Part 1: Modi Gov’t Ignores Internal Red Flags on Health Risks

to Force Fortified Rice on Poor

On August 15, 2021, Prime Minister Narendra Modi mounted the Red Fort, a place that tempts leaders to make grand speeches to the crowd below. He announced that more than half of Indians would be fed rice fortified with micronutrients by 2024 to eradicate anaemia. But in haste, he served a public health policy that was raw and potentially dangerous to health.

Documents accessed by The Reporters’ Collective reveal that while going ahead with the decision Modi ignored the fact that the majority of pilot projects launched by his government to test the rice’s nutritional impact had not taken off at all. The government overruled the finance ministry’s red flag calling the move “premature” before understanding its impact on human health. Sacks of fortified rice were trucked out despite the head of the country’s leading medical research body calling for wider consultations following “serious concerns” on the “adverse effects” of fortified rice on children.

But Modi, unhindered by internal and external warnings, announced the government’s plan to mandatorily supply fortified rice to over 80 crore Indians, most of them poor, under all food security schemes. So far the government, to mitigate rising incidence of anaemia and micronutrient deficiency, has allocated over 137.74 lakh tonnes of fortified rice to states for beneficiaries under different welfare schemes.

Official data shows that over 1.7 million children in India are classified as “severely acute malnourished”. Of particular concern to public health activists is the rise in anaemia– caused by deficiency in dietary iron. Overall, it’s estimated that 67.1% of children under five and 57% women between 15-49 years of age in India are anaemic. In 2019-2021, anaemic cases among children rose 9% compared to 2015-16. The government claims rice fortified with iron, folic acid, Vitamin B-12, will mitigate India’s problem of rising micronutrient deficiency, also called hidden hunger.

Globally, food fortification has been one of the weapons in the war against micronutrient deficiency. In India, the most famous was the campaign to fortify salt with iodine to eliminate goitre. Even as the government’s plans to supply fortified rice under all welfare schemes by 2024 powers on, it has simultaneously begun supplying fortified wheat, oil and milk under select welfare schemes in some states.

Experts say the artificial injection of micronutrients by fortification is not a long-term solution. They say a diversified diet and adequate food delivered at affordable prices are the solutions. But, in the past, to cut costs, the Union government has actively worked to either diminish or restrict access to fresh nutritious food under its various food security schemes. And now it has fallen back on supplying artificially fortified food to improve the population’s health.

But science hasn’t yet given a thumbs up to fortified rice.

Fortified rice is made by beating rice grains into a dough, adding micronutrients to it and then machine-carving the dough back into grains that resemble rice. One such artificial kernel is mixed with 100 normal rice grains.

To test if such fortified rice really cures anaemia and other micronutrient deficiencies like stunting and wasting, the government launched test projects under a pilot scheme in February 2019. They were to go on till March 2022. But instead of waiting for the results of all the pilots, Modi announced a full blown scheme in 2021, affecting over half of the country’s population.

By then, nine of the planned fifteen pilot projects across fifteen states that consented to the pilot scheme had not even taken off. But government officials took Modi’s Independence-Day announcement as a call to action and even cited the Prime Minister’s speech when seeking administrative approvals for the scheme.

The states didn’t show much appetite for the pilot scheme, and rice was supplied in just six districts – one district per state – at project halftime. And four states started distributing rice just after Modi’s Independence Day speech. Result: The pilot scheme flopped.

“So many people questioned us about why our pilots were not successful,” said Sudhanshu Panday, the then Secretary in the Food and Public Distribution Department, at a seminar held in Delhi on 25 October 2021. “We had started pilots in 15 states — one district in each of (the 15) states. But there were fundamental problems in the pilot,” he said, adding that “the problems were purely logistics and supply-side related”. He did not go into how these pilots with fundamental flaws could have generated valid scientific results.

India’s state-run think tank NITI Aayog’s senior adviser Anurag Goyal too, in an internal meeting of the government on universalising the scheme admitted that the pilots were “not very successful”.

But, when asked about the success of pilots in Parliament on August 5, 2022, the Women and Child Development Ministry lied: “The pilot was successful in ensuring the ecosystem for fortified rice throughout the country.” It said that the pilots allowed key players in the scheme to prepare for a universal scale-up. However, it remained mum on the impact of fortified rice in nutrient deficiency despite it being one of the key objectives of the pilot.

The Collective sent detailed queries to the NITI Aayog, the Food and Public Distribution Department and the Women and Child Development Ministry. None of them responded despite reminders.

One Questionable Pilot

The only study the government had in its hands before it moved to universalise fortified rice was a Tata Trusts research from a pilot project in Maharashtra’s Gadchiroli district.

The pilot project, which began in November 2018, focused on Bhamragad and Khurkheda, villages, with a total population of 1,22,398.

In reply to another question, the government told Parliament that the study had shown fortified rice was “useful”. It did not mention the actual results of the study. [The Government of Maharashtra had conducted an evaluation study regarding the effectiveness of rice fortification and found it useful,” Sadhvi Niranjan Jyoti, Minister of State for the Consumer Affairs Ministry, told Parliament on 27 July 2021.]

