A fact-finding visit by ASHA (Alliance for Sustainable and Holistic Agriculture) Kisan Swaraj and the Right to Food Campaign to four districts of Chhattisgarh (Bastar, Surguja, Korba, Kondagaon) has found the pilot programme of distributing iron-fortified rice under the public distribution system to combat anaemia to be faulty and ill-advised. This report by Rina Mukherji focuses on the conclusions drawn on the basis of a survey covering thousands of beneficiaries who received iron-fortified food under the programme
ASHA Kisan Swaraj is an alliance of several organisations that have been vocal on the rights of marginal farmers and the nutritional rights of people. The Right to Food Campaign, which was spawned by the alliance, currently operates from its own secretariat. The food fortification programme was undertaken by the state government of Chhattisgarh, under pressure from the Central Government to combat widespread anaemia among the target population. Similar conclusions were drawn by another fact-finding team which visited the state of Jharkhand.
In Jharkhand too, the state government embarked on a similar project in September 2021, selecting East Singhbhum as the pilot district. Distribution of fortified rice commenced in October 2021 and covered the blocks of Dalbhumgarh and East Chakuliya in the district. Subsequently, the project was scaled up to cover the districts of West Singhbhum, Dumka, Hazaribagh and Ranchi, besides others. In February 2022, reports of adverse effects started emerging from Karra Block of Khunti District.
Food fortification was embarked on by the government following plans for the same announced by Prime Minister Narendra Modi during his Independence Day speech in 2021. Prior to this, a pilot project for Fortification of Rice and its distribution under the Public Distribution System (PDS) had been launched in 2019, at an outlay of Rs 174.64 crore. Even as the pilot was underway, the project was scaled up to cover 248 districts in 11 states by May 2022 (as per the government’s official news portal).
Quoting a study published in the Cochrane Review in 2019, and a statement by the Indian Council of Medical Research – National Institute of Nutrition (ICMR-NIN), the team points out that there is no evidence of fortified rice addressing anaemia. Furthermore, it regrets the neglect of holistic traditional nutritional solutions incorporating millets, healthy fats, and superior grains in favour of corporate-controlled food fortification solutions.
The huge outlay for the food fortification project, which will soon cover many more districts in several states, the team feels, is unjustified. Especially since the Government of India already has an iron supplementation programme running for many years now. Besides, owing to the levels of iron folic acid intake being found to be low under earlier initiatives, the government had launched a National Iron+ initiative in 2013 to overcome Iron deficiency anaemia. Iron-fortified rice is coated, and hence takes longer to cook. Termed “plastic rice” by locals, it is very unpopular in the districts where it is distributed under the PDS. But there are serious medical implications of consuming such fortified rice.
Medical reasons against fortification
Food fortification for providing supplementary iron is ill-advised and dangerous due to other concerns. Iron supplements given through food fortification can have adverse effects on patients of sickle cell disease, thalassemia, malaria and tuberculosis. In those affected by sickle cell disorder, the red blood cells are sickle shaped. These cells break down easily, releasing iron in circulation. Regular destruction of Red Blood cells (RBCs) results in the build- up of body stores of iron in patients; further supplementing of iron through food fortification can easily lead to iron overload and damage to the liver, heart or endocrine system of such individuals.
In thalassemia, frequent blood transfusions have to be given to the patients. This results in an iron overload in thalassemia patients; supplementary iron given through food fortification adds to the iron overload and can result in cardiac damage, liver fibrosis, reproductive problems, and growth retardation.
In malaria-endemic zones, increased amount of iron in the gastro-intestinal tract affects the structural integrity and gut microflora and immune systems. This results in increased risk of malarial infections, while also making individuals prone to bacterial and viral infections.
In the case of tuberculosis patients, iron overload due to ingestion of iron-fortified food has the potential of tuberculosis flare-up. Elevated levels of iron can impair the immune defence mechanisms in a patient and can enhance the tuberculosis infection, disease progression, ultimately leading to death
Significantly, sickle cell disease (SCD), thalassemia, tuberculosis and malaria are rampant in both Chhattisgarh and Jharkhand, especially among the tribals, who form over 30 per cent of the population in these states. Hence, food fortification works against the very population it is aimed to benefit
India, it should be noted, has the second highest SCD burden in the world, and within India. SCD disproportionately impacts vulnerable tribal communities. Studies undertaken by the Indian Council of Medical Research (ICMR) have shown the prevalence of sickle cell disease among the tribal population to be as high as 5-34 per cent. Thalassemia, too, is the commonest genetic disorder in India, with an estimated 65000-67000 patients currently known to be affected with the disease.
Tuberculosis patients in India, currently number 19.33 lakh, with 2021 having recorded a 19 per cent increase. Where malaria is concerned, India carries 2 per cent of the global malaria burden and deaths due to the disease. Over 80 per cent of India’s malarial infections occur in the tribal and inaccessible parts of the country, with malaria being especially endemic to Jharkhand and Chhattisgarh.
Jharkhand is an endemic zone of Sickle Cell Disorders (SCD) and Thalassemia, with a prevalence of 8 to 10 per cent, which is twice the national average. East Singhbhum District in Jharkhand has a particularly high number of affected patients. The Mundari Communities, comprising the Munda, Ho and Santhal Tribes, are known to have high incidence of the disease. Studies conducted by researchers among the tribal people revealed nearly 87 per cent of the persons screened to have the sickle cell trait, while 5 per cent were found to actually have the disease. In view of the dangers involved, the study notes, iron-fortified food is ill-advised for distribution in these states.
(The writer is a senior journalist based in Pune.)
July – September 2022