Fortify Staple Foods and Crops

3 billion people around the world cannot afford a healthy diet. Micronutrient deficiencies and malnutrition affect an estimated 2 billion people, undermining health, survival, and child development, costing the global economy billions annually in lost productivity and healthcare. Anaemia, in large part attributed to deficiency of iron and other micronutrients, is estimated to contribute to 20% of maternal deaths. It is estimated that up to 50% of new-borns in Europe might not reach their full cognitive potential due to insufficient iodine intake. Other impacts include reduced resistance to infections from vitamin A and zinc deficiencies; neural tube defects due to insufficient folate and vitamin B12; mental deterioration of the elderly due to lack of vitamin B12; beriberi due to vitamin B1 deficiency; and rickets due to insufficient vitamin D. 

Nearly half of the world’s countries would benefit from new LSFF programs. Currently, 142 countries mandate fortification of at least one food vehicle – salt, sugar, oil, wheat flour, maize flour, or rice – but constraints in programme compliance, enforcement, and epidemiological monitoring limit its benefits. In many countries, staple foods are not fortified to nationally mandated standards, or standards need updating to better address dietary inadequacies. Consumer-level monitoring remains weak, and improved industry compliance and government enforcement are needed to ensure access to adequately fortified staple foods for all.  

Widespread introduction of biofortified crops began in earnest in 2010. While progress has been promising – nearly 400 biofortified varieties of 12 staple crops in 41 countries – the intervention must be brought to scale by ensuring sustainable supplies of biofortified crops for farmers; providing strong incentives to grow them; and facilitating access to markets that can reach consumers at high risk of malnutrition. As with LSFF, assessments of coverage and dietary contribution would significantly help guide planning and investment.

A recent systematic review of 50 studies indicates the far-reaching impact of fortification in LMICs. LSFF programs with iron, folic acid, vitamin A, and iodine have led to dramatic reductions in serious diseases, including anaemia, neural tube defects, nutritional blindness, and goitre. The efficacy of biofortification in reducing micronutrient deficiencies has been demonstrated in several studies for a crops, including iron biofortified beans and pearl millet; and vitamin A biofortified cassava, maize, and sweet potatoes. Studies have demonstrated the impacts of consumption of these crops on functional, cognitive, health, and productivity outcomes. Improving access to fortified and biofortified foods and deploying these two interventions at scale, alone or in combination, would address preventable death and disability linked to micronutrient deficiency across a large percentage of the world’s population. 

LSFF and biofortification aim to increase the supply and/or bioavailability of specific widely consumed micronutrients in the diet, reaching a large proportion of the population without significantly changing purchase and consumption patterns. Because micronutrient needs and deficiencies, food consumption patterns, food environments, and food vehicles vary by population, socio-economic status, and geography, a single intervention will not be sufficient to fill all nutrient gaps. But a combination of biofortified, industrially fortified, and other micronutrient-dense foods has the potential to do so. Deciding which foods to fortify should be based on an understanding of the national food system, opportunities in the food supply chain and market structures, and key micronutrient gaps across the population. This highlights an action area that is critically important across both interventions modernising data generation and use.  

While the interventions are complementary, their entry points differ, as do the challenges to be tackled to scale up and maximise their impact. For LSFF, action and investment should be focused in four key areas: 

1. Policy/governance: Update or implement standards/regulations incorporating fortified foods into national nutrition strategies and assess appropriate fortification type and level by vehicle (key actor: government);
2. Compliance/enforcement: Improve quality control and enforcement, including investment in more effective, simple, and low-cost monitoring practices and tools, and their adoption by industry and governments (government, industry, donors, development partners);
3. Design: Innovation, research, and development to improve fortified products, packaging, and marketing (private sector, donors, development partners); 
4. Social-driven assessment, accountability, and advocacy: Equip civil society and local research institutions to advocate for compliance and accountability of national fortification programmes, based on an independent assessment of national fortification policies and practices and a transparent evaluation of fortification quality and compliance (civil society, local universities and research institutions, donors, development partners).

New, innovative approaches are needed to mainstream biofortification into national breeding programmes, address segregation between biofortified and other crops, and for market incentives and the enabling environment to make biofortified crops more visible and widely available. Recommended actions include: 

1. Commitment to making all new crop varieties biofortified: Establishing mandatory minimum levels for nutrient content in new varieties of core staple crops and product standards for micronutrient content of biofortified foods (government);
2. Improvement in crop segregation and traceability: Organising farmers into verified sourcing areas with agreed production practices and certification and verification using technology (e.g., blockchain) to enhance traceability and market confidence (private sector, government, development partners); 
3. Create market interventions to strengthen the market for biofortified crops: Cost-effective aggregation models and market-shaping strategies such as volume guarantees that assure crop merchants that they can sell the biofortified products that they aggregate, particularly to large-scale public distribution systems, commodities traders, and food processors (government, private sector);
4. Use government purchasing power and consumer education to strengthen demand for biofortified crops: Mandating procurement of biofortified crops for social safety net and other public programmes, such as school feeding programmes (government).

This solution draws on a series of discussions convened through the Global Fortification Technical Advisory Group, as well as from the Bill and Melinda Gates Foundation (BMGF)’s nutrition strategy refresh and the new USAID LSFF Results Framework. In addition to BMGF and USAID, contributing organizations include Food Fortification Initiative, Global Alliance for Improved Nutrition, Helen Keller International, International Zinc Nutrition Consultative Group, Iodine Global Network, HarvestPlus, Kofi Annan Foundation, Micronutrient Forum, Nutrition International, PATH, UNICEF, and World Food Programme. 

Throughout 2021, the Second Global Summit on Food Fortification #FutureFortified virtual series is drawing attention to the unfinished agenda on LSFF and biofortification and driving political will to scale up and maximise their impact. This solution cluster places staple food fortification at the core of the broader global dialogue on making food systems work better for the most vulnerable and as an opportunity for new member state commitments to combat micronutrient malnutrition. 

LSFF and biofortification align with SDG2 on zero hunger, specifically on targets to ensure access to nutritious foods, end all forms of malnutrition, and double agricultural productivity and incomes of smallholders. They contribute to achievement of SDG4, on education, as iodine deficiency and anaemia impact school performance, as well as to SDG1 on poverty, which is a cause and effect of malnutrition. Better nutrition also brings about good health and well-being (SDG3), and biofortified crops have potential to offset reductions in crops’ nutrient content caused by rising atmospheric carbon dioxide, contributing to SDG 13 on climate action.