A rice sack comes with a necessary label at a mill in East Singhbhum, a districtin Jharkhand. Those with thalassemia, a blood disorder, should take the rice under medical supervision. The contents of the sack include iron-fortified rice, a subtype with increased micronutrients like iron so as to improve the rice’s nutritional quality. Poised to do wonders for curbing malnutrition, the fortified rice was recently approved by the Union Government to be included in the public distribution scheme, which includes about 800 million beneficiaries.

But a group of health, nutrition, and pediatric experts has cautioned against the policy: distributing iron-fortified rice on a mass scale can adversely impact vulnerable proportions of the society. These were the takeaways of a fact-finding team, led by the Right To Food Campaign (RTFC) and Alliance for Sustainable and Holistic Agriculture (ASHA-Kisan Swaraj). The researchers looked at five panchayats in Jharkhand’s Khunti and East Singhbhum districts. The researchers met different actors of the welfare scheme: cooks in government schools, beneficiaries of the public distribution system, community health center doctors, officials and patients in district hospitals, and dealers. Their finding was incisive and cautionary; the mass distribution of fortified rice is a veritable “misadventure,” they said, which the government needs to curb immediately.

The introduction of fortified rice, in theory, is meant to act as a nutritional boost forundernourished populations on a mass scale. The very grain of rice is reconstituted — to a quintal of powdered rice, one kilogram of iron powder, vitamin B12, and folic acid are added. Previous health surveys have painted a dire picture of anemia and malnutrition that prevails across the country. The said fortified rice would reach India’s poor by 2024 and curb this deficiency, the Prime Minister had asserted last year. Fortified rice, then, is seen as a cost-effective solution, particularly in a society that is plagued by micronutrition deficiencies but has a high rice consumption.

But this consumption also comes with health risks; iron-fortified rice may prove risky for people with blood disorders like thalassemia and Sickle Cell anemia. Worryingly, a significant population in Jharkhand has high levels of anemia, and experts have previously noted the Adivasi population is more vulnerable to the said blood disorders. According to a 2015 study, most of the Adivasi population living in states like Andhra Pradesh and Telangana are affected by Sickle Cell anemia; and almost 3% of India’s tribal population suffers from sickle cell anemia. The condition is widespread enough for welfare schemes to screen beneficiaries and even account for the disorders.

The report then outlines the grey area where public health and public policy intersect —food meant to address the hunger crisis may pushpeople further into a health exigency. This causation worsens in the context of the state of health infrastructure in Jharkhand, awareness of health comorbidities, in general, is already low. “In Jharkhand due to lack of population-based screening, people with these health conditions may not know that they have these blood disorders,” the team noted in their report.

“On the one hand, the government understands the health risks of consumption of iron-fortified food for many people with particular health conditions in our society and brings in regulations like this. On the other hand, the government itself is distributing such rice in all its food schemes where the poor have no option but to depend on this entitlement for their food security,” the team further pointed out. The said rice is currently being supplied to poor households, Anganwadi centers (government-supported childcare centers), and schools in Jharkhand. On their field visit, researchers found many people even come up with make-shift solutions: locals are separating and removing the fortified rice kernels before they consume the rice.

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Even India’s statutory body on food approvals, the Food Standards and Safety Authority of India (FSSAI), asks for a mandatory label on fortified foods: while thalassemia patients should consume iron-fortified food under medical supervision, Sickle Cell anemiapatients are advised not to consume iron-fortified food at all.

These steps, then, feel counterintuitive; to offer nutritional foods while comprising other health conditions. They are part of “pilot” projects launched in 2019-20, less than three-years-old three years old; lacking any data on how much, or how little, they impact people. Yet, their distribution has been extended to 257 districts across India rather hastily, as experts pointed out.

In May, Reuters reported that India reduced the allocation of wheat to 7.1 million tonnes from 18.2 million under its food welfare program. At the same time, the allocation of rice has been raised to 32.7 million tonnes from 21.6 million. But the devotion to making rice the locus of welfare schemes may be more exclusionary — by health and nutrition standards.

“For populations with these blood disorders, fortified iron is not the answer,” said Kavitha Kuruganti, a farm activist with the Alliance for Sustainable and Holistic Agriculture (ASHA), a nationwide non-government farmers’ rights group and a team member.

This echoes the limitations of an umbrella solution like fortified food to address nutritional deficiencies. A diversified diet, one that considers health blind spots, remains critical to addressing malnourishment across social groups.

What is the answer then? A natural, safe, and community-driven approach — one based on raising awareness among the community and initiating dialogue with them. There are a set of recommendations the group highlighted for those listening. Expanding the scope of food schemes to include pulses, eggs, millets, and milk so that people don’t rely only on rice; local communities that focus on raising awareness about nutrition; setting up “Nutrition Gardens” in the locality; charting an easy supply of necessary micronutrients.

The most critical of them is one: rice is not the only nutrition the body needs. “Dietary diversity is an important approach and cannot be given the short shrift due to hasty adoption and attention to risky unproven approaches like food fortification,” the experts hadnoted.

The way the stars — and policies — have aligned themselves indicates a grim truth: there remains a lack of political will and initiative to understand how different welfare schemes impact people from vulnerable sections.