What we do

Fortify Health has a vision for a healthier world where everyone has the micronutrients they need to survive and thrive. We aim to fulfil this vision by enabling access to micronutrient-rich wheat flour to reduce and prevent iron deficiency anaemia. Iron deficiency anaemia is a formidable public health and economic issue, both in India and internationally. 
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We seek to address iron deficiency anaemia and other micronutrient deficiencies by supporting millers to fortify the wheat flour they sell, supporting government actors to provide fortified wheat flour to their beneficiaries, and generating evidence for the public about the benefits of wheat flour fortification.

Why Fortification

A Global Issue: Iron Deficiency Anaemia
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Iron deficiency anaemia, which occurs when a person does not have enough iron to carry oxygen around the body, is the most common micronutrient deficiency both in India and worldwide (WHO 2023). 67% of children between 6-59 months of age and 52% of pregnant women in India are anaemic (NFHS-5) and both of these figures have increased over the past 5 years (NFHS-4). Anaemia and micronutrient deficiencies are a global issue, but the prevalence of anaemia in India is well above global averages (WHO).

Anaemia takes a heavy toll on the people that it affects:

1. Anaemia causes chronic tiredness and fatigue and low moods, as well as depressive symptoms and heart disease;
2. Anaemia impairs cognitive development in children and lowers productivity in adults (Low et al. 2013); and
   
3. Women with severe anaemia have double the risk of dying during or shortly after childbirth (UNICEF 2019).​

How  can  fortifying  food  help  ​to  tackle
anaemia  and  micronutrient  malnutrition?

Food fortification is the addition of essential micronutrients to food staples, such as rice, flour, salt, milk and cooking oil. There are several benefits to food fortification, including: 

1. Cost-effectiveness - food fortification has been recommended by the World Health Organisation as a highly cost effective way of combating anaemia (because it is relatively cheap to fortify staple foods like wheat flour, WHO, 2023); 
2. Reliance on existing supply chains - that it can be implemented through the private sector, without substantial changes to current production or distribution dynamics or processes; and
3. Low or no need for behavioural change - fortification generally does not require consumers to significantly change their consumption patterns because micronutrients are added to foods that are already widely consumed.

What  Evidence  Is  there to support food fortification?

There is ample global evidence to demonstrate the effectiveness of large scale food fortification (and of wheat flour fortification specifically) in combating iron deficiency anaemia and other micronutrient deficiencies. To name just a few relevant studies:

• 1) A global meta-analysis of several studies from 2021 found that consumption of iron-fortified wheat flour reduced rates of anaemia by 27% (Field et al. 2021). The meta-analysis incorporated six trials. Each trial measured the change in the risk of anaemia in populations when comparing iron‐fortified wheat flour against wheat flour not fortified with iron. 


• 2) An earlier global meta-analysis from 2012 found that consumption of fortified foods reduced anaemia rates by 41% (Gera et al. 2012). The meta-analysis incorporated sixty trials involving food fortification or biofortification (i.e. using selective breeding or genetic modification to increase the content of micronutrients in crops) of different staples with iron across various geographies.
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• 3) In India, a randomised control trial in 2012 found that food fortification reduced iron deficiency rates among students from 62% to 21% (Muthayya et al. 2012). The study involved school age children being provided with wheat flour that had been fortified with NaFeEDTA (the fortificant that Fortify Health uses) for seven months.

How  is  wheat  flour  regulated  in  India?

The Food Safety and Standards Authority of India (FSSAI) has published comprehensive standards for the fortification of wheat flour, which are administered by the Food and Drug Administration of India (FDA). We work closely with our partners to help them to fortify wheat flour in accordance with those standards set by the FSSAI.

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