For many years the Food Fortification Initiative (FFI) has been campaigning for the vitaminization of industrially produced flours and their enrichment with minerals in order to eliminate deficiency symptoms caused by malnutrition. And it has made significant progress, as it has become a mandatory practice in 82 countries.

There is also an effort to fortify other grain-based foods, including rice. World Grain recently interviewed the director of the FFI, Scott J. Montgomery, to get an update on the initiative.

WG: Food Fortification made significant progress over recent decades globally. Why does FFI further advocate fortification and how can we make a significant impact globally in mandating fortification?

MONTGOMERY: Although much progress has been made, we have more work to do. We estimate that in 2018, of the world’s industrially milled cereal grains, only about one-third of the wheat flour, half the maize flour, and less than 1% of the rice was fortified. We also know many countries lack monitoring systems to ensure that fortified products contain the amounts of vitamins and minerals required by their country. We can make a significant impact by helping countries that are not fortifying now to start and implement effective programs, and also helping countries with established programs ensure they are maximizing fortification’s potential impact.

WG: What are the main challenges facing fortification programs?

MONTGOMERY: The challenges to fortification vary according to countries and are sometimes region specific. For example, some places have a cultural bias against any perception of food adulteration, including fortification. In other places, foods do not comply with the amounts of vitamins and minerals stipulated in the national standard, and this compromises the health impact of the program. Non-compliance is due to a host of reasons, such as limited number of food safety inspectors or lack of effective industry incentives. In some countries, the national standards do not optimize the number or levels of nutrients to include in fortification programs.

WG: Rice fortification is a key focus of the Food Fortification Initiative. What is the strategic approach to scaling up rice fortification

MONTGOMERY: With advances in technology for fortifying kernels in the last few years, rice has been accepted as an appropriate food to fortify. Yet less than 1% of industrially milled rice is fortified today, which means that rice is not fortified at volumes needed to reach economies of scale and long-term sustainability. Rice prices are extremely sensitive, so fortified rice must be produced at scale to lead to a viable and cost-effective intervention. FFI has identified countries and regions where scaling up rice fortification is feasible based on the supply of industrially milled rice and the volume of rice consumption. These include West Africa and parts of China and India where massive demand for fortified rice would instantly lead to scale-up. We believe that rice fortification has to be mandatory to create equitable competition for producers and to simplify the monitoring process.

WG: How does rice fortification differ from fortifying wheat flour?

MONTGOMERY: Rice fortification differs from wheat flour because it’s not just a powder-to-powder blending process. Instead, rice fortification involves producing a fortified kernel that is blended with the non-fortified, milled rice, with fortified kernels making up between 0.5% to 2% of the blend. Producing these fortified kernels is not simple, but every country may not need its own fortified kernel production plant, depending on its demand for fortified rice. Industrial rice mills in rice exporting countries need to easily procure fortified kernels prior to export. Basically, the supply chain needs consolidated points that allow an efficient blending of fortified kernels with the non-fortified, milled rice. Before investing in a facility to create high quality fortified kernels, it is critical for a company to be assured that there is a high demand for fortified kernels. We estimate that a demand of nearly 2 million tonnes of rice per year is needed to keep a fortified kernel plant operating at scale.

WG: Rice fortification is at a very early stage, although rice is a staple food for over 3 billion people globally. What are the key nutrients missing in polished rice?

MONTGOMERY: Most naturally occurring vitamins and minerals in rice are removed with the bran in milling. The remaining polished grain is predominately the starchy endosperm. The rice bran includes vitamins B1, B3 and B6 as well as the minerals iron, copper and manganese. Ultimately, each country decides which nutrients and the levels of each nutrient to include in fortified rice based on the needs of its population.

WG: Which regions do you see rice fortification will be scaled-up and what is needed to make it happen?

MONTGOMERY: West Africa is an obvious answer. We have identified 12 countries in this region where rice is commonly consumed, and the milling industries or imported rice industries could be candidates for fortification. Scaling up rice fortification in these countries would require a critical mass of countries to mandate that imported rice as well as local industrially milled rice is fortified. We are in the midst of a very specific proposal and road map to make that happen.

WG: What are the main drivers of micronutrient deficiencies beside poverty and lacking access to food and water?

MONTGOMERY: Micronutrient deficiencies are not prejudiced; they impact low- and middle-income countries as well as high-income countries. Being overweight or obese can cause vitamin mineral loss, and this is increasing in countries of all economic strata. Chronic diseases and infectious diseases also lead to micronutrient deficiencies. Increasing urbanization can change people’s diets and food sources, which may result in micronutrient deficiencies. Folate (vitamin B9) is very hard for the body to absorb, making it difficult to get enough of this essential nutrient to prevent brain and spine birth defects without consuming folic acid (the type of vitamin B9 used in fortification and supplements).

WG: What opportunities and benefits does fortification open up for the private sector and its customers?

MONTGOMERY: Iron deficiency limits cognitive ability and productivity. Consequently, fortifying with iron provides the private sector with a smarter, stronger workforce. Micronutrient deficiencies also take a toll on a country’s economy. This impacts millers because when economies are healthy and people have more disposable income, they buy more foods made with the millers’ products. Also, fortifying can improve the company’s reputation as it is recognized for its corporate social responsibility.

WG: Still, many millers see fortification only as a cost factor to their business. How can we change this perspective?

MONTGOMERY: The global fortification community may be partly to blame for this as we have not always made sure millers understand the key role they play in improving the health of people in their country as well as the wealth of the country. We need to always acknowledge the role of millers when we report on the success of a fortification program. We can also more strongly urge governments to make fortification as inexpensive for millers as possible by exempting premix from import duties. Mainly, we need to be sure millers are involved in every aspect of fortification planning from the beginning of a country’s program.

WG: What are your personal wishes to all stakeholders to develop fortification programs in a sustainable manner?

MONTGOMERY: I have a lot of aspirations for fortification, but in short, I wish that all stakeholders would prioritize nutrition because poor nutrition undermines the success of many other programs such as education and workplace development. In many countries, grain fortification is a logical, cost-effect way to correct nutritional deficiencies, but stakeholders will not consider this without prioritizing nutrition. Food fortification has been happening for 100 years. I wish grain fortification was standard milling practice around the world. To be sustainable, this will require all stakeholders to work together to promote, plan, implement, and monitor effectively.