The Reporters’ Collective accessed the study. It also asked Tata Trusts to respond to queries on it. “The pilot found a positive change in the target categories of the 2 program blocks in Ghadchiroli, and that such a programme was feasible,” a Tata Trusts spokesperson informed The Collective over mail.

The study shows improvement in the haemoglobin levels of those served fortified rice for 11 months. But the study also shows that mothers in the age group of 19-49 who were served fortified rice had shown reduced smoking habits by 30% while those who were not, cut down smoking by 8%. The study results also show that consumption of alcohol increased among mothers in the age group of 19-49 by 350% when they were not served fortified rice and by only 21% when they were served the fortified staple. The scientists behind the study or Tata Trusts does not explain in the study how or why they correlated fortified rice consumption to smoking and drinking habits of these mothers.

In their response, quite incredibly, Tata Trusts also states, “The full immunisation status was also found to have improved in both intervention blocks. The treatment/care at the Health Centre for medical problems of children had also improved.” Again, it did not elaborate how this could be linked to consumption of fortified rice.

Experts The Collective spoke to say the study is “very poorly designed” and pointed out that neither have the results of the pilot project been published in any journal and nor are they peer-reviewed. The focus of pilots, public health researchers have previously pointed out, seems to be more on logistical feasibility rather than impact on nutrition.

Eighteen days after the government’s reply to Parliament claiming the Tata Trusts study had been useful, Prime Minister Modi announced the plan to supply fortified rice across the country even as the government’s pilot scheme had collapsed.

Served in Haste

With their pilot projects failing, the government instead relied on select scientific studies to justify supplying fortified rice to over 80 crore citizens.

In June 2021, the Department of Food and Public Distribution compiled a list of thirteen research papers for an internal presentation to Consumer Affairs Minister Piyush Goyal, whose ministry is responsible for the procurement and distribution of fortified rice.

A closer look at this evidence the Food Department compiled raises more questions about the decision to supply fortified rice.

While eleven of the thirteen on the list showed efficacy of fortified rice, two explicitly say that fortified rice has little effect on iron, Vitamin A and haemoglobin levels.

Another paper on the list used to justify fortified rice is co-authored by a researcher who has been publicly warning of the risks of supplying fortified rice.

Curiously the food department omitted a review by Cochrane, a UK-based scientific nonprofit whose evaluations, experts The Collective spoke to say, are considered a gold standard on efficacy of fortified rice in scientific literature.

The Cochrane review aggregates evidence from many studies on efficacy of fortified rice and analyses their results. In the case of fortified rice, its analysis of 17 research papers found no mention in the presentation. Six of thirteen papers in the Food Department’s list of evidence to prove fortified rice’s efficacy are among the 17 studies reviewed by Cochrane.

This review showed “Fortification of rice with iron alone or in combination with other micronutrients may make little or no difference in the risk of having anaemia or presenting iron deficiency.” The researchers further noted, “we are uncertain about an increase in mean haemoglobin concentrations in the general population older than 2 years of age.”

“One thing is very clear, the Cochrane Review is the most respected source of evidence globally,” said Dr HPS Sachdev, who serves as senior consultant for the Union government’s Food Safety and Standards Authority of India’s (FSSAI) panel on Nutrition and Fortification. FSSAI would later go on to classify the fortified rice kernel under ‘high risk category’, which means if it is not manufactured properly it can lead to devastating health effects.

“I would go by that (Cochrane review). I have gone through the review. Excellent review with standard methodology. Even if there is evidence that has come subsequently (after the review was published) which shows positive results it must be added to that. We need to look at overall conclusions,” he added.

The Food Department’s list of evidence also includes a 2004-05 study in Bengaluru schoolchildren that found a decline in iron deficiency among those who were fed fortified rice. But it also noted an increase in levels of a protein called serum ferritin – linked to a rise in the risk of diabetes.

One of the seven authors of this research was Dr Anura Kurpad, who is a member of NITI Aayog’s National Technical board on nutrition. He has been publicly warning of the risks associated with high ferritin levels.

Dr Kurpad’s trial that established a potentially dangerous increase in ferritin now finds itself in a list of studies that the government uses, ironically, as evidence of rice fortification’s efficacy because it showed a dip in iron deficiency in school children.

But why should people worry about fortified rice when salt, similarly fortified with iodine, has been consumed by millions across the country for more than half a century?

“One of the reasons salt fortification is probably successful is because it’s very hard to overeat salt,” Dr Kurpad explained to The Collective. “At some point you’re going to say that the food is too salty and don’t eat it. Rice, on the other hand, is very easy to overeat.”

Experts also pointed out that unlike iron, excess amounts of iodine goes out of the body through urine. There is no natural way for the body to rid itself of excess iron.

“Our study was focused on very poor people,” Dr Kurpad told The Collective over phone. “Secondly, we were also focussing on iron-deficient people. These studies were not a general, universal thing.”

