LAHORE: Micronutrient deficiencies are severely impacting the health of almost all segments of society in Pakistan, particularly women and children. Micronutrients play a vital role in enhancing immunity, supporting growth and fostering cognitive development.
Iron deficiency anaemia, one of the most prevalent micronutrient deficiencies, has significant economic implications for Pakistan. Recent reports indicate that anaemia costs the country over $3 billion annually in lost productivity and human capital. Beyond anaemia, the broader spectrum of undernutrition, including other micronutrient deficiencies, imposes an even greater economic burden. Estimates suggest that undernutrition costs Pakistan approximately $17 billion annually, representing 4.6 per cent of the country’s gross national income (GNI).
Iron fortification of wheat flour is a crucial public health intervention aimed at reducing iron deficiency and anaemia -- conditions that impair cognitive development, weaken immunity, and reduce productivity. In Pakistan, more than half of women and children suffer from deficiencies in essential micronutrients, including iron.
Despite the implementation of the Food Fortification Programme (FFP), anaemia rates among women and children remain alarmingly high. Several key factors have hindered progress. Many flour mills do not comply with fortification regulations due to weak enforcement, and small and medium-sized mills often avoid participation due to additional costs and a lack of incentives. A study by GAIN and USAID revealed that the cost of fortifying a 20kg bag of wheat flour in Pakistan is approximately Rs3.5 -- an amount so minimal that it has a negligible impact on the overall price.
However, unregulated flour mills continue to produce unfortified wheat flour, which dominates the market. A significant proportion of Pakistani households consume chakki atta (whole-wheat flour milled at small local mills), which is not fortified. Many rural families also prefer homemade flour, further bypassing fortified options.
Another challenge is that fortified iron is not always efficiently absorbed due to high phytate levels in wheat, which inhibit iron absorption. The traditional Pakistani diet, rich in tea, dairy, and certain vegetables, contains iron inhibitors that reduce uptake in the body. Low intake of vitamin C-rich foods, which aid iron absorption, exacerbates the problem.
Iron deficiency is not the only cause of anaemia -- deficiencies in folate, vitamin B12 and zinc also contribute significantly. Many women and children suffer from multiple micronutrient deficiencies, making iron fortification alone insufficient.
A lack of consumer awareness further hampers fortification efforts. Many people are unaware of the benefits of fortified wheat flour and do not actively seek it out. Misconceptions persist, with some believing fortified foods are ‘synthetic’ or ‘less nutritious’. Low-income families struggle to afford a diverse, iron-rich diet that would complement fortified wheat flour. Meat consumption remains low, and reliance on plant-based iron sources -- less readily absorbed by the body -- remains high.
Monitoring of fortification quality across flour mills is also inadequate. The government has yet to effectively scale up or enforce mandatory fortification across all wheat flour production.
In Pakistan, the price of iron-fortified wheat flour is generally comparable to that of traditional chakki atta, with only a slight difference due to fortification costs. While minor price variations exist among brands and types of wheat flour, the cost difference is minimal, allowing consumers to choose fortified options without significant financial impact while gaining essential nutritional benefits.
To address this crisis, the government must ensure that chakki mills also fortify wheat flour, alongside stricter enforcement and monitoring of mills to ensure compliance. Public awareness campaigns should educate consumers on the benefits of fortified flour. Dietary habits must be addressed by promoting iron-rich foods and vitamin C intake to enhance iron absorption. Integrating iron fortification with folate, vitamin B12 and zinc fortification is essential to comprehensively combat anaemia in the country.