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UNICEF Urges Fortification of Staple Fooods to Improve Child and Maternal Health and Economic Gains

© (Left to right) Ms. Vilma Tyler, UNICEF Nutrition Specialist, Mr. Sheldon Yett, UNICEF Representative and Dr. Bujar Osmani, Minister of Health

Skopje, 23 June 2009: Opening a regional workshop on flour fortification, UNICEF Representative Sheldon Yett urged participants to work with industry and host governments to ensure flour consumed in their countries was fortified with micronutrients. Fortifying flour is a proven cost effective strategy to improve population health and productivity.

“Wheat flour is a major food staple consumed regularly by all population groups.  Most of the natural vitamins and minerals of wheat are lost during the milling process. Fortification allows for the restoration of the lost nutrients.  Costing only pennies per ton, fortification is a proven strategy to boost the nutritional wellbeing of children and their communities,” said Sheldon Yett, UNICEF Representative.

Deficiencies of vitamins and minerals in diets make people vulnerable to infection and disease. Globally, such deficiencies contribute annually to the death of 1 million children younger than 5 and approximately 50,000 young women during pregnancy and childbirth, and cause 200,000 serious birth defects a year. 

In the Central and Eastern European and Commonwealth of Independent States (CEE/CIS) region, anemia represents a major public health problem among children under five. Countries with the most severe deficiencies include Albania, Bosnia, Bulgaria, Moldova, Russia, Turkey, and Armenia where at least one in every third child under five is anemic due to inadequate intake of iron.

In what is known as the Copenhagen Consensus, a panel of distinguished economists and public health experts concluded that as measured against a ratio of social benefit to cost, fortification of flour with micronutrients was one of most effective interventions possible to improve the lives of populations throughout the world.

“This is something we want to start preparing for now,” said the Minister of Health, Dr. Bujar Osmani. “This would build on the success of previous efforts such as the iodizing salt initiative that eliminated iodine deficiency and the more recent initiative to add fluoride in milk to reduce tooth decay among pre-school and school aged children.”
Already a well-established practice in many developed countries, fortifying flour with iron and folic acid has contributed to a dramatic decrease in micronutrient deficiencies.  In the United States, Canada and Chile, for example, serious birth defects went down by more than one-third in five years following the introduction of mandatory folic acid fortification. 

 “The fortification of flour reduces iron deficiency and anemia among women of childbearing age,” said Ms Hye Kim, Executive Officer of the Flour Fortification Initiative.  “Furthermore, it improves children’s physical and intellectual development, and reduces the incidence of certain birth defects.”
Some 50 countries have enacted laws to fortify cereal flours. In this region, Romania, Bulgaria, Georgia, Turkey, Belarus, Kosovo, Armenia, Uzbekistan, Kyrgyzstan, Tajikistan, Turkmenistan, Kazakhstan, Azerbaijan have started planning or have already introduced mandatory legislation for flour fortification.
“This workshop provides an opportunity for us to look at how we can use this strategy in this country and elsewhere in the region to improve the health and productivity of our communities” continued Mr. Yett.   

Data from 1999, the latest available statistics in the country, highlight that one in 2.7 children aged 6-24 months is anemic; and that one in five neo-natal mortalities is the result of congenital anomalies – an anomaly that can be reduced with proper dietary intake of folic acid among women.  While a new nutritional survey is needed to provide updated information, fortifying flour would be a cost effective way to improve the nutritional status of children in the country. 

The call for increased fortification came at Central and Eastern European and Commonwealth of Independent States regional flour-fortification workshop, which has been jointly organized by UNICEF and the Flour Fortification Initiative, a network of public, private, and civic organizations that promote micronutrient fortification of wheat and maize flour around the world.  The four-day event is part of regional efforts to create an enabling regulatory and business environment for the mandatory fortification of flour, an important staple that can be easily fortified with micronutrients. 

Representatives from milling industries, milling associations, bakers’ associations, public health officials, food standards and food safety experts from eight countries in the region are participating in workshop.  While the workshop has been organised to provide the technical knowledge on how to implement flour fortification, participants will also gain technical knowledge on how to conduct a cost benefit analysis and how to develop a flour fortification strategy and action plan.

For additional information please contact:
Irina Ivanovska, UNICEF Skopje (02) 3231-150 (ext :127),  072 236 722  or




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