“If you look at studies around the world that focussed on the general population, they were all put together in the Cochrane review. It showed there’s no benefit of rice fortification on anaemia,” he added.

When The Collective asked Dr Kurpad if there had been any discussion on rice fortification’s efficacy at NITI’s National Technical Board on Nutrition, he replied, “No. Not as far as I know.”

The government’s own top medical research body Indian Council of Medical Research has previously shown that fortified rice had no substantive effect on mitigating anaemia levels among school-going children.

Public health experts have been warning of the risks of mandatory rice fortification.

This also made its way to NITI Aayog’s file notings. Professor Ramesh Chand, NITI Aayog’s member on agriculture, said in November 2021, “Some medical experts have expressed serious concern about the adverse effect of iron-fortified rice on the health of children. This was also mentioned by DG (Indian Council for Medical Research)…”

“Therefore, there is a need for consultation with a wide range of experts on the effect of fortification of rice on human health before pushing it further,” he added. Multiple Right to Information requests with the ICMR, India’s top medical research body, reveal there have been no consultations on the issue.

Professor Chand in his note added, “In any case, such intervention should be for the short term only.” The government has overruled this suggestion too.

Most experts are wary of adding what are, in essence, drugs to food. The medical experts Professor Chand referred to in his file note have been vocal in their criticism. One of them is Dr Kurpad. “They’re already running an iron supplementation program under Anaemia Mukt Bharat. That’s more than enough because it gives a lot of iron. Why on earth would we then want to go for fortification, which is a much weaker method than supplementation?,” Kurpad asked.

Fortified rice is also harmful to people suffering from diseases that worsen with iron intake.

“So, we do know that for example, you don’t want to give iron to people with thalassemia and sickle cell anaemia. We also don’t want to give it to those in the acute phase of tuberculosis,” Dr Vandana Prasad, the founding secretary of Public Health Resource Society, told The Collective.

The Food Department’s operational guidelines on fortification try to address this concern with a ‘Not recommended for people with Thalassemia and people on low iron diet,’ label on bags carrying food items fortified with iron.

The Collective travelled to Jharkhand to review how the fortified rice distribution was working in villages with predominantly tribal communities which have higher incidence of sickle cell anaemia. Jharkhand has the highest number of thalassemia and sickle cell anaemia patients in the country. The number of people suffering from sickle cell anaemia in Jharkhand is estimated to be twice the national average.

In multiple instances in Kuchiyasholi, a village in Jharkhand’s East Singhbhum district, for several months gunny bags with fortified rice did not carry the labels that warned of the harmful effects of fortified rice on people suffering from thalassemia.

Responses to the recent Right to Information queries by activist Kavitha Kuruganti, reviewed by The Collective, showed that the Centre does not have any means to profile those suffering from thalassemia or sickle cell anaemia from among the beneficiaries of the fortified rice. Yet the government steamrolled this rice into millions of homes across the country.

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Part 2: Confidential NITI Aayog Report Reveals

Centre Bungled Rice Fortification Pilot Projects

The Union government’s apex think tank NITI Aayog found the Modi government bungled its pilot projects designed to collect crucial scientific evidence on the impact of fortified rice on citizens’ health. It wrote a confidential report, which was never made public.

The Collective is now revealing the findings of the report.

Part 1 of the series revealed how the Narendra Modi-led Union government ordered that 80 crore Indians be fed fortified rice despite high-ranking officials and public health experts calling for wider consultations to understand the adverse effects of feeding iron-laced rice on human health, particularly that of children, before rolling out the scheme.

Once the orders to make fortified rice mandatory for all central government food security schemes had been passed, NITI Aayog decided to study how “prepared the ecosystem” was to ensure the supply of fortified rice and what “bottlenecks existed before the programme.”

But, what it found was damning. None of the pilot projects that NITI Aayog reviewed had carried out the basic, but most essential, surveys to map the existing levels of micronutrient deficiency in the district population before forcing them to consume the fortified rice for a year. In other words, the pilots were fundamentally flawed and incapable of assessing the safety and efficacy of fortified rice.

It also found that the pilots were marred by patchy responses by states, botched quality control, lax scientific parameters, and shoddy supervision. The report reveals how Aayog’s officials found quality checks missing despite India’s food safety regulator listing fortified rice kernels – grains of rice laced with micronutrients – under its ‘high risk’ category. Food items categorised as high risk are to be inspected carefully and are dangerous for public health when not well-produced.

The report, marked confidential, did not matter much anyway. After Prime Minister Narendra Modi’s grand announcement in August 2021 to universalise fortified rice and the government’s subsequent rollout of a programme in April 2022 following up on the Prime Minister’s announcement, the report’s findings on the failed pilot projects had no takers.

The government has so far allocated over 137.74 lakh tonnes of fortified rice across all states. Part two of the series today reveals how government officials flagged shoddy implementation of the scheme eight months after the Prime Minister announced it.

