Prevent Serious Birth Defects and Anemia in India : Are we missing the opportunity ?

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From before the moment babies are conceived until they stop breastfeeding, they depend on their mothers for nutrition. Essential vitamin and mineral deficiencies put mothers at risk of pregnancy-related death and increase the infant’s risk of severe birth defects, death and disease. Many countries add nutrients to common foods such as wheat flour and rice to protect the health of mothers and infants. Fortification’s success in India, however, is in jeopardy unless the Food Safety and Standards Authority of India (FSSAI) goes back to its 2016 standard for fortified wheat flour.

Be the voice of change! Please sign and share this petition for FSSAI to revert to its 2016 standards for fortified wheat flour. In India, 34 of every 1,000 infants die before their first birthday, and 130 mothers die for every 100,000 live births. Too much is at stake to get this wrong.

In 2016, FSSAI developed standards for the type and amount of nutrients that can be added to fortified wheat flour. Those were very much in line with World Health Organization (WHO) recommendations. In 2018, FSSAI switched to dramatically lower standards that will lead to no health impact.

The three nutrients required in fortified flour in India are iron, folic acid, and vitamin B12. Deficiencies of each can cause anemia. Pregnant women with severe anemia are twice as likely to die during or shortly after pregnancy than non-anemic women – and around half the women in India have anemia. Babies born to anemic women are at risk of low birth weight; this makes the child prone to death and disease.

Low intake of folic acid (vitamin B9) also increases the chance of babies having a birth defect of the brain, called anencephaly, or a birth defect of the spine called spina bifida. Anencephaly is always fatal. Spina bifida requires immediate medical attention and a lifetime of care. Spina bifida is a serious birth defect that causes childhood paralysis which is more severe than poliomyelitis. Many children with spina bifida can die before their 5th birthday, especially in developing countries.

In India, about 45 brain and spine birth defects occur in every 10,000 pregnancies. That equates to 115,390 birth defects every year. Fortifying India’s staples with adequate amounts of folic acid could prevent more than 100,000 deaths among children under five years of age every year.

The link here - https://www.cdc.gov/ncbddd/birthdefectscount/data.html shows results from five countries that were among the first to fortify flour with enough folic acid to prevent birth defects. If India adapts the 2018 FSSAI standard, it will not see results like this because the level of folic acid included is 17 times lower than WHO recommendations.

In addition, the amount of vitamin B12 in the 2018 FSSAI standard is 13 times lower than WHO recommendations. Everyone needs vitamin B12 to maintain functions of the brain and nervous system, and women especially need vitamin B12 when they are breastfeeding.

The amount of iron in the 2018 standard is about right, but many allowed types of iron are not recommended globally. The alternative types of iron are hard for human bodies to absorb, and they will be useless in combatting iron deficiency anemia.

Currently 81 countries have mandates that require wheat flour to be fortified. Global experts in grain fortification are questioning the 2018 FSSAI standards and have refuted all the concerns raised by naysayers. Here are three examples:

·         Some people say consumers should get all the nutrition they need through the foods they eat. The way most people eat is far from ideal when it comes to vitamins and minerals.

·         Others fear that extra vitamins in flour may hurt men and older adults. Everyone needs nutrients, and WHO recommendations are appropriate for the entire population.

·         Years ago people feared that too much folic acid caused health problems; further scientifically rigorous studies prove that the recommended amounts of folic acid are perfectly safe.

A recently published review of 19 studies, mostly from Asia and South America, demonstrated a 34% reduction of anemia as a result of large-scale programs to fortify food with iron. The authors noted that implementation problems could limit the program’s potential. The 2018 standards are an example of such a problem.

The levels of anemia, spina bifida, infant mortality, and maternal mortality in India are too high to make a mistake with this. Fortifying flour can make a difference, but only if it is done correctly. Please sign this petition for the concerned authorities to revert to the 2016 standards.

For more information:

·         World Health Organization recommendations for flour fortification (2009) https://www.cdc.gov/ncbddd/birthdefectscount/data.html

·         Safety of folic acid (2017) https://www.cdc.gov/ncbddd/birthdefectscount/data.html

·         Global birth prevalence of spina bifida by folic acid fortification status: A systematic review and meta-analysis (2016) https://www.cdc.gov/ncbddd/birthdefectscount/data.html