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The importance of flour fortification for Indonesian children

© UNICEF/2009/Salman
Flour sold at a traditional market in Eastern Indonesia is also fortified.

On January 25, Indonesia celebrates Nutrition Day. Here is one of two stories on the best interventions to improve the nutritional status of children in Indonesia which includes the promotion of breastfeeding and micronutrient supplements. The UNICEF report on the “Global Progress of Maternal and Child Nutrition” to be launched in Jakarta on this day identifies Indonesia as the fifth country in the world with the largest number of stunted children or children who are short for their age.

By Karen Emmons

JAKARTA, 25 January, 2010 — In the great rice bowl of Asia, another grain is flowing in popularity and may be a vital link to mother and child nutrition – once a little spice of government intervention is added in. Indonesia joins Japan, Republic of Korea, Malaysia, Philippines, Taiwan (China) and Thailand where half of the total wheat supply is consumed in the form of noodles and steamed breads.

Asia has become the fastest-growing wheat market in the world according to U.S. Wheat Associates, especially where gross domestic product and urbanization have increased.

Unfortunately, those foods bring little nutritional value to the table. Most of wheat’s crucial nutrients are stripped away as it is milled into flour.

“Staple foods, such as rice, noodles and bread, make up a huge proportion of the average diet, especially for the poor, but these foods are not packed with much protein, vitamins or minerals,” said Sonia Blaney, a nutritionist from UNICEF Indonesia.

The Flour Fortification Initiative is a unique partnership to promote legislation among its members.

However, some staple foods do not have to be a nutritional dead end, according to the Flour Fortification Initiative (FFI), a unique public-private partnership of more than 60 members from the flour milling industry, public health organizations, governments, academic and technical institutions, non-government organizations and international agencies, including UNICEF.

FFI’s members are working together to encourage governments to legislate the return of nutrients to wheat flour as an important and cost-effective strategy to improve global nutrition and social development.

This strategy is applauded by five Nobel Laureates, commissioned by the Copenhagen Consensus Center in 2008 to analyse optimal ways to combat the world’s biggest problems. They ranked fortifying staple foods with iron and salt with iodine as the third-best investment that governments and philanthropists could make (micronutrient supplements ranked first).

Micronutrient impact

Fortification replaces lost nutrients and makes staple foods far more nutritious without changing the taste or appearance.

Lack of vitamins and minerals in the diet is detrimental to the physical and mental potential of up to one-third of the world’s population, UNICEF and the Micronutrient Initiative reported. The World Health Organization recently endorsed guidelines for fortifying flour with iron, folic acid, zinc, vitamin B12 and vitamin A. Iron and folic acid are the two most commonly added nutrients, and these can be added to flour at a cost of about 10 US cents per person per year.

Fortifying flour with iron would help prevent a significant portion of the mental impairment that occurs among young children who do not consume an adequate level of iron. It would also increase adult productivity – thus raising incomes – and help reduce anaemia, which contributes to maternal mortality.

Women need folic acid during the first days of pregnancy to prevent neural tube defects, such as spina bifida that causes child death and a large proportion of child disabilities. Fortification is a particularly effective strategy because the alternative strategy of supplementation often only starts after women know they are pregnant – which is usually too late.

According to the FFI, an adolescent girl consuming 150 grams of fortified flour daily – about two slices of bread or two packs of instant noodles – gets about 50 per cent of her daily needs for iron and 84 per cent of daily needs for folic acid.

The few cost-benefit analyses available lean considerably in favour of fortification. Researchers in Chile, for instance, found that every $1 spent to fortify flour with folic acid saved $11.80 in medical costs; in South Africa it saved $46 and in the US it was $40 (due to the higher costs of medical care in those two countries).

© UNICEF/2009/Salman
The Indonesian government had made fortifiying flour mandatory through legislation before it can be sold in markets.

Countries that fortify

Globally, legislation in 57 countries requires the fortifying of flour with iron and/or folic acid. Some countries go further, requiring additional vitamins and nutrients, such as vitamins A and B, zinc and thiamine. Such legislation gives nearly 2 billion people access to fortified wheat and/or maize flour.

However, only five countries that make it mandatory are in the Asia–Pacific region: Indonesia are among the five including Australia, Fiji, New Zealand and Philippines. Malaysia may soon join them. Yet, flour fortification is standard practice throughout the Americas and in about a third of the flour milled in African countries.

The Indonesian government was the first country in East Asia (1998) to see the value in fortifying. A year after the onset of the 1990s’ Asian financial crisis, the “nutrition status of women and children deteriorated significantly,” said Nina Sardjunani, Indonesia’s Deputy Chairperson for Human Resources and Cultural Affairs within the National Development Planning Agency.

According to Sardjunani, Indonesia learned that a government response to a financial crisis – and a way of buffering people from it – is to fortify food through legislation in 1998.

The need for legislation

FFI has learned that millers typically will not fortify on their own initiative, despite the low cost of the process. There is no marketing value to fortifying, explains Greg Harvey, CEO for InterFlour Group, one of Asia’s largest millers and a private-sector partner with FFI. “To ensure it works,” he says, “it has to be mandatory.”

<-> InterFlour is a good example. The company operates a mill in Indonesia where fortification is mandatory. “I feel on a long-term basis it’s good business practice to serve our market – for women and children to get the maximum nutritional benefit from our product,” Harvey said.

 

 
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