August 24, 2021 6:50:49 pm
The Prime Minister, in his Independence Day Speech, made a path-breaking announcement to achieve independence from malnutrition. Citing malnutrition and lack of essential nutrients in poor women and children as a “hurdle” in their development, he announced that by 2024 from ration shops to mid-day meals, all rice being provided to the poor will be fortified.
The timing of the announcement could not have been more opportune given malnutrition remains one of the biggest and most persistent challenges. The National Family Health Survey 2015-16 states that every second woman is anaemic, every third child is stunted and malnourished and every fifth child is wasted. Further, over 70 per cent of the population consumes less than 50 per cent of the Recommended Dietary Allowance. Disturbingly, we have underperformed on nutrition indicators against not only similar cohort countries like China, Mexico, Brazil but also other South Asian countries like Nepal, Sri Lanka and Bangladesh. India’s low rank on the Global Hunger Index (GHI) at 94 out of 107 countries underlines the urgent need to address malnutrition and micronutrient deficiencies.
Despite efforts, there has been no perceptible decline in anaemia among women. The WHO declares it a severe health problem if 40 per cent of the population has anaemia. The NFHS-5 (2019-20) shows that actual anaemia among non-pregnant women and children has increased in 16 and 18 states/UTs respectively. A public health emergency is staring at us with consequential impacts on under-5 deaths, low working capacity and low-income generation. Malnutrition causes 68 per cent of the under-5 mortalities in India; stunted children earn comparatively 20 per cent less as adults than healthy adults. It also poses an economic burden of an astounding amount of $10 billion annually in terms of lost productivity, illness, and death. We are at risk of wasting two generations as the inter-generational perpetuation of anaemia has long-lasting consequences.
With 65 per cent of the population consuming rice at the rate of 6.8 kg per capita per month and an abundance of supply at around 350 lakh metric tonne (LMT) through social safety net programmes in India, covering 81 crore people in PDS, 8.5 crore in ICDS and 10.4 crore beneficiaries in MDM, rice inarguably is the most effective vehicle for supplying micronutrients to the vulnerable population.
Among the three pathways — bio-fortification, micronutrient-rich (vitamin B1, B6, Thiamin) unpolished rice and fortification of rice with Iron, Folic acid, Vitamin B-12 — fortified rice was found to be the best and most cost-effective option to enhance the nutrient value for improving nutritional outcomes in a short period by requiring minimal behavioural change for its acceptance. The efficacy of bio-fortification, though a potentially promising long-term strategy, is yet to be ascertained. Unpolished rice has a low shelf life (3-6 months), is susceptible to insects and microbial infestation and has low micronutrient absorption due to high dietary fibres. Integration of fortified rice in social safety net schemes such as PDS, MDM and ICDS will address the micronutrient gap sustainably.
Long-standing empirical evidence supports the benefits of rice fortification globally, with many countries experimenting with it as a tool to address malnutrition through mandatory and voluntary approaches. The WHO’s meta-analysis of 16 countries on rice fortification shows that fortified rice reduces the risk of iron deficiency by 35 per cent. Successful pilot programmes have been conducted by states like Gujarat, Karnataka, Uttar Pradesh, Odisha, Maharashtra, Chandigarh, Andhra Pradesh, and Kerala through their ICDS and MDM programmes and offer evidence of a reduction in anaemia by 10 per cent in the districts of Gadchiroli (Maharashtra) and Narmada (Gujarat).
India is in a good position to leverage established ecosystems to scale up rice fortification at the national level. FSSAI has already notified its standards in 2016. In a significant move, Centrally Sponsored Pilot Scheme on Rice Fortification through PDS, an idea that was germinated at the NITI Aayog, has been rolled out in six states (Andhra Pradesh, Gujarat; Maharashtra, Tamil Nadu, Chhattisgarh, and Uttar Pradesh) and is expected to be started in Jharkhand, Madhya Pradesh, Odisha, Telangana, and Uttarakhand soon. In total, 1.73 LMT of fortified rice is being supplied through the pilot scheme. Moreover, the Food Corporation of India is already procuring 6.60 LMT out of 31 LMT of fortified rice for distribution in the ICDS/MDM. Also, 2,600 rice millers across 14 states have installed blending equipment with a capacity to blend 14 LMT of fortified rice. 34 manufacturers of Fortified Rice Kernels (FRK), are operating in the market with an annual production of 60,000 MT, which is enough to meet the requirements of the pilot scheme, ICDS and MDM combined. This policy announcement by the PM will induce a further ramping up of FRK production and milling capacity within a short time due to definitive demand.
With this existing ecosystem, pan India expansion of rice fortification (at 73 p/kg) can be covered in two years at a minimal cost of about Rs 2,600 crore amounting to only 1.1 per cent of the total food subsidy bill but the GDP will gain by a massive Rs 49,800 crore, according to FSSAI.
The country is at a crossroads and is facing a public health emergency. Rice fortification will be a potential game-changer to steer the country away from this crisis sustainably in a short period. It can play a critical complementary role to diversification, supplementation, health, nutrition and education to combat this nutrition challenge. The success of the scaling up, however, is predicated on designing better quality programmes, data alliances, continuous monitoring and evaluation, robust quality control and assurance and gender integration to enable freedom from hunger and malnutrition for all.
(The writer is an associate at Niti Aayog)