Globally, deficiencies in micronutrients are staggering in scale. According to some estimates, between 40 and 60 percent of all children in developing countries suffer negative health consequences from not receiving enough iron, and a similar percentage don’t get enough Vitamin A.
One response to this problem has been more widely adopted than any other: food fortification, the process of adding micronutrients to basic foods such as wheat flour, salt or vegetable oil. According to the Food Fortification Initiative, 81 countries have passed legislation requiring at least one cereal food to be fortified.
While the rationale behind this approach is clear: fortification costs relatively little and has the potential to rapidly reach large numbers of people, case studies by IDS and partners have highlighted that fortification programmes need to do more to have an impact on the social groups that suffer the most from undernutrition – especially the rural poor. These programmes need to examine whether they are successfully covering the products and markets that reach the poorest people.
Why mandatory fortification as a nutrition strategy?
There is a clear logic underlying using legislation to make fortification mandatory: markets, if left on their own, don’t provide enough nutrient-dense foods. This is because consumers are often unwilling to pay for these foods compared to cheaper, unfortified alternatives, and there are numerous products that falsely claim to contain added nutrients or provide health benefits.
Mandatory fortification gets around these challenges by levelling the playing field, requiring all food producers to add micronutrients to their products. At the same time, they avoid the complexities of changing consumer behaviour by providing nutrients in products that people already eat.
The difficulty of regulating value chains at the bottom of the pyramid
- To be successful, a fortification programme needs to accomplish two things: Cover the products that poor people eat
- Motivate ALL businesses making the product (and similar alternative products) to comply with the rules
Our research in Nigeria and Tanzania highlights why these conditions are difficult to achieve.
Even under the best of circumstances, motivating businesses to comply with fortification requires a well-functioning regulatory system. Experience from Nigeria shows how difficult it is to achieve this: even with support from government and donors, and commitments from large companies, only about 30 percent of products covered by the programme contained enough micronutrients.
Meanwhile, the value chains that reach poor people at the ‘bottom of the pyramid’ are difficult for policymakers to regulate. For example, in Tanzania, there are tens of thousands of small businesses processing maize flour, many of which do not appear in government records. One donor-funded project has strived to motivate these small businesses to fortify since 2011. Yet, as of early 2014, none of them had started fortification – most were unable to meet the requirements for registration with the government.
Such experiences suggest that programmes need to provide support for small enterprises over longer periods, while also improving the ability of regulating institutions to cover these markets.
Fortification programmes need strategies to work with informal businesses
Food fortification programmes and partnerships should develop strategies to ensure they reach the poor, and recognise that success with larger companies doesn’t necessarily lead to better nutrition for the poorest people. If they are to improve nutrition for the poorest, programmes need strategies for working with small and informal businesses. They also need to grow and protect households’ ability to access these foods through social protection.
We still have a lot to learn about what combination of approaches works. Our policy briefing on fortification in Tanzania recommends that policy actors and donors should pursue the following actions:
- Invest in robust regulatory systems that cover both large and small food businesses and are effective at the local level.
- Create incentives for small enterprises to complete business registration – even if they are not currently fortifying. This will make them easier to identify, support and monitor.
- Fund research on how poor households source food, and strengthen national surveillance systems. Nutrition stakeholders need much more accurate data on which groups are reached by which fortified products.
- Government and donors should fund other programmes that do reach the poorest households, including social safety nets, food distribution and support for the poorest farming households.
About the Authors
Ewan Robinson is Research Officer at Institute of Development Studies, involved in the ‘Strengthening Agri-food Value Chains for Nutrition research project‘.
Martha Nyagaya is Food Security and Nutrition Advisor at Irish Aid.
This blog was previously published on Globalisation and Development and is reproduced with permission.
6 Responses
…with all the efforts to fortify, spending untold millions of public and private funds, it seems that the coordination efforts there could be used to inform people of other foods rich in Vitamin A in their fields or near them. A quick glance at the NIH (National Institute of Health) site and a list of foods come up that, from last time I visited the tropics, are abundant in just about every shamba, village, or town. See here: http://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/
Foods like: Sweet Potato (white or orange), Leafy Greens, Carrots, Melons, Sweet Peppers, Mangoes, Cowpeas, Broccoli, Tomato Juice…among others (the last two would be outliers for a poor family).
From my experience, it seems that cultural issues are at play here. Are Mangoes just foods that children eat? or are they sources of food that could be preserved if they were valued? Are collards (which seed like crazy and grow over two or three seasons) not sought after in lieu of cabbages? Are sweet potatoes so much a ‘food security’ crop that they cannot be harvested for ongoing consumption? *Sweet potato can stay in the soil for quite a while and be reproduced quite easily. Cowpeas could be substituted or mixed with beans.
