Abstract
Micronutrient deficiency is a pertinent global challenge that affects billions of people and has deleterious health effects. Large-scale food fortification (LSFF) is a cost- effective way to tackle micronutrient deficiency and improve health outcomes, particularly in low- and middle-income countries (LMICs). However, the success of LSFF in LMICs is often hampered by limited compliance with fortification mandates by the private sector, who supply fortified foods. In this paper, we use a case study of the edible oil produced in Bangladesh to analyze the factors facilitating and impeding this compliance by for-profit actors. We identified four bottlenecks that disincentivize private sector actors’ decision to comply. First, fortified and non-fortified products co-exist in the market, disincentivizing producers to invest in fortification. Second, the lack of traceability reduces the risk for large-scale producers’ non-compliance with the regulation. Third, small-scale producers face economic pressures that prevent them from adequately fortifying oil products. Lastly, law enforcement is currently inconsistent, allowing the supply of under-fortified oil in the market. Given the evidence, we recommend to strengthen the control of bulk item fortification through more frequent and rigorous surveillance at the production level. This will ensure that resource constrained consumers who also have the greatest potential to benefit from added nutrients, remain able to access affordable and nutrient-enriched food.
Highlights
Micronutrient deficiency is a pertinent global challenge: at least 2 billion people are estimated to be deficient in at least one of the essential micronutrients needed for growth, development, and survival (Bailey et al, 2015)
Our study identifies ways to improve private sector compliance with fortification regulations without jeop ardizing the access to fortified commodities based on an in-depth qualitative study in Bangladesh
In order to understand the relevance of these drivers of private sector compliance and how they interact to shape Large-scale food fortification (LSFF) outcomes, we address the following research questions in the context of Bangladesh: What demand and supply-side factors influence key decisions by actors in the edible oil value chains that affect fortification outcomes? How do these factors enable or undermine the uptake of fortified foods, among low-income groups?
Summary
Micronutrient deficiency is a pertinent global challenge: at least 2 billion people are estimated to be deficient in at least one of the essential micronutrients needed for growth, development, and survival (Bailey et al, 2015). Vitamin A deficiency is wide spread and can increase the risk of morbidity and mortality (Bailey et al, 2015). In Bangladesh, for instance, one in every five children of school age was estimated to be vitamin A deficient according to the 2011/2012 National Micronutrient Survey (icddr’b et al, 2013). Large-scale food fortification (LSFF hereafter) is seen as a cost-effective means to improve nutritional and functional outcomes (Method and Tulchinsky, 2015). Fortifying widely consumed food items – e.g., staples and condiments – can significantly increase micronutrient intake by poor and marginalized people who lack access to these critical nutrients (Raghavan et al, 2019)
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