Critical Deficiencies

Fortified rice grains are prepared by beating normal rice into a dough, and mixing them with powdered micronutrients, known as premix. This dough is then machine-carved into grains to resemble rice, known as fortified rice kernels (FRK). One such kernel is mixed with 100 normal rice grains and supplied through public distribution system.

NITI Aayog flagged major lacunae in each step of the process, beginning with the preparation of kernels, after visiting 7 of the 11 districts where the scheme is being implemented. On the ground, they found none of the districts had in place a process to regulate the quality of premix used so that there is no underdosing or overdosing of micronutrients, none checked the sample of fortified rice that reached schools, anganwadis (state-run daycare that caters to infants, pregnant women and lactating mothers) and public distribution shops for quality despite central guidelines saying so, and none set up project monitoring units to evaluate how the scheme was being implemented.

In the kitchens of Gujarat, they heard complaints that the fortified rice “looked different, took more time to boil and tasted insipid”, belying the Centre’s claim that fortified rice will have greater acceptance than an iron pill because it demands no lifestyle change.

The NITI Aayog report paints the picture that the Modi government’s major health policy intervention, affecting over half of India’s population, was a leap of blind faith. We break down the report’s findings, detailing what went wrong during the pilots.

No Surveys for Scientific Evaluation

When the intention of rolling out fortified rice is to tackle micronutrient deficiency, the government should know the extent of deficiency in its people. To find out, researchers have to first monitor the level of nutrition in the population by looking at markers that indicate deficiency. This is called baseline survey. They then have to supply iron-fortified rice to beneficiaries for 12-18 months to see if fortified rice is working its magic. NITI Aayog’s confidential report shows that in none of the districts its officials visited, the baseline survey, which was “needed for scientific impact evaluation”, was conducted.

In other words, the government did not know the anaemia levels of people before they were forced to eat fortified rice and therefore could not conclude if this artificial rice intake made any difference at the end of the pilot study.

In the absence of baseline surveys, the report suggests conducting ‘concurrent evaluations’ – continuous real-time surveys. However, this new system of evaluation is yet to take off with only a little over a year left before universal scale-up.

As reported in Part one of the series, only eleven of the planned fifteen pilots took off under the scheme. Of these, only five completed at least a year by the time the scheme ended in March 2022. The results of the other six pilots would become available after the fortified rice has been forced upon all 80 crore people. If at all the pilots are continued.

Quality woes

The Union Food Department had scripted a lead role for the food safety regulator (FSSAI) when it drafted the scheme guidelines. FSSAI is the Union government’s apex authority to establish, review and ensure safety of food consumed by the citizens.

Though FSSAI was tasked with checking the quality along every step of manufacturing and supplying fortified rice, it sat on the sidelines.

“In all districts, FSSAI was reported to have almost no role, when it came to the fortified rice quality assurance and control. It’s not conducting any quality testing related to fortified rice or FRK in any of the districts,” the report said.

“FSSAI officials reported they have not received any guidelines or protocols in this regard. FSSAI is only involved in granting licences to rice mills and FRK manufacturing plants,” it said.

Result: quality control across the seven districts suffered. The most critical of these – quality checks of fortified rice samples collected from schools, anganwadi centres and fair price shops – was missing in all the districts.

The report also noted there are no processes in place to check the quality of the premix used in fortifying rice. FSSAI’s standard operating procedures for the artificial rice kernel manufacturers say that each batch of premix should be tested by an NABL-accredited laboratory. NABL, a board under the Commerce Ministry, was set up to accredit labs that conform to scientific assessment standards.

In India, there are only 20 such NABL-accredited labs. These labs together had “a total estimated testing capacity of approximately 2.6 lakh samples a year,” according to the report. By the time the scheme is universalised, in two years, the total testing capacity would have to reach 24 lakh samples a year. These labs were concentrated in just 10 states. This posed additional logistical constraints for remote districts.

For example, in Uttarakhand’s Udham Singh Nagar, which is one of the pilot project centres, samples are not tested for micronutrients at mills, warehouses or ration shops. Millers and district authorities rely on the self-certification by fortified rice kernel manufacturers. This is despite the fact that government’s guidelines specify tests of micronutrient analysis of fortified rice to be conducted by state officials once every three months.

In response to The Collective’s queries, the FSSAI said, “FSSAI has covered Fortified Rice Kernels under high-risk categories and mandated pre-license inspection for FRK manufacturing units, so as to ensure the unit is in compliance of FSS (Food Safety and Standards) Regulations.”

“Apart from this, surveillance and enforcement samples are being drawn to check the quality of FRK as per FSSR,” it added. This contradicts the findings of the confidential NITI Aayog report. The Aayog did not respond to detailed queries despite reminders.

“Plastic Rice”

In some places, sceptical district-level officials responsible for implementing the pilot treated the fortified rice like unappetising food that gets pushed around the plate.

In Tamil Nadu’s Tiruchirappalli (Trichy), the report noted, district officials “appear to not be fully convinced about the benefits of rice fortification, and are more keen on using modes of supplementation and diet diversification”.

