1. CS122586 FFI Global Update

2. What is Flour Fortification? Fortification is adding vitamins and minerals to flour during the milling process so that staple foods are more nutritious. Modern mill with three feeder lines

3. 3 Thiamin Riboflavin Vit. B6 Folate Iron Niacin Wheat and maize lose much of their nutrients in the milling process. Fortification replaces those and can add other vitamins and minerals as needed. Essential Nutrients Nutrient Retention

4. Burden of Deficiencies Impair millions of growing minds and lowers national IQ Cause damage to immune systems and deaths of more than a million children a year Cause 300,000 serious birth defects annually Contribute to the death of approximately 60,000 young women a year during pregnancy and childbirth Impair millions of growing minds and lowers national IQ Cause damage to immune systems and deaths of more than a million children a year Cause 300,000 serious birth defects annually Contribute to the death of approximately 60,000 young women a year during pregnancy and childbirth Vitamin and Mineral Deficiencies: Micronutrient Initiative, UNICEF, and March of Dimes

5. Burden of Iron Deficiency World Health Organization: http://www.who.int/nutrition/topics/ida/en/index.html Leading cause of anemia which: Reduces work capacity Impairs a child’s physical and intellectual development Contributes to 20% of all maternal deaths

6. 17% lower productivity in heavy manual labor 5% lower productivity in other manual labor Estimated 4% loss of earnings due to lower cognitive skills. Economic Burden of Anemia The Economics of Food Fortification (2006) by Sue Horton

7. Burden of Folic Acid Deficiency Leads to neural tube defects (NTDs) such as spina bifida and anencephaly. 50% to 70% of these birth defects are preventable. Anencephaly is malformation of the baby’s brain. It is always fatal. Spina bifida is malformation of the baby’s spine. It causes permanent disability. Centers for Disease Control and Prevention: http://www.cdc.gov/ncbddd/folicacid/faqs.html

8. Centers for Disease Control and Prevention, “Folic Acid in the Prevention of Birth Defects” Public Health Grand Rounds, February 18, 2010 Neural tube birth defects per 10,000 live births -37% 1998 USA 0 2 4 6 8 10 12 14 16 18 Before fortification After fortification 10.8 6.6 - 46% 1998 Canada 15.8 8.6 - 41% 2000 Chile 10.1 17.0 - 31% 2003 South Africa 14.1 9.8 - 35% 1998 Costa Rica 9.7 6.3 Birth Defect Reduction

9. Savings From Preventing Spina Bifida Chile United States South Africa $1 spent $12 saved $1 spent $48 saved 1 rand spent 30 rand saved Economic Burden of neural Tube Defects and Impact of Prevention With Folic Acid: A Literature Review European Journal of Pediatrics published online 19 May 2011

10. FFI is network of partners working together to make flour fortification standard milling practice so that people worldwide are smarter, stronger and healthier. FFI Network

11. 11 Private Sector Public Sector Civic Sector FFI Agencies of the United Nations, government agencies and other national entities, non-government organizations, academic organizations Disability groups, advocacy associations, other civil organizations Millers, equipment and flour-product companies, wheat traders and baking organizations, other affiliated businesses FFI Stimulates Network Interaction

12. Mandatory Planning Voluntary No Flour Fortification Flour Fortification Status June 2011: Fortifying with at least iron and/or folic acid

13. 13 Flour Fortification Progress Since 2004: Nearly 2 billion people now have potential access to fortified flour - 858 million more than in 2004. Growth in fortified flour from roller mills increased from 18% to 30% The number of countries with documented national regulations for mandatory wheat flour fortification increased from 33 to 60.

14. 14 Condiments Oil Rice Wheat & Corn Multi-faceted Approach Sprinkles Supplements Population With Market Access Population Without Market Access

15. 15 Impact on Nutrition Security Fortifying flour puts more vitamins and minerals in staple foods which people continue to purchase and consume during economic downturns. As food prices go up, consumers often stop buying as many meats, fruits and vegetables

16. 16 Cost to Fortify Recurring costs of buying quality premix ranges from US$2 to US$3 for iron, folic acid, and other B vitamins. The per person, per year cost to fortify wheat flour may be as little as eight to ten cents. One metric tonne of flour is about 2,200 pounds, as pictured here.

17. 17 RankSolutionChallenge 1Micronutrient supplements for children (Vitamin A and zinc) Malnutrition 2The Doha development agendaTrade 3Micronutrient fortification (iron and salt iodization) Malnutrition 4Expanded children’s immunizationDiseases 5BiofortificationMalnutrition 6Deworming and school nutrition programsMalnutrition and education 7Lowering the price of schoolingEducation 8Increase and improve girls’ schoolingWomen 9Community-based nutrition promotionMalnutrition 10Provide support for women’s reproductive roleWomen Nutrition interventions are five of the top 10 most cost effective means to address global challenges, according to the 2008 Copenhagen Consensus

18. 18 Flour fortification is most successful when it is driven by national leaders. Multiple sectors must work together. Success of flour fortification in one country can have an accelerating influence in the region. A national standard approach is the most effective way forward. Reaching the top decision makers is essential. Focus On National Partnerships

19. 19 STRATEGY 1. Catalyse, support and sustain the operation of national partnerships STRATEGY 2. Create and disseminate communication & training and technical support materials in key areas STRATEGY 3. Through the Leaders’ Group ensure that organizations