India has made remarkable progress in addressing food insecurity, transitioning from severe food shortages to becoming a major food producer. The country now stands as a leading producer of cereals and for the first time in decades, the gross value added from fruits and vegetables has surpassed that of cereals, indicating a diversification in agricultural production. Additionally, India is the largest producer of milk and ranks among the biggest producers of poultry. These achievements, coupled with well-designed and implemented social safety net programs such as the National Food Security Act, which guarantees subsidised cereals to 67% of the population, have significantly reduced food insecurity.
However, the focus has now shifted from simply ensuring food availability to improving the quality of the diet consumed. Poor diets lead to both undernutrition and overnutrition. India faces the ‘double burden of malnutrition’, where both undernutrition and over-nutrition coexist. This is further exacerbated by widespread micronutrient deficiencies, often referred to as ‘hidden hunger,’ which affect both undernourished and overweight or obese individuals. Achieving optimal nutrition requires addressing various factors such as access, affordability, and behaviour changes, ensuring that the population consumes a diverse and nutrient-rich diet.
Micronutrients are essential vitamins and minerals (e.g., iron, iodine, vitamin A, and zinc etc) which are crucial for growth and development. Since the human body cannot produce most micronutrients, these must be obtained through the food we eat. Deficiency of these micronutrients, largely due to unbalanced diets, has become a global health issue, affecting nearly five billion people worldwide. In India, micronutrient deficiencies are a major public health concern – with high prevalence of anaemia among women and children being one example. Promoting a diverse, nutrient-rich diet is vital for overall health and well-being
A recent working paper from the Prime Minister’s Economic Advisory Council, titled Changes in India’s Food Consumption and Policy Implications, analysed Household Consumption Expenditure Survey (HCES) for 2022-23 and 2011-12. The findings reveal rising per capita household expenditure nationwide, though disparities remain. Notably, for the first time, food expenditure has fallen below 50% of total spending across states and consumption classes, including the bottom 20%. Consumption of fruits, vegetables, dairy products, meat, eggs, and fish has increased across all states, including among the bottom 20%. However, intake levels remain below recommended amounts for most people. Cereal consumption has decreased across rural and urban areas and among all consumption classes. Despite this, an improvement in the diversity of food consumption was seen, indicating better availability, access, and affordability, likely due to food security programmes that have enabled households to save on cereals and spend more on other food items.
The study underlined that despite increased intake of essential vitamins and minerals, the consumption of micronutrients remains inadequate compared to 2011-12. Iron deficiency is particularly concerning, as intake in most states is less than the average requirement. This is worrying because cereals, the major iron source for most of the population, especially the bottom 20%, are consumed less. This downward trend in cereal intake could further reduce dietary iron intake in these households. Anaemia, largely caused by iron deficiency, is also linked to other nutrient deficiencies, such as folate and vitamin B12. The study found inadequate consumption of these nutrients contributes to the high prevalence of nutritional anaemia in the country.
Addressing micronutrient deficiencies requires a clear strategy, including dietary diversification, supplementation for high-risk groups, and fortification of staple foods. These strategies are complementary and often used together. As shown in the HCES, dietary diversity is improving, but reaching the required level may take time. Addressing anaemia has always been a high priority in India. The revamped Anaemia Mukt Bharat programme is comprehensive and includes iron and folic acid supplementation for high-risk groups, behaviour change communication, and fortified foods in social safety-net programmes.
As part of the comprehensive strategy to address anaemia, the Government of India has decided to fortify rice with iron, folic acid, and vitamin B12. This decision was made after careful consideration of available options. Rice was chosen as the vehicle for fortification because it is consumed by about 65% of the population and is the dominant cereal distributed through the public distribution system (PDS). Although the efficacy and effectiveness of rice fortification are proven, the government implemented the programme in phases. Large pilots were conducted in 15 districts across 15 states as a learning exercise to ensure the feasibility of integrating fortified rice into the PDS. The cost-effectiveness and evaluation of these pilots was documented. Encouraged by the positive results, the government proceeded to scale-up the distribution of fortified rice nationwide. In addition to fortified rice, nutrient-rich foods like pulses and millets have been included in the PDS in many states as part of efforts to diversify and improve dietary intake.
Fortification is not a new concept in India – we have a long history of food fortification, starting in 1953 with the fortification of vanaspati ghee with vitamin A. One of independent India’s significant achievements is salt iodisation, which has nearly eliminated goitre and cretinism. Studies on iron, folate, and vitamin B12-fortified rice have shown positive results in addressing anaemia. For example, a United Nations World Food Programme study in Odisha and Uttar Pradesh demonstrated a decrease in anaemia among children and women who received fortified rice through the PDS and school meals. Similarly, a study in Gujarat noted improved haemoglobin levels, reduced anaemia prevalence, and better cognitive performance among schoolchildren who consumed fortified rice. These studies not only show the biological impact but also prove that fortified rice can be easily integrated into the existing public distribution system.
While a diversified diet should ideally provide necessary nutrients, unfortunately, this is not always the case due to factors, like availability, access, affordability, and food habits. Despite efforts to encourage people to diversify their diets, it is essential to ensure that they consume optimal levels of micronutrients. Public health authorities have formulated a combination of strategies to meet the nutrient requirements of the population, including rice fortification programme. The strategy should be viewed as part of a broader strategy to address dietary gaps in iron, folate, and vitamin B12, rather than a standalone solution. These measures, combined with disease control efforts such as improved water, hygiene, and sanitation, are likely to result in a much faster reduction in anaemia among women and children.
Rice fortification is a practical, cost-effective, and evidence-backed solution to combat micronutrient deficiencies, bringing us closer to a healthier, more nourished India.
This article is authored by Dr Rajan Sankar, public health consultant and former director, nutrition, Tata Trusts.