At the grassroots, few knew anything about the purpose, benefits, storage, usage and consumption and shelf life of fortified rice. “Awareness among local officials, FPS (ration) dealers, ICDS (integrated child development schemes) and PM-Poshan functionaries, frontline workers, AWC (anganwadi) staff, local leaders, gram panchayat was found ranging from limited to no awareness”.

Besides, the alien stuff in the rice scared people. The Collective saw this during its visits to districts of Jharkhand where fortified rice was supplied.

When fortified rice first reached Pahar Toli, a small village in Jharkhand’s Khunti district, in February 2022, villagers recoiled at the sight of rice that looked the part but didn’t taste or feel the same. They feared they were being fed plastic rice.

“We fell sick. My husband and I suffered from diarrhoea after eating the plastic rice. My gut health improved only after I stopped eating it,” Basi Munda, a 65-year-old farm worker, told The Collective. The Collective could not independently verify if the sickness Basi complained of was indeed caused by fortified rice.

“We tried to burn the plastic rice,” one local resident said. “We were trying to test if it would melt the way plastic does.”

Somari Munda, a mother of two, told The Collective that they found the rice strange. “It wouldn’t cook the same way as regular rice and gets washed away when we drain the excess water after cooking rice.”

The report attributed these to lack of communication.

“Commonly available fortified rice kernels tend to float while normal rice sinks,” the report said. “In Chandauli, Singrauli and Trichy beneficiaries threw away FRK while sieving or washing the fortified rice,” because it is a common kitchen knowledge that it is the chaff that floats.

“Unless beneficiaries are aware of this, they are likely to allow floating FRKs to get washed away/discarded.” The report says this renders the scheme “ineffective”.

The Collective, in its travels to Khunti’s Pahar Toli and East Singhbum’s Kuchiyasholi found that women were winnowing out the fortified kernels from normal rice at homes and in schools under mid-day meal schemes. This is in line with what NITI Aayog officials found during their field visits.

People also had to be told that shelf-life of fortified rice isn’t flexible and shouldn’t be aged like normal rice, a practice followed to improve texture, flavour and size.

The officials found “Information, Education and Communication” activities falling short of what the guidelines prescribed. This was despite the fact that the pilot scheme allocated Rs 2 lakh just for this purpose in each district.

And the crucial part: eyes were missing. The Union Food and Public Distribution Department’s guidelines called for project monitoring units in every state and district, apart from one at the central level. But none of the seven districts the officials visited had set it up. And the Union Food ministry rejected The Collective’s RTI queries on the monitoring unit saying they didn’t have any such records.

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Part 3: Forcing Indians to Eat Fortified Rice a Bonanza for a Dutch Firm

On Independence Day, 2021, when Prime Minister Modi announced that over 80 crore people will be fed rice fortified with iron and vitamins to combat rising cases of anaemia and other micronutrient deficiency diseases, it was touted as a major health policy initiative.

Part one and two of the investigation by The Reporters’ Collective showed the Modi government rushed with its plan to supply fortified rice despite internal and external expert warnings on the adverse effects of feeding people, particularly children, fortified rice.

In this final part of the series, we reveal, how at least six international organisations, found their way into an Indian government agency to influence decisions and open the Indian market to global suppliers and manufacturers of premixes that are used to produce the artificial fortified rice kernel – an annual business opportunity of Rs 1,800 crore created solely by Union government’s mandate. [Fortified rice is made by beating grains into a dough, adding micronutrients or premix to it and then machine-carving the dough into grains that resemble rice. One such kernel is mixed blended with 100 natural rice grains.]

The Collective’s investigation found, all the six organisations are linked to one company based in The Netherlands. Royal DSM NV, one of the world’s most prominent producers of fortified rice premix. DSM claims to be a health and nutrition company. It produces the powder used in fortification. The firm, The Collective found, funds one of the six organisations, collaborates with another, sits on the advisory board of third and partners with the rest.

These six organisations influenced government policy on supplying rice and other food items fortified with micronutrients across the country, collected evidence to buttress the case for fortification, ran pilot projects with governments, worked to set standards and charted countrywide rollout. The government used ‘science’ generated by these organisations to justify mandatory supply of fortified rice in India. The government guidelines on fortification were developed by plagiarising in parts verbatim from toolkits developed by some of these organisations.

In return Modi’s announcement gave a bonanza to Royal DSM.

The company did not hide its gratitude. “We are very thankful that Prime Minister Modi’s government has mandated the fortification of rice, at least in the social safety nets part of the rice pipeline in India,” François Scheffler, Regional Vice-President, Human Nutrition and Care, Asia Pacific & President, DSM Asia Pacific told the Indian media.

The Collective’s evidence gathered is based on internal government records as well as public documents.

Within eighteen months of Modi’s announcement Royal DSM set up a 3,600-tonne capacity fortified rice kernel plant in Hyderabad. Scheffler told The Print that Royal DSM is working with the government, NGOs and rice millers in India to expand its production.

