Let Them Eat Fortified Rice...
S Krishnaswamy
THE 75th year of independence heard the announcement, from the ramparts of Red Fort, that poor Indian people were to be given rice fortified with iron and vitamins through the public distribution system (PDS), the school midday meals scheme and other government programmes. The ostensible reason for this declaration made in 2021, was the reduction of malnutrition and anaemia in the population out there. Who would have thought the beneficiaries might be a cartel involving a mining company that was started in 1902 called the Dutch State Mines (DSM) that expanded into the lucrative food business. The cat came out of the rice bags thanks to the investigative articles of the Reporters Collective which showed that the scheme that was going to affect about 80 crore Indians was started without evidence and preparation.
Even the department of expenditure, in an office memorandum, warned in 2019 that universalising fortified rice supply without first studying the outcomes of the pilot project, is premature. The problem is not the technology of fortified rice. It is just the lack of quality evidence in the global and Indian context that fortified rice will iron out anaemia and malnutrition. But, the poor were to be blessed with fortified rice, which in this case is rice mixed at a fixed ratio with kernels made from premix (controlled by a cartel) containing iron and vitamins added to milled rice and shaped like rice – at a cost of Rs 2,700 crores annually till 2024. As a spin off, a cartel of six organisations, including a Dutch company would have a bonanza of Rs 1,800 crores annual business.
FOOD FORTIFICATION AND INDIAN CONTEXT
Food fortification is the deliberate increase of micronutrient(s) in a food so as to improve the nutritional quality of the food. There are several distinct ways of fortification that are possible: biofortification through engineering, microbial methods such as probiotics, industrial ways such as adding micronutrients to flour, rice, cooking oils, sauces, butter etc during manufacturing or processing or home fortification which involves adding micronutrients as tablets or packets during cooking or consuming foods.
In 1953, hydrogenated edible oil (vanaspati) was fortified in India with vitamin A and vitamin D. In the 1960s, India was one of the early countries to start iodine fortification of salt based on a path breaking work done in 1956 in the Kangra Valley, Himachal Pradesh that showed the cause of endemic goitre was iodine deficiency and people getting iodised salt had significant reduction in prevalence of goitre. These were the days when solid science preceded policy announcements. The initial programme in 1962 was restricted to the regions then identified as having severe incidence of goitre. However, when subsequent work showed that the problem is widespread geographically, the programme was expanded to universal salt iodisation, mandating the addition of iodine to salt, not as a decree but by public policy intervention based on studies.
Reams have been written about the extent of anaemia and malnutrition in the country with arguments of the “hidden hunger” of micronutrient deficiency based on the National Family Health Surveys. To give an indication, the NFHS-5 gives the statistic that 1496 news articles dealt with malnutrition and 793 were on anaemia!
But is the solution to simply throw more iron and other micronutrients into the works? Arguably not. One major problem is that anaemia and malnutrition are related to economic inequality. As a recent study pointed out, the greater incidence of anaemia is related to poorer socio-economic conditions, lower education, gender, rural background and number of children. It requires not just a technological fix but a mix of social, cultural and economic solutions. And within the existential situation, as nutrition experts point out, a diversified diet using locally available foods is the sustainable way to fight malnutrition.
Interestingly, the Parliamentary Library and Reference, Research, Documentation and Information Service (LARRDIS) of the Lok Sabha Secretariat brought out a background note on food fortification in India for the members of parliament in July 2022, that goes into the results of a study from UP and Telangana looking at the excess intake of micronutrients due to consumption of fortified foods and says. “The evidence suggests that there is a prevalence of excess micronutrient intake, which kills the whole essence of the food fortification programs as the aim is to add different micronutrients to benefit public health with minimal risk being caused to health.” As to the solution to this problem, the note goes on to mention “Rather than making fortification mandatory in case of a single staple, the focus should be on people having a diversified diet”. Adding more micronutrients through fortified food staples like rice to existing pharmacological iron supplementation becomes counterproductive leading to a situation when the cure can become a malady. “Also worrying is that significant doubt has been raised whether excess iron, as if inevitable in many children will do serious harm. These may not yet have been proven, but since we are talking of harming normal children, the level of precaution needs to be much higher” says Dr T Sundararaman, former executive director, National Health Systems Resource Centre.
The one size fits all approach to forcing people to consume the mandated iron fortified rice, irrespective of the nutritional and medical background was exposed by activists from the Alliance for Sustainable and Holistic Agriculture (ASHA) and the Right to Food Campaign (RTFC) in their fact finding missions in May and June 2022 to Jharkhand and Chhattisgarh. They found that especially adivasis in these regions were at risk because of their medical conditions of either thalassemia or sickle cell disease which is contra indicated for iron fortified rice since it can lead to excess presence of iron causing deleterious side effects.
It turns out that both World Health Organisation guidelines and Cochrane Reviews which is a gold standard in the field of medical research say that “Fortification of rice with iron (alone or in combination with other micronutrients) may make little or no difference to the risk of anaemia”. In 2019, the Centre launched pilot projects to study the effect of mandatory fortified rice through the government schemes. 15 states consented and only six started distributing fortified rice in one of its districts. Only one of them submitted its report. However, even as the pilots were underway the diktat for fortified rice to be pushed upon the poor was made. Administrative file notes by officials for getting approvals ended up referring to the prime minister’s speech of August 15, 2021. Eight months after the decree, Niti Aayog in a fire fighting exercise decided to study the pilot projects. It came out with a confidential report that said the pilot schemes had been badly implemented, with low quality control and poor science. But, even without the clothes the emperor marched on.
THE BENEFICIARIES
Why should fortified rice be hastily served given the risks and lack of 'evidence'?
In 2016 at Cancun Mexico, DSM sponsored a meeting of global nonprofits with the agenda to scale up rice fortification in developing countries. Policy advocacy for influencing governments like India became important. Just two months afterwards the Government of India’s food regulator Food Safety and Standards Authority of India (FSSAI) set up a Food Fortification Resource Centre (FFRC) for promoting fortification across India! Not surprisingly also, FFRC setup a partnership with these global nonprofits enabling them to attend important policy meetings that were ‘closed doors’ where they could lobby for food fortification with those that matter. They were even able to conveniently help the government setup standards for rice fortification. The Reporter’s Collective investigation found that even government manuals had plagiarised from the ‘toolkits’ of the nonprofits! As Dr Sundararaman mentions, “The whole evidence build up that led to the policy has been exposed as having been ridden with conflict of interests and corporate influence”.
In Hyderabad a 3,600 tonne capacity factory to produce fortified rice kernels was setup by DSM in April 2023. François Scheffler, president, DSM Asia Pacific told the Indian media: “We are very thankful that Prime Minister Modi’s government has mandated the fortification of rice”. DSM's Indian firm has seen healthy growth coinciding with the scheme and is not malnourished or anaemic.
