A ready solution to tackle anaemia

Why in the News

Anaemia affects over half of Indian women and almost three-fourths of children, yet Double Fortified Salt (DFS), a proven preventive tool, remains underused. Its inclusion in the Public Distribution System (PDS), India’s largest food safety net, is uneven because it is left to State governments. The recently revised 7X7X7 Anaemia Mukt Bharat (AMB) strategy seeks a comprehensive response.

What is Double Fortified Salt, and what problem does it solve?

1. Iron-deficiency anaemia: Anaemia, driven largely by a lack of iron, causes harm across a lifetime:
   • maternal deaths;
   • malnutrition passed from one generation to the next;
   • impaired cognitive development and lost productivity.
2. What it is: DFS is salt fortified with both iodine and iron. It is like the iodised salt households already buy, with iron added.
3. Why salt works: Virtually every household eats salt daily in predictable amounts, whatever its income or location. So DFS solves sustained compliance, people getting iron regularly, because no one changes a habit.
4. Ready platform: Universal Salt Iodisation, which adds iodine to edible salt, reaches around 95% of households, so the delivery chain already exists.
5. The takeaway: India can deliver iron through a food everyone already eats, unlike supplements and diet changes that depend on regular adherence.

What does the evidence show?

1. Proven impact: A global review found DFS can reduce anaemia by up to 21%.
2. Indian trials: Randomised controlled trials in Bengaluru, Darjeeling and Punjab, and large-scale use in Uttar Pradesh, showed better iron status. Consumers accepted the salt, and it proved highly cost-effective.
3. Low cost: DFS costs about ₹14 to ₹20 per person a year.
4. High return: Its benefit-cost ratio is 4.2:1, meaning each rupee spent returns about four rupees in better health and productivity.
5. Manufacturing base: India has established fortification technology, centralised salt production and laboratory infrastructure, which make quality checks simpler than for many other fortified foods.

Why has DFS not scaled nationally?

1. AMB’s broad design: The AMB strategy covers prevention, screening, treatment, dietary diversification and behaviour change, yet leaves DFS underused within it.
2. State-by-state reach: DFS reaches an estimated 76 million people in only four States through safety-net programmes.
3. Partial mandates: The Food Safety and Standards Authority of India (FSSAI) has issued a DFS standard. The Centre mandates DFS in PM POSHAN, the school meal scheme, and Integrated Child Development Services (ICDS), the child nutrition scheme.
4. PDS reach: The PDS reaches around 800 million beneficiaries, which makes it the decisive channel for any national rollout.
5. Fixable barriers: The obstacles to wider adoption lie in policy and funding decisions, not technology, and are within India’s capacity to fix.

Challenges

1. Quality risk: DFS delivers its benefits only when made to validated specifications, so weak quality control undermines it.
2. Limited market reach: Commercial availability and consumer awareness of DFS remain too low for nationwide uptake.
3. Blood disorders: Iron fortification must go with screening for haemoglobinopathies, inherited blood disorders such as thalassaemia and sickle cell disease.
4. Salt reduction goals: Promoting salt as an iron carrier has to stay aligned with India’s sodium reduction goals.

Way Forward

1. Central flagship scheme: The Centre should take DFS to all States, especially through the PDS, under a central flagship scheme.
2. Dedicated financing: Back the scale-up with dedicated funds and a firm policy commitment.
3. Regulated rollout: Run DFS within a robust regulatory framework that complements AMB, borrowing monitoring systems from the rice fortification programme.

Conclusion

India’s anaemia response has a preventive tool ready but no national channel to deliver it at scale. Whether the Centre builds that channel through the PDS, instead of leaving uptake to each State, will decide whether DFS becomes a model for other low- and middle-income countries.

Government Initiatives on Hunger and Malnutrition

1. POSHAN Abhiyaan 2.0: A mission-mode approach to improve nutritional outcomes for children and mothers.
2. Fortified rice: Rice fortified with iron, folic acid and vitamin B12 has been rolled out across all districts covered by the National Food Security Act, 2013, to combat anaemia.
3. Food Fortification Resource Centre (FFRC): Supports scaling up fortification in staple foods.
4. Eat Right India: An FSSAI initiative promoting safe, healthy and sustainable food.

Matching Previous Year Question

“[2023] Consider the following statements in the context of interventions being undertaken under Anaemia Mukt Bharat Strategy: 1. It provides prophylactic calcium supplementation for pre-school children, adolescents and pregnant women. 2. It runs a compaign for delayed cord clamping at the time of child-birth. 3. It provides for periodic deworming to children and adolescents. 4. It addresses non-nutritional causes of anaemia in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis. How many of the statements given above are correct? (a) Only one (b) Only two (c) Only three (d) All four ANSWER: (c)”