The fortification question seems to me like a once tried experiment that went well with certain crops (wheat flour/folic-acid) or products (salt/iodine; vitamin D to milk, butter, oils) and in refugee camps; but the ongoing reality is that even with reduced budgets, families can eat mixed meals if we dealt with some of the cultural baggage that many carry with eating white maize meal, white bread, white Irish potatoes, white rice, etc.
@johnbrittell @CapitolFood
John, thank you for your comments. You are right to point out that there is a huge diversity of nutrient-rich fruits, vegetables, etc. Many households already grow/buy these foods, but there is huge variation in availability – even between regions in Tanzania. They are perishable and depend on local supply so there are usually seasons there are few fresh foods available. They also tend to get shipped from rural areas to cities or exported, where consumers can pay much higher prices.
There are certainly plenty of initiatives funded by governments or donors to encourage people to produce more of these foods. (often called ‘nutrition-sensitive agriculture’ – very trendy at the moment). I think we know much less about ensuring these foods consistently reach the groups that are most vulnerable to undernutrition (especially those in the ‘1000 days’).
Why do national governments and international agencies still seem to put much more money and effort into large fortification programmes? Our hunch is it has a lot to do with political economy. The reach of these programmes is also easier to measure – and can provide big numbers (the programme claims to reach 10 million people, in Tanzania). Whether these numbers would hold up to rigorous assessment is another question.
If you are interested in programmes targeting nutrient-rich fruits, vegetables, etc., check out our recent report on policies and nutritious food in Tanzania. There’s a section looking at these programmes.
http://opendocs.ids.ac.uk/opendocs/bitstream/handle/123456789/4304/…
Hi Ewan,
Thanks for your article, always interesting to read your work. I stumbled upon this piece from the newsletter.
What are your thoughts on the resource-poor rural households who grow their food? In Ghana I am familiar with QPM varieties (Quality Protein Maize) where small-scale rural farmers can buy high-protein maize seed. However, most rural farmers lack access let alone the financial resources at the time of planting to buy certified seed to sow. Further to the question, these rural households would typically not buy staple crops for their meals, and therefore I imagine a national fortification initiative would completely overlook these households (who probably need it most).
I am minded to agree with John’s point of view on this. I am concerned as to who really benefits from these fortification programmes and their long term impact on the food chains. Why isn’t this money spent on teaching people the value of good nutrition based on what they have access to, especially the varieties that occur naturally or in the wild. I appreciate that some areas of the world are food poor but equally concerned that the” sachet foods” are peddled in areas with plenty of food which in my experience has contribute to food waste.
Dear Wayne and Ida, Thank you both for your comments.
Wayne – Very good point about smallholder farming households. I agree, my hunch is that centralized fortification will not work for them, due to high distribution costs, extremely low spending power. There’s lots of work on promoting home vegetable gardens, but less analysis of how this fits into the rural household economy (how much labour? How much competition with growing emphasis on cash crops?) I would guess there is no one size fits all solution, and models should probably vary from place to place. On quality protein maize and other biofortified crops: There’s lots of hype, but many of the initiatives focus on breeding crops with higher nutrient content, but don’t necessarily engage with local farming systems to understand how farmers make decisions about what they plant, eat and sell. Two interesting anecdotal stories: first, the well-known success of orange-fleshed sweet potatoes in some regions in Mozambique and Uganda, where there was an existing strong market for white sweet potato. These programmes did training for local traders and public awareness to generate demand; as a result, farmers seemed to be willing to grow more. Second, I had a conversation with a crop scientist at CRI (Ghana) who said that, although few farmers grow centrally-released Quality Protein Maize seed, he estimated that 70 percent of all maize contains QPM genes. Over time, farmers were selecting maize for pest resistance, which had reduced protein content somewhat. It didn’t work out as planned, but seemed like there was an element of success there. (Forgive me for being hazy on the details and the science.)
Ida – Good points. I agree, more work is needed on the political economy of which kinds of nutrition programmes are supported. I’m not an expert in Behaviour Change Communications, but I wonder if one reason large BCC programmes don’t get more focus is because the outcomes depend on many drivers (changing incomes, food prices, who makes decisions in households) and funders want interventions whose impact they can measure easily. But we shouldn’t underestimate the difficulty of trying to shape people’s preferences for food – I wrote a blog about this last year.
http://www.globalisationanddevelopment.com/2013/08/paying-for-nutri…