With the Union Cabinet approving continuation of initiative to provide Fortified Rice under all schemes of Government including Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY) and Other Welfare Schemes etc. in its present form, from July 2024 and up to December 2028, the Centre is continuing the ambitious initiative as a complementary strategy to combat micronutrient deficiencies in the country.
Needless to say, scientific evidence supports consumption of Fortified Rice is safe for all including for individuals suffering with haemoglobinopathies such as Thalassemia and Sickle Cell Anaemia.
Fortified rice packaging in India were initially required to carry a health advisory for individuals with Thalassemia and Sickle Cell Anaemia, as per the Food Safety and Standards (Fortification of Foods) Regulations, 2018. The necessity of this advisory was questioned by a scientific committee, noting that no other country mandates such advisory label on packaging. In response, the Department of Food and Public Distribution (DFPD), Government of India, established a working group in 2023, to assess the safety of iron-fortified rice for people with these hemoglobinopathies.
The working group’s report concluded that current evidence does not support any safety concerns for such individuals. The iron intake from fortified rice is minimal compared to the iron absorbed during blood transfusions for Thalassemia patients and are treated with chelation to manage iron overload. Furthermore, individuals with Sickle Cell Anaemia are unlikely to absorb excess iron due to naturally elevated levels of hepcidin, a hormone that regulates iron absorption.
This assessment was followed by an extensive review conducted by a committee chaired by Director General, Indian Council of Medical Research (ICMR). The committee, comprising experts in haematology, nutrition, and public health, conducted a thorough literature review on iron metabolism, the safety of iron doses from fortified rice, and global labelling practices.
Based on this global scientific review, the committee found no evidence suggesting that iron-fortified rice poses a health risk to individuals with these hemoglobinopathies. A large community study in India, involving over 8,000 participants from tribal areas, indicated that nearly two-thirds of patients with Sickle Cell Disease experienced iron deficiency. No specific evidence exists regarding harm from consuming fortified rice for sickle cell anemia or thalassemia .
It is notable that organizations like WHO and the U.S. Food and Drug Administration (FDA) also do not mandate such advisories on packaging.
In India, where large-scale distribution of fortified rice has already taken place in states like Jharkhand and Maharashtra, with more than 2,64,000 beneficiaries in each state, no adverse health outcomes related to iron overload have been reported. This further substantiates the committee’s recommendation to omit the advisory.
The committee recommended removing the advisory, which the Food Safety and Standards Authority of India (FSSAI) accepted. The advisory was officially removed in July 2024, following approval by the Food Authority in its 44th meeting.
India’s rice fortification program started in 2019 as a pilot program and scaled up in a 3 phased manner. Fortification is a globally recognized practice, and India follows guidelines aligned with the World Health Organization (WHO). According to WHO’s 2018 recommendations, rice fortification with iron is essential in countries where rice is a staple food. In India, with 65% of its population consuming rice daily, iron-fortified rice is particularly relevant.
Under the Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY), 520 Lakh Metric Tons (LMT) of fortified rice is to be procured annually. There are currently 1,023 FRK manufacturers across the country, with an annual production capacity of 111 LMT, which significantly exceeds the 5.20 LMT required for the program. Additionally, there are 232 premix suppliers with a capacity of 75 LMT per annum, far surpassing the 0.104 LMT needed.
The ecosystem for rice fortification in India has expanded significantly. Of 30,000 operational rice mills, more than 21,000 have installed blending equipment, with a total capacity of 223 LMT of fortified rice per month. Testing infrastructure has also grown, with numerous NABL-accredited labs across India conducting rigorous quality checks on fortified rice.
Rice fortification is a well-established global practice. According to the Global Fortification Data Exchange, 18 countries actively allow rice fortification, 147 support salt fortification, 105 have adopted wheat flour fortification, 43 endorse oil fortification, and 21 promote fortification of maize flour. Advisory labels for individuals with Thalassemia or Sickle Cell Anaemia are not required in these countries.
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