Wheat Flour Fortification

Micronutrient Malnutrition: Addressing Hidden Hunger

1. Wheat Flour Fortification Malik Tariq Sarwar Awan, Food Technologist, Chairman Research Wing to Pakistan Flour Mills Association, Editor, Wheat Milling News, PFMA . Member Pakistan Society of Food Scientists and Technologists & Munawar Hussain Program Manager Food Fortification Global Alliance for Improved Nutrition (GAIN)

2. What is Food Security? When all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. Source: according to World Food Summit FOOD SECURITY Availability of nutritious food Food Access Stability Food Utilization

3. Food Security in Pakistan

4. Food Insecurity Food Insecurity principally connected to Low production Low socio-economic status Increasing prices of food Geographic hurdles and distribution The main determinant of food insecurity is malnutrition

5. Malnutrition and Food I nsecurity The worse the food insecurity, the higher the child malnutrition

6. Pakistan’s Progress on Malnutrition Indicator NNS 2001-02 NNS 2011 1. Wasting % (Low Weight for Height) 12% 15% 2. Stunting% (Low Height for Age) 31% 44% 3. Under Weight% (Low Weight for Age) 42% 32% 4. Anemia (Children) 51% 62% 5. Anemia (Pregnant w omen ) 29% 51% 6. Iodine Deficiency (Children) 63% 36% 7. Iodine Deficiency (Women) 76% 36% 8. Vitamin A Def (Children) 13% 54% 9. Vitamin A Def (Non-pregnant women ) 6% 42%

7. Why Malnutrition Matters? 45 % attributable to Under nutrition Globally 45% of under-five deaths are attributable to under nutrition

8. Why Malnutrition Matters? Costly inefficiencies (e.g. illness, deaths) Direct links: Decreased physical productivity Indirect links: impaired cognitive development, schooling and productivity Overall loss to the economy of 3% of GDP annually Bigger than energy crises (2% of GDP)

9. Micronutrient Deficiencies Affect mainly women and children due to poor quality of diet or depletion due to losses (e.g. infections) Main deficiencies: Iodine Vitamin A Iron Folic acid Zinc Also called HIDDEN HUNGER – often invisible

10. Consequences of Iron and Folic Acid Deficiency Iron deficiency anemia Poor cognitive development Reduced body immunity and resistance against diseases Neural tube defects Increased child and mother mortality

11. “Hidden Hunger” Iron Deficiency Folic Acid Deficiency

12. Maternal Anemia Source: NNS 2011

13. Anemia - Children Under Five Years of Age Source: NNS 2011

14. Addressing Micronutrient Malnutrition

15. Addressing Micronutrient Malnutrition Food Fortification Dietary Diversification Supplementation Food fortification is safe and cost-effective intervention for the prevention of micronutrient deficiencies and has been widely practiced in developed countries for well over a century

16. Why Fortification? Could target population at large Technology - simple and well established Global success history of addressing deficiencies of micronutrients Economical - very cost-effective No need to change dietary habits of targeted population Fortification vehicles are easily accessible

17. Top 10 Investments for advancing global welfare 1 Micronutrient supplements - Malnutrition 2 The Doha development agenda - Trade 3 Micronutrient fortification - Malnutrition 4 Expanded immunization coverage for children - Diseases 5 Agricultural R&D on micronutrients - Malnutrition 6 Deworming and nutrition programs at school - Malnutrition 7 Lowering the price of schooling - Education 8 Increase and improve girls’ schooling - Women 9 Community-based nutrition promotion - Malnutrition 10 Provide support for women’s reproductive role - Women Copenhagen Consensus

18. Fortification - Key Success Factors Political commitment and support Industry support Adequate legislation Consumer a cceptance No cultural or other objection Availability of micronutrients and fortification equipment/ dossifiers Economically sustainable interventions

19. Wheat Flour Fortification National Wheat Flour Fortification Program started in 2007 with the support of GAIN Over 200 flour mills started producing fortified wheat flour More than 12.7 M people got access to fortified wheat flour Program suspended in 2011 after 18 th constitutional amendment. GAIN agreed to support Punjab Government toward end of 2013 to restart the program.

20. GAIN’s Support to Project Training and capacity building of industry and regulatory bodies Laboratory strengthening and provision of spot testing kits Set up supply chain mechanism for market based availability of micronutrients in Pakistan BCC to increase the demand of fortified wheat flour Support government and industry for legislative and legal framework Support in setting up monitoring and evaluation mechanism Assist government and industry for mechanism to pass through the fortification cost to consumer

21. PFMA’s Support to Project Secure commitment from industry Production and distribution of fortified wheat flour Set up fortification equipment at mills Demand generation of fortified wheat flour Design and use the bags for fortified flour in line with BCC campaign

22. Government Support to Project Political commitment and patronage of the program Legislation for mandatory fortification and legal framework Allow industry to pass through the minor cost of fortification to consumer Coordination and collaboration among stakeholders Awareness raising through public services messages Regulatory monitoring and enforcement of legislation

23. Thank you