It often takes stepping outside India to notice what we overlook at home, for instance, identifying clues to better nutrition policy that are often hiding in plain sight.
Anyone who has stayed in the United States beyond a holiday notices, among other things, how milk and yogurt drinks taste different and keep you full longer. What’s also different is that milk is universally fortified with Vitamin D, both in the United States and Canada.
Similarly, the United Kingdom mandates fortification of flour with iron, calcium and B vitamins. In the United States and Canada, wheat flour has long been fortified with iron and folic acid, a measure associated with significant reductions of about 20–50% in neural tube defects.
Several countries in Africa and Latin America, including Nigeria and Indonesia, fortify edible oils with Vitamin A and D to reach entire populations through everyday cooking practices.
As India observes Poshan Pakhwada from April 8 to 23, the national conversation on nutrition once again returns to anaemia and to whether fortification strategies must move beyond a rice-centric approach. While POSHAN Abhiyaan spans a broader set of goals, from reducing stunting and wasting to improving maternal and child nutrition, addressing anaemia is often seen as central because it reflects many of these underlying conditions.
According to the National Family Health Survey (NFHS-5), nearly 57% of women and 67% of children in India are anaemic, underscoring the scale of the challenge. To address this, POSHAN Abhiyaan has leaned on fortification of staple foods, particularly rice, to deliver essential micronutrients at scale. Anaemia, however, is not a uniform condition. It stems from multiple causes, including nutritional deficiencies and infections, making single-solution approaches inadequate.
The logic behind rice fortification is compelling. As a staple distributed through the Public Distribution System, mid-day meals and Anganwadi programmes, it offers unmatched reach. But scale alone cannot solve a problem that is inherently complex. A strategy anchored in a single staple risks oversimplifying a multi-dimensional nutrition challenge.
Recent policy decisions to temporarily discontinue large-scale rice fortification under government schemes, following concerns around storage and nutrient stability, underscore a critical point that the effectiveness of fortification depends as much on delivery systems as on design.
This makes it even more important to move towards a diversified fortification strategy that does not rely on a single delivery channel.
It is encouraging that India has begun to move beyond a rice-centric approach. The promotion of millets that are both, nutrient-rich and climate-resilient grains, within nutrition programmes and public messaging marks an important shift. Their inclusion reflects a growing recognition that dietary diversity must complement fortification.
However, unlike staples such as milk, edible oil or flour, millet consumption depends more on behavioural change and individual preferences than on universal consumption patterns. The challenge, therefore, is to ensure that such efforts translate from policy intent into sustained dietary change across populations.
India’s nutrition landscape is shifting. While undernutrition persists, micronutrient deficiencies are no longer confined to the poorest households. Urbanisation, dietary transitions and sedentary lifestyles have created a more layered challenge, one where hidden hunger coexists with rising obesity.
Even among urban populations, deficiencies in Vitamin D, Vitamin B12 and iron are widely reported, including the paradox of widespread Vitamin D deficiency in a sun-rich country shaped by indoor lifestyles and dietary gaps. These trends point to gaps that extend beyond what a rice-centric fortification strategy can address.
India’s approach also remains largely welfare-driven. While voluntary fortification of foods such as edible oil, milk and wheat flour is permitted, actual practice or application in retail markets is uneven. As diets diversify, particularly in urban and peri-urban India, this may limit the effectiveness of a broader nutrition strategy if not complemented by additional approaches. Fortification, however, cannot substitute for diverse, balanced diets; it can only complement them.
And so, policies designed with the poorest and their basic nutritional needs in mind must now evolve to reflect a more complex and changing nutrition landscape. Expanding the current approach does not mean diluting the focus on vulnerable populations. Rather, it calls for complementing targeted interventions with a wider public health view, one that includes additional food vehicles such as edible oils, dairy and packaged staples to reach urban and peri-urban populations as well, backed by stronger regulation, monitoring and public awareness.
As India’s diets and lifestyles evolve, so too must its nutrition strategy. If prevention is to remain at the heart of public health, fortification must move beyond a single staple and reflect the complexity of the country’s changing nutritional realities.
Disclaimer
Views expressed above are the author’s own.
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