Context: Public health challenge: Anaemia, driven significantly by iron deficiency, affects over half of Indian women and nearly three-fourths of children, contributing to maternal mortality, impaired cognitive development, reduced productivity and intergenerational malnutrition.
- Government initiative: The Anaemia Mukt Bharat (AMB) strategy adopts a 7×7×7 approach, combining preventive measures, screening, treatment, dietary diversification and behaviour change.
- Key gap: Despite existing interventions, Double Fortified Salt (DFS) remains underutilised as a population-wide preventive measure.
Double Fortified Salt (DFS): An Effective Intervention
- What is DFS? Salt fortified with iron and iodine, designed to address iron-deficiency anaemia while preventing iodine deficiency disorders.
- Advantages: Salt is consumed regularly across income groups and geographical regions, making it a practical vehicle for delivering micronutrients. It complements iron supplementation and dietary diversification, which require sustained adherence.
- Existing infrastructure: India’s Universal Salt Iodisation (USI) programme provides an established platform, with around 95% of households consuming iodised salt. DFS is already distributed to an estimated 76 million people across four States through government safety-net programmes.
- Evidence of effectiveness: Global reviews indicate that DFS can reduce anaemia by up to 21%. Trials in Bengaluru, Darjeeling and Punjab, along with large-scale implementation in Uttar Pradesh, have reported improvements in iron status, consumer acceptability and cost-effectiveness when validated manufacturing specifications are followed.
- Regulatory and programme support: The Food Safety and Standards Authority of India (FSSAI) has issued standards for DFS. Its use is supported under PM POSHAN (school meals) and the Integrated Child Development Services (ICDS) programme.
- Affordability: At an estimated ₹14–₹20 per person annually, DFS has a reported benefit-cost ratio of 4.2:1, mainly through improved health and labour productivity.
- Manufacturing feasibility: Established fortification technologies, centralised salt production and laboratory infrastructure enable large-scale manufacturing and quality monitoring.
Barriers to Nationwide Adoption
- Uneven PDS integration: DFS integration into the Public Distribution System (PDS) remains inconsistent across States, despite the programme reaching around 800 million beneficiaries.
- Institutional constraints: Wider adoption is limited primarily by implementation gaps rather than technological barriers, including inadequate policy commitment, dedicated financing, quality assurance and consumer awareness.
- Market availability: Wider commercial distribution and reliable last-mile access are necessary to ensure sustained consumption beyond existing safety-net programmes.
Safeguards and Way Forward
- Nationwide scale-up: Introduce a centrally supported flagship programme to expand DFS distribution through the PDS and other nutrition safety nets across States.
- Quality assurance: Enforce FSSAI standards through regular testing, monitoring and quality control across production and distribution.
- Integration with AMB: Use DFS as a complementary preventive intervention, alongside iron supplementation, screening, dietary diversification and behaviour-change measures.
- Disease-specific screening: Continue screening for haemoglobin disorders such as thalassaemia and sickle cell disease, since not all anaemia is caused by iron deficiency and iron supplementation may be inappropriate in certain conditions.
- Sodium reduction: Align DFS implementation with India’s salt-reduction goals; fortification must not encourage higher salt consumption.
Important Concepts for UPSC
- Universal Salt Iodisation (USI): A public health strategy to prevent iodine deficiency disorders by ensuring that edible salt is fortified with iodine.
- Food fortification: The addition of essential micronutrients to commonly consumed foods to improve nutritional status and address deficiencies at population scale.
- Anaemia Mukt Bharat: A Government of India initiative under the National Health Mission to reduce anaemia among children, adolescents, women of reproductive age, pregnant women and lactating mothers.
- PM POSHAN and ICDS: PM POSHAN supports nutritional outcomes among schoolchildren through school meals, while ICDS provides nutrition and early-childhood services through the Anganwadi system.
Significance for Viksit Bharat 2047
- Human capital: Reducing anaemia can improve maternal and child health, cognitive development, educational outcomes and workforce productivity.
- Scalable public health model: By building on its existing salt-iodisation infrastructure, India could demonstrate an affordable, scalable approach to reducing iron deficiency for other low- and middle-income countries.
Conclusion: Double Fortified Salt can strengthen India’s anaemia-prevention strategy, provided nationwide expansion is supported by effective regulation, quality assurance, appropriate screening and integration with existing nutrition programmes.
