Let’s talk about…wheat flour fortification

By Haris Gazdar

Wheat flour chakki in Pakistan
Photo credits: Wikimedia Commons

1. What is food fortification?
Food fortification is the addition, usually at an industrial scale, of essential micronutrients to commonly consumed foods, to overcome nutritional deficiencies in vulnerable populations. It is a response to ‘hidden’ hunger – or the persistence of deficient diets in populations where hunger, as such, may not be obvious. Common examples of deficiencies are minerals (iron, zinc, iodine) and vitamins. Common examples of food fortification are salt iodisation, fortification of milk, condiments, cooking oils and staple foods with various micronutrients.

2. Why is it in the news?
Major stakeholders in the world of nutrition are supporting or taking part in fortification initiatives currently being launched. These are donor-supported programmes in various provinces to fortify wheat flour with iron and folic acid, salt with iodine, and cooking oil with Vitamin A. Mandatory regulation has been put in place in some provinces.

3. Why is food fortification so popular among stakeholders?
It seems like a low-cost response that can reach large numbers of those in need relatively easily through existing government and market systems. It does not require major economic uplift or poverty reduction – in fact it is best suited to addressing micronutrient deficiencies precisely in those populations which no long face extreme hunger and poverty.

4. So, does it really work?
Yes, no, maybe.

Salt iodisation has a good record globally and in Pakistan. Staple food fortification with folic acid has worked in many countries to address a foetal condition known as NTD. But there is little evidence that staple food fortification with iron reduces anaemia.

And in Pakistan the fortification of wheat flour with iron and folic acid has been tried several times without any publicly available evidence of success.

5. What is the hitch with wheat flour fortification?
There may be several, some technical others practical.

Technically, there is no clinching evidence that adding iron to staple food is an effective way of reducing anaemia. There are questions about quantities and absorption.

Practically, for fortification to be even considered, it should be applied to a food that is consumed by much of the target group through the year. In Pakistan there is no precise information on:

• What proportion of wheat flour that is consumed is milled industrially? Estimates range from 30 to 50 per cent. 
• What proportion of the population consumes milled flour all-year round, and what proportion of the population most vulnerable to anaemia consumes it? 
• Why do most rural households and many urban ones prefer chakki flour, and those that do use milled flour often opt for ‘fine’ varieties rather than regulated flour? 

6. Anything else?
Yes.

Around half of Pakistan’s population suffers from inadequate energy intake. One in three households say that they are vulnerable to hunger. So, Pakistan needs to urgently deal with actual hunger and not just hidden hunger.

7. What does that have to do with wheat fortification?
We need a serious reform of food security policies to ensure that no person is vulnerable to hunger. Current policies which aim to address food security are based on government wheat procurement and its subsidised supply to private sector mills who are then supposed to provide subsided flour to the population. This clearly does not work. The system has created adverse incentives and rent-seeking for capturing subsidies. Regulatory weaknesses in the sector arise from these rent-seeking opportunities.

Wheat fortification projects, by focusing on a technical solution around the same inefficient sector, are in danger of doing two things:

• Detracting from the need to address actual hunger, and not just ‘hidden’ hunger 
• Ignoring numerous sector analyses which call for a reform of the wheat system 

8. What needs to be done?
Policy and public debate must focus on ‘hidden’ hunger as part of a broader agenda of food security and combatting hunger – rather than imagining that stand-alone technocratic solutions are possible. And existing fortification programmes might avoid disappointment if they recognised some of the problems highlighted here, revised some of their expectations, and took on board existing critiques of the wheat subsidy system. 

This blog is a part of a new “Let’s talk about…” series that distils key research findings aiming to start a public conversation on emerging issues.

The Dairy Reform That Wasn’t

By Rashid Mehmood and Natasha Ansari

Modern, packaged milk still struggles to compete with the traditional alternative of loose, raw milk.
Photo credit: Fawad A. Najam, Flickr.com

There is a public debate about the quality and safety of milk sold to consumers. Most recently the Supreme Court took regulatory action with respect to some brands of packaged milk and also issued notices to companies regarding clearer labeling of whiteners as not being milk. Public attention on the dairy sector is welcome, but as government and courts gear up for action, it is important to understand the roots of current regulatory lapses, and to set out a broader agenda of reform that goes beyond consumer protection.

Understanding agri-food value chains for nutrition

by Nigel Poole, Haris Gazdar and Mar Maestre

Photo credit: Flickr/ADB

Undernutrition is a central and persistent challenge for global development, above all in South Asia. Mobilising agri-food businesses to support efforts to reduce undernutrition is challenging. The LANSA (Leveraging Agriculture for Nutrition in South Asia) team has been researching for the past two years how the markets for food can be improved so that substantive and sustained consumption of nutrient-dense foods by the poor in households that are post-farm-gate is achieved. Here, nutrient rich foods are those that, if consumed in adequate quantities (WASH and health conditions not considered) are likely to improve the nutritional status of individuals who are undernourished in terms of micronutrients. We understand agri-food value chains as the initiatives, either donor, government or business driven that we will be analysing.

Plugging the gaps between farm and fork

by Samar Zuberi and Rashid Mehmood

Increased production does not mean improved diets for the undernourished
Photo credit: Flickr/Asian Development Bank

Nutrition has been an increasing concern in Pakistan for almost half a decade. The release of the 2011 National Nutrition Survey showed no improvement in nutrition indicators in decades, and highlighted alarming rates of undernutrition, and micronutrient deficiencies. These results alongside a strong international push to re-focus on nutrition have succeeded in placing nutrition higher on the policy agenda within Pakistan. Pakistan has recently adopted the Sustainable Development Goals (SDGs), which were proceeded by the Millennium Development Goals (MDGs). SDG #2 aims to end hunger, achieve food security and improve nutrition and promote sustainable agriculture.

Making value chains work for little children

by Samar Zuberi

Photo Credit: Wikipedia/Scanned from 1000 Fragen an die Natur, via The Metropolitan Museum of Art, Rogers Fund, 1948.

In Pakistan, 44 per cent of children under the age of five are stunted while 15 per cent are wasted and 32 per cent are underweight (NNS, 2011). These statistics indicate that malnutrition is a serious problem in Pakistan - according to World Health Organisation classifications Pakistan falls in the ‘very high’ range for severity of malnutrition for all three figures. The occurrence of micronutrient deficiency is also alarmingly high with half of the population of children under 5 suffering from anaemia and vitamin A deficiency, while 39 per cent are deficient in zinc (NNS, 2011).

Despite the high proportion of the population that is involved in agriculture (45 per cent of the workforce) many rely on the market to purchase their food. Seventy-seven per cent of households are net buyers of wheat, the main food staple in the country. Good nutrition, however, is not just about having enough bread to fill your belly. It is about having a varied and nutritious diet with adequate levels of protein and micronutrients. And for nutritious foods the reliance on markets is even greater than it is for the main staples, in urban and rural areas alike. Understanding how markets can work better to deliver nutritious foods to the poor and undernourished, therefore, can help to improve diets and in turn nutrition.