Distribution of iron fortified rice through government schemes as a “silver bullet” to curb anaemia must stop in States like Jharkhand, which have large tribal populations that suffer from sickle-cell anaemia, thalassemia, and tuberculosis, for whom an overload of iron can create adverse health issues, warn activists, who in a fact-finding exercise discovered that neither field functionaries nor beneficiaries had been educated about the potential harms, and there were no warning labels despite the food regulator’s rules on fortified foods.
According to a report prepared jointly by the Alliance for Sustainable and Holistic Agriculture (ASHA-Kisan Swaraj) and the Right To Food Campaign, Jharkhand, where fortified rice is being distributed under Central government-funded schemes such as the public distribution system (PDS); PM-Poshan (erstwhile mid-day meal scheme) at schools; and Integrated Child Development Services (ICDS or anganwadi services), consent is not being obtained from beneficiaries.
PDS dealers and frontline workers too have not been informed beforehand about the potential harmful effects of fortified rice for certain categories of the population.
The fact-finding team discovered that among the beneficiaries who received fortified rice in the State were also patients diagnosed with thalassemia, sickle cell disease, and tuberculosis, and there may be many more who have been not diagnosed yet.
Thalassemia, sickle cell anaemia and malaria are conditions where there is already excess iron in the body, whereas TB patients are unable to absorb iron. Consumption of iron-fortified foods among patients of these diseases can reduce immunity and the reduce functionality of organs.
Jharkhand is an endemic zone of sickle cell disorder and thalassemia, with a prevalence of 8%-10%, which is twice the national average. Jharkhand is also an endemic zone for malaria — in 2020, the State ranked third in the country in malaria deaths.
“The Right to Informed Choices about one’s food is a basic right. The right to know what one is consuming is also a basic right. In the case of rice fortification, it is seen that no prior informed consent was ever sought from the recipients,” notes the report.
The Food Safety and Standards Authority of India’s (FSSAI) Food Safety and Standards (Fortification of Foods) Regulations 2018 require that fortified food packets must mandatorily display the fortification logo (+F), and that every package of food fortified with iron shall carry a warning statement that people with thalassemia may consume it under medical supervision, and persons with sickle cell anaemia are advised not to consume iron fortified food products. The rule came into effect from March 2022.
Often, these warnings were missing from gunny sacks, and even when they were present, they carried little import as rice is often distributed loosely or without packaging in the PDS.
There are also instances of women cooking the rice, including in schools and anganwadis, picking out by hand and discarding the fortified rice kernels that are mixed with regular rice kernels as they are easily identifiable, and referred to them as “plastic rice”.
In 2019, the Union government initiated a pilot scheme for fortified rice and its distribution under the PDS for three years in 15 districts of 15 States till March 2022 to deal with the high levels of anaemia in India. In 2021, Prime Minister Narendra Modi revealed that fortified rice would be supplied in all food schemes of India by 2024. The Union Cabinet on April 8, 2022 approved phased expansion of rice fortification across the country by March 2024. Though the usage of fortified rice has been scaled-up, there is no evaluation report yet of the pilot started in 2019.
The report recommends that even a screening process before the distribution of iron fortified rice is unlikely to be of help as households are unlikely to cook two different types of rice for those who can consume this kind of rice and those who can’t, and, therefore supply and distribution of iron fortified rice should stop in Jharkhand, and the State government must reject rice fortification in government food schemes as an approach to tackling malnutrition.
The report recommends instead promoting diet diversity by adding millets, pulses and eggs to the PDS.
“There is a need for precision because no nutrient taken in excess will do you good. Universal fortification is not the answer for nutrition deficiencies,” said Dr. Anura Kurpad, Professor, St. John’s Medical College and Hospital, Bengaluru, who has also argued that ”layering” of government schemes, such as the distribution of iron-folic acid tablets at anganwadi centres and schools as well as iron fortified salt in some States may lead to excessive consumption of iron leading to health risks.