DSM is estimated to have already cornered 17% of the Indian micronutrient premix market, says market research agency Giract. The domestic market was estimated to be worth over Rs 660 crore in 2021. And, soon it would be worth Rs 1,800 crore a year, thanks to the Union government’s mandate.

While DSM is open about its business strategy involving nonprofits and engagement with governments, it’s not the only corporate that would stand to gain significantly from the government’s decision. Neither is their modus operandi unique. Many global companies in the business of food and nutrition products lobby through nonprofits and directly to create markets in the developing world.

A Meeting In Mexico

The idea to rapidly “rally” nonprofits and corporates to push rice fortification in developing countries was crystallised way back in 2016 in Cancun, Mexico. International nonprofits congregated to attend a symposium on rice fortification organised by DSM and some global NGOs. The agenda on the table was a grand one: “Create a movement that will deliver a global roadmap for scaling up rice fortification”.

One of the speakers, the current president of nonprofit group Nutrition International, Joel Spicer, said at the symposium, “The policy advocacy piece is missing from the rice fortification agenda. We need to communicate with the governments’ policy-makers — and establish how much the scale-up of rice fortification will cost, what they will get from it, and who’s going to pay for it.”

A month after the conference, the food safety regulator of India, Food Safety and Standards Authority of India, set up a ‘resource hub’ geared specifically towards fortification. One can only guess if it was a mere coincidence or not. The Food Fortification Resource Centre, as it came to be called, planned ‘alignment and advocacy’ and worked towards ‘creating demand’ for fortification.

These are business terms to describe the act of convincing governments to make it a must for people to consume such food products. Indian and international food product companies have always eyed the Union government’s vast food security schemes serving more than 80 crore people in India. In 2016, the fortified food producers set their sights on this Indian market.

A bevy of international nonprofits, including Nutrition International and one previously owned and still funded by DSM, became partners in the resource centre, which works as the government’s nodal arm for fortification and is dependent on nonprofits for every aspect of its functioning. They attended meetings on fortification, and were invited to major government policy meetings, thus playing a major role in lobbying for food fortification with lawmakers in India.

When the resource centre released the primary document that sketched out the plan for fortification in 2017, it listed nutrition nonprofit Sight and Life as one of the government’s partners in scaling up fortification across the country. Sight and Life previously operated ‘under the umbrella’ of DSM and continues to be funded ‘generously’ by the firm. While the nonprofit claims it is an ‘independent foundation’, half its board members, including the chair of the board of trustees, are DSM personnel. As a partner, the nonprofit would be involved in setting policies and even have a say in notifying the food regulator’s standards for fortifying rice.

The 2017 document calls for a joint advocacy campaign led by FSSAI – “bringing the credibility, authenticity and trust of the government” – but adds, “with financial contributions from the industry and premix suppliers”.

While the government was still chalking out plans to scale up the fortification programme, the food regulator held a meeting with the premix industry in March 2017. The minutes of the meeting recognise DSM as the only premix supplier for rice fortification. In the meeting, the firms decided on a price range for both premix manufacturing and fortified rice kernels. “FSSAI does not fix any market price of any food commodity,” said the government’s food regulator over mail. However, the minutes of the meeting clearly show each premix supplier enumerating the price range of the premix they offer.

Experts say the fact that the resource centre is intertwined with nonprofits funded by firms with commercial interests in the fortification policy raises ethical questions about its functioning.

“Having the Food Fortification Resource Centre in FSSAI requires investigation about its role,” Dr Arun Gupta, a paediatrician and convenor of Alliance Against Conflict of Interest, told The Collective over mail.

“The majority of FFRC partners are funded by the food industry, why on earth should they be asked to play the role of a resource centre?”

“FSSAI invites various stakeholders to attend meetings for better understanding. However they do not have any role to decide policy matters etc,” the FSSAI told The Collective via mail in response to detailed queries.

None of the meetings on fortification in the files The Collective reviewed, however, involved civil society or consumer groups not linked to food businesses. This was a departure from the meetings held, for example, on the contentious issue of the government’s Front of Pack Labelling policy, which involved a more diverse set of stakeholders.

DSM has nurtured allies in NGOs, and governments to promote fortification, and is open about it. “In partnership with governments, the private sector and NGOs such as GAIN, DSM is pioneering the establishment of staple food fortification programs worldwide,” it says on its website.

By now the signs of the government’s growing chumminess with DSM became apparent. The Modi government finalised India’s fortification policy despite overwhelming evidence pointing towards its lack of efficacy. But internally, it cherry picked a list of evidence to convince states to start supplying fortified rice. One of the research papers cited as evidence on this list is by Sight and Life – the nonprofit previously functioning under DSM – and DSM itself. The DSM-affiliated research concluded that fortified rice is an effective way to combat malnutrition. The resource centre website too, cites multiple studies by Sight and Life.

