods with essential micronutrients is a proven and cost-effective method to get better nutrition to those who in need. Staple food fortification is ranked by the Copenhagen Consensus 2012 as one of the highest-return interventions in global development, with every $1 invested generating $27 in economic returns.
The COVID-19 pandemic has made it even more difficult for people in the most vulnerable situations to get the requisite nutrients. Disrupted supply chains and income losses have left people turning to the cheapest food they can afford, which is also often the least nutritious. Staples like wheat flour, rice or maize will satiate their hunger but not fill their nutritional needs. But by fortifying these common foods, more people can be reached with improved nutrition.
Wheat flour is an ideal vehicle for fortification because it is a staple in many countries and widely consumed in breads, noodles and other processed foods. It can be fortified with several micronutrients, including iron and folic acid, and can therefore help prevent two of the world’s most common micronutrient deficiencies: iron-deficiency anaemia and folate deficiency – both of which disproportionately affect women, girls and children.
According to the World Health Organization, nearly 30% of women, 38% of pregnant women and 15% of adolescent girls around the world are anaemic. Iron-deficiency anaemia decreases energy levels, causing fatigue and diminishing physical capacity, concentration, and quality of life. This affects school performance, work productivity and perpetuates cycles of poverty and malnutrition. Fortifying staples like flour with iron can ensure that almost the entire population – even women and girls in vulnerable situations – can access this critical micronutrient.
Pregnant women are at higher risk for folate insufficiency throughout their childbearing years, which means their babies may be born with neural tube defects such as spina bifida or anencephaly. Folic acid deficiency can lead to mental confusion and depression, diarrhoea, or megaloblastic anaemia.
Fortification with folic acid improves the folate status of women, greatly reducing the risk of giving birth to babies with neural tube defects, should they become pregnant. Given that some 40% of pregnancies globally are unintended and that most women start supplementation late, good pre-conception nutrition through fortification is crucial for both mother and baby.
Nutrition International works with governments, industry stakeholders and partners across Africa and Asia to increase policy coherence, scale up fortification, and improve program monitoring. In Indonesia, for example, we have worked closely with the national government to strengthen the wheat flour fortification program and advocated for the adoption of new flour fortification standards which use more effective bio-available iron compounds. Previously, there were no guidelines, leaving many millers to use the cheapest compound available, which had little impact on reducing anaemia rates. But in February, the Indonesian government passed new legislation to align the country with World Health Organization recommendations and mandates on the use of bioavailable iron, such as ferrous fumarate, ferrous sulphate or ferric sodium ethylenediaminetetraacetate for fortification.
We also work directly with millers, providing technical and business advisory support to strengthen food fortification industries. Through our Food Fortification Programme in Pakistan, we worked with wheat flour millers across the country to introduce better quality assurance and quality control, and provided testing equipment to ensure fortified wheat was up to standard. More than 1,000 of the country’s functional roller flour mills are now able to fortify wheat flour. The project is scaling up to a new phase as we endeavour to reach everyone, so that every citizen has a chance at a healthier, more productive future.
Food fortification is one of the most cost-effective and sustainable interventions with an unparalleled ability to reach entire populations with essential nutrients, particularly those who might not otherwise have access. The COVID-19 pandemic has further emphasized the value of fortification and the importance of scaling up, so that more people will get the nutrition they need – not just to survive – but to reach their full potential.
1World Health Organization. The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015
2Guttmacher Institute. Intended and Unintended Pregnancies Worldwide in 2012 and Recent Trends. Studies in Family Planning, Vol. 45, Iss. 3. September 2014.aaa