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A mother gives her son a piece of fortified bread A man in a mill fills bags with fortified flour

Fortifying Pakistan against hidden hunger

Pakistan is suffering a malnutrition emergency that’s impeding its social and economic wellbeing. In particular, children and women of childbearing age experience harmful deficiencies in critical vitamins and minerals, leading to long-term health and development issues that contribute to an annual loss of 2-3% in GDP.

This is a chance for Pakistan to catch up with other nations, as food fortification has shown to be a low-cost intervention with a big impact in 85 other countries worldwide.

Diane Northway

Team leader, Food Fortification Programme

Help is at hand. A new countrywide intervention aims to tackle this growing crisis at source by fortifying wheat flour and edible oils – a proven, cost effective means of addressing micronutrient deficiencies and therefore strengthening immune systems and improving cognitive productivity.

Key facts

  • 62% of young children in Pakistan are anaemic
  • 54% of young children in Pakistan are vitamin A deficient
  • 69% of pregnant women in Pakistan are vitamin D deficient
  • 40% of young children in Pakistan are vitamin D deficient
  • 51% of pregnant women in Pakistan are anaemic

(Source: National Nutrition Survey, 2011)

Challenge

According to the United Nation’s Food and Agriculture Organisation (FAO), as many as 37.5 million people in Pakistan are not receiving proper nourishment. Every year approximately 250,000 children die before reaching their fifth birthday due to factors related to malnutrition. Indeed, nearly half of Pakistan’s children are chronically malnourished, which causes life-long damage to brain development and immunity.

Women of childbearing age are another group at severe risk from malnutrition, caused primarily by poor diet diversity and a lack of awareness of the importance of nutrition during pregnancy. The high cost of fruit and vegetables (typically ‘5 a day’ would consume half of the family living budget) contributes to this chronic shortfall in micronutrients. Moreover, cultural expectations on women to cover up from the sun and spend daylight hours indoors results in deficiencies in Vitamin D, which is critical for a healthy pregnancy.

While neighbouring countries are registering reductions in malnutrition, Pakistan’s rates are stagnating, bringing serious impacts on individual opportunity and also nationwide progress. Despite improvements in the domestic economy, Pakistan is now one of the most undernourished countries in the world.

Solution

Our team in Pakistan is managing the Food Fortification Programme (FFP), a five-year programme funded by UK aid. Backed by specialist expertise from Nutrition International, one of the world’s leading bodies for nutrition and food fortification, the programme aims to significantly enhance the production, access and consumption of fortified wheat flour with iron and folic acid, and edible oils and ghee with vitamin A.

Bringing our long-standing experience of project management in Pakistan, we are working closely with the Government to improve the food fortification regulatory system, raise awareness and generate evidence to formulate relevant policies to combat micronutrient deficiencies. The programme is also working with the private sector, building capacity for food fortification at flour and oil mills. It will also fund new micro-feeder equipment, technical assistance and provide pre-mix supplements in the initial stages while long-term sustainable capacity is built. Given that wheat and oils are consumed daily by most of the population, food fortification can yield dramatic improvements in nutritional status without a change in eating habits.

At the consumer level, current awareness of the health benefits is low and there is some resistance to purchase fortified food because of perceived costs or taste. To meet these concerns, the programme is engaging at a district level with public awareness and education campaigns to increase demand and promote fortified foods. Provincial and national campaigns will follow when the fortified foods are accessible in the marketplace.

Outcome

These are early days, but there is already political will across the country to act, with both federal and provincial governments committed to ending malnutrition through food fortification.

By 2021, the programme aims to see:

  • Over 1,000 wheat flour mills and 100 edible oil mills meeting standards
  • One third reduction in iron deficiency and iron deficiency anaemia, and at least a one quarter reduction in vitamin A deficiency among women and children
  • A decline in births with neural tube defects
  • Improvements in vitamin D consumption
  • Mandatory legislation for fortification across Pakistan, as well as improved standards, regulatory compliance, quality assurance and quality control
  • Improved management and administration to meet legislative requirements, technical assistance for mixing and storage of premixes, building industry capacity for compliance and testing
  • Consumers demanding fortified foods due to their awareness of the benefits it offers
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