DSM being the early bird was positioned to reap profits. Government tenders for picking fortified rice kernel suppliers list eight premix suppliers allowed – one of them was DSM. The government’s fortification resource centre lists DSM’s Indian group company, DSM Nutritional Products India Pvt Ltd, as a supplier of both fortified rice kernels and centrally licensed premix.

The government’s fortified rice programme has coincided with the healthy growth of DSM’s revenue. DSM Nutritional Products India’s profits after tax saw a near 30% hike in the financial year 2021-22 over its 2020-21 numbers. The 2020-21 year was also a great one for the firm with a 60.5% rise in profit after tax when compared to 2019-20. In fact, the company’s profit of Rs 20.65 crore in 2021-22 is the best figure it has posted so far, shows a review of the company’s corporate filings. The company’s annual filings, however, do not segregate its revenues based on sale of particular products.

The Collective sent detailed queries to DSM. A spokesperson on behalf of the multinational got in touch with The Collective and assured that the company would respond to the questions. But no reply came through.

Financial welfare of business corporations was on the government’s mind too. Though rice fortification was touted as a health move, government documents reveal an underlying aim to foster the wealth of businesses. The Food Department in a note, dated 12 September 2019, said one of the objectives of its rice fortification scheme was to “give a fillip to the FRK (fortified rice kernel) industry through assured demand”.

The industry includes those who produce micronutrients, units that manufacture machines to mix rice with nutrient powders to make fortified kernels, machines that blend these kernels with normal rice in the right proportion, rice millers and suppliers.

Calculations by The Collective, based on figures included in official documents, show that under the scheme the business generated for the blending industry alone would be between Rs 1,560 crore and Rs 13,500 crore depending on the type of blending units millers opt for. For the kernel supply industry, meanwhile, a market totalling at least Rs 1,800 crore a year would be generated. This in addition to the market created for multinational micronutrient companies.

Fortifying Profits

At least six partners of the Food Fortification Resource Centre have indirect links to the DSM. One of them, Nutrition International, until as recently as December 2022 listed DSM as one of its private sector partners. Another partner of the Food Fortification Resource Centre is a supercluster of nonprofits. Called ‘Food Fortification Initiative’, the nonprofit is focused solely on advancing fortification as a means to mitigate malnutrition worldwide. The Food Fortification Initiative also lists DSM as one of its members.

“Food Fortification Initiative (FFI) does not endorse any premix supplier, and this includes DSM,” Food Fortification Initiative told The Collective over mail. “Premix suppliers do not influence FFI’s work globally and are not represented on FFI’s Executive Management Team.”

The Collective found The Initiative’s Executive Management Team, however, does include Nutrition International, which has previously listed DSM as one of its private sector partners.

And, FFI acknowledged working with premix suppliers. It said, “By working together, we achieve more than any of us could independently.”

Some of these global nonprofits partnering with the resource centre share a symbiotic relationship with DSM.

PATH, a tech-focused public health nonprofit, has developed the technology widely deployed by developing nations for rice fortification, called Ultra Rice, its development was partly funded by DSM Nutritional Products.

Yet another partner of the resource centre with indirect links to DSM is the international consortium called Global Alliance for Improved Nutrition (GAIN). Its primary donor is the Bill and Melinda Gates Foundation. DSM’s president of Global Malnutrition Partnerships Mauricio Adade is on the council that advises GAIN’s board.

In 2017, GAIN’s India office informed the Indian government that the Government of the Netherlands, the home ground of Royal DSM, was funding GAIN to work on fortification in India.

GAIN isn’t just involved in lobbying for fortification. It also acts as a broker between micronutrient sellers, including DSM, and interested buyers.

In 2009, GAIN set up a ‘premix facility’ where customers can buy premix of their choice including that for rice. The facility is akin to Amazon — but just for fortification premixes. GAIN says the facility was set up to “help fortification projects by establishing an easier, more cost-effective way of procuring high quality vitamin and mineral premix”.

A report an Indian farmers’ welfare nonprofit Alliance for Sustainable and Holistic Agriculture on conflict of interest in India’s fortification pointed out that among the facility’s suppliers is DSM.

In response to detailed queries by The Collective, GAIN said the nonprofit did not have any partnerships with DSM in India to achieve its objectives. However, they added, “The only way to achieve this is to work together with partners (governments, businesses, and development partners) at the country and global level.”

GAIN has a history of championing corporate interests. In 2013, the World Health Organisation refused to recognise GAIN as an NGO over a business alliance network of food companies the group had set up. The alliance basically acted as an international hub to broker and lobby food deals, and offered companies assistance in lobbying for favours in targeted countries.

WHO was concerned about “the nature and extent of the alliance’s link with the global food industry”. Eventually, GAIN got recognition after scrapping its business alliance. Health activists, however, pointed out that the group co-chaired a similar business network, Scaling Up Nutrition Business Network, along with the World Food Programme.

The World Food Programme works with DSM in implementing its rice fortification programme. In its responses to The Collective’s queries about concerns of conflict of interest , it noted, “WFP has a global partnership with DSM.”

