Scaling up production and distribution of fortified salt in India
Iron deficiency is the most widespread form of malnutrition and afflicts nearly two billion people globally, primarily women and children. In India, iron deficiency is to blame for more than 200,000 maternal deaths each year, and the rates of anemia are staggering — 53% of women ages 15-49 and 58% of children ages 6-49 months are affected. Hundreds of millions of women worldwide are iron deficient, which negatively affects cognitive functioning and energy levels.
Following two decades of research in Canada, a cost-effective and sustainable way to reduce iron deficiency and anemia was developed by scientists. The process involves double fortifying iodized salt — consumed daily by 80% of India’s population — with iron, which combats anemia.
Producing double-fortified salt
The double-fortified salt (DFS) technology was transferred from the University of Toronto to JVS Foods in Jaipur, India. JVS Foods licensed the technology and established production facilities to make the iron premix in mass quantities so that designated salt producers could blend it with iodized salt. A full-scale commercial plant was built, commissioned, and subsequently expanded to produce enough premix to create 300,000 tons of DFS, enough to meet the needs of nearly 100 million people. Other leading salt producers have retrofitted their plants to manufacture DFS at scale, creating almost 500,000 tons of DFS production capacity overall within two years. The production of the salt is also very economical: adding iron costs less than CA$0.25 per person per year.
A microencapsulation technology helped to prevent any unwanted interactions that occur when iron and iodine interact (when iodine evaporates the iron becomes less effective, turning the salt black and causing a metallic taste). The premix was refined to make it more palatable to consumers (e.g., taste, smell, colour).
In 2018, double-fortified salt (DFS) reached 50 million people in India, up from zero in 2016. Several key factors contributed to the rapid scale-up in production and distribution of DFS, including strong government backing; distribution through the public system; the massive consumer reach of iodized salt; and a strong partnership between public, private, and civil society organizations.
This highly cost-effective model was first introduced across 10 districts in the state of Uttar Pradesh. The state now supplies DFS through its public distribution system (PDS) and subsidizes the cost for 15 million low-income consumers in districts with the highest levels of anemia. The states of Jharkhand and Madhya Pradesh have since launched similar programs (subsidizing DFS for 25 million people and 10 million people respectively), and several other states are also considering adopting the model. Approximately 60 million 1 kg bags of DFS have been produced and distributed through more than 8,000 Fair Price Shops, and field reports show that 100% of the DFS stocks in the stores are being purchased each month by consumers.
Large signs at retail shops and public presentations communicate the value and benefits of DFS and more than 10,000 village women health workers were trained to promote its health benefits.
Informing decision-makers to actively promote DFS to processors and consumers
The National Consultation on Anemia, hosted by the All India Institute of Medical Sciences New Delhi and India’s Ministry of Health and Family Welfare, concluded that a daily intake of 10 grams of DFS can contribute to reducing anemia. This recommendation will inform the government’s policy and will guide programming related to the prevention and treatment of anemia, especially in women and children.
The project has been supported at the national level by the Ministry of Women and Child Development and the Ministry of Health and is guided under the auspices of the Food Standards and Safety Authority of India. National policymakers issued a circular requesting the use of fortified foods in state programs and have set a technical standard for DFS that allows it to be used. Large national private sector brands are carrying out internal testing of DFS samples for potential commercial distribution outside the PDS.
Major population-based studies are underway to examine the health impact of DFS among millions of people in India.
Economists at the St. John’s Research Institute in Bengaluru are calculating the economic impact of DFS use and a digital marketing campaign is in the works with the government of Uttar Pradesh to promote DFS among consumers via voice messages sent to their mobile phones.
Meanwhile, the research team is developing ways to encapsulate or add other micronutrients to double-fortified salt, including folic acid, vitamin B12, and zinc, as well as adding iron to tea.
The Canadian International Food Security Research Fund is jointly funded by IDRC and Global Affairs Canada.