It then added, “However, there is no formal partnership between DSM and WFP’s India Country Office. WFP in India is not receiving any funds or other resources from DSM.”

Manufacturing Evidence

In the case of the fortification policy, the line between evidence and lobbying is blurry.

Ahead of scaling up fortified food across the country, the Food and Public Distribution Department on 29 June 2021 presented research papers to the Minister of Consumer Affairs showing the efficacy of rice fortification. The department presented thirteen papers in the presentation titled “Rice Fortification with Iron, Folic Acid, Vitamin B-12”. Of these thirteen, only six studies were conducted on Indian citizens. Five of six of the India-based papers, The Collective found, were affiliated with nonprofits that are part of the resource centre and in one case directly with DSM.

“I believe that researchers or studies supported by the food industry cannot be trusted for their findings or recommendations,” Dr Arun Gupta of the Alliance Against Conflict of Interest told The Collective.

One of the studies is a 2004-05 research paper co-authored by Dr Anura Kurpad. He is a member of NITI Aayog’s National Technical board on nutrition and professor at the St John’s Medical College, Bengaluru. His study found an increase in serum ferritin levels in children who were given iron-fortified rice. Serum ferritin is linked to an increased risk of diabetes. Dr Kurpad has been publicly warning of the risks of iron-fortified rice.

The government has listed this paper too, as evidence of the efficacy of fortified rice.

By 2019, the government was chalking up its centrally sponsored pilot project scheme to distribute fortified rice. Even in the development of this pilot scheme, the Department of Food and Public Distribution worked with PATH. The government’s pilot project focused on distributing fortified rice in 15 districts. To enable this, Tata Trusts, PATH, World Food Programme and Nutrition International have been paired with states that evinced interest in the scheme as technical partners. It is unclear how they were chosen by each state to help execute the scheme.

“Today, World Food Programme (WFP) does not engage with the food fortification resource centre – WFP’s role with the entity was limited to building the capacities of the staff positioned there in the initial months,” said World Food Programme over mail.

On 15 August 2021, the Prime Minister announced that fortified rice would be supplied through the country’s PDS by 2024. Three days after the announcement, officials at the NITI Aayog began drawing up a plan to universalise rice fortification.

For this, they decided to rely on GAIN. A file noting, dated 18 August 2021, by Vedeika Shekhar, an Associate at the Niti Aayog, said, “A detailed implementation action plan will be developed for the pan India expansion of rice fortification with GAIN. GAIN has been chosen as the development partner because it has been chosen as the focal point for all the development partners by BMGF (Bill and Melinda Gates Foundation).”

Why should a group be chosen as India’s development partner only because the BMGF considers it their ‘focal point’ is not made clear. The role such an entity would play in the policy remains similarly unclear.

GAIN, in its response to queries by The Collective said that it is not working on rice fortification in India. But it did not respond to the question on NITI Aayog’s file notings that said GAIN has been chosen as the government’s partner in scaling up rice fortification across India. The nonprofit also did not respond to queries related to its premix facility, which procures fortified rice kernels from an Indian supplier as well. The Aayog did not respond to any queries.

Plagiarism

Here is the smoking gun to prove the government’s lack of independence in setting unbiased standards for the fortification industry. A plagiarism check run by The Collective shows the government’s fortification manual, which codifies processes to follow in rice fortification, reproduced verbatim portions of a document jointly-written by PATH and GAIN in August 2015 for their hand-outs, raising questions about the originality and independence of the government’s manual.

The slight tweaks it made included changing ‘toolkit’ to ‘hand-out’ and inserting ‘India’ once every few sentences. Then FSSAI CEO Pawan Agarwal credited PATH in the hand-out’s preface: “I appreciate the support of PATH, who has assisted in the development of this technical manual.”

The Food Department too, lifted some portions of PATH and GAIN’s toolkit for its guidelines. It patchwrote the text by erasing references to PATH’s Ultra Rice in its document. The draft guidelines, reviewed by The Collective, explicitly refer to Ultra Rice, the product PATH created partly with funding from DSM .

In its guidelines on personnel health, for example, the manual says, “No person who is suffering from any contagious or infectious disease is permitted to enter the packing area or touch Ultra Rice.” When the guidelines were made public in 2019 the sentence was edited to: “No person who is suffering from any contagious or infectious disease is permitted to enter the packing area or touch fortified rice.”

But, all this is now history. By the end of this financial year 80 crore Indian citizens would have no option but to consume the fortified rice delivered through government schemes for survival.

(Shreegireesh reports and writes on issues of economy and governance. He particularly loves to use the Right to Information Act to find stories. A former TEDx licensee (2016-18), he graduated from Delhi’s Indian Institute of Mass Communication with a diploma in English Journalism. Before joining the collective, he worked with Business Standard. Courtesy: Reporters Collective, a group of like-minded Indian journalists who collaborate to report on stories that put the spotlight on those in power; and who shed light on how India’s political economy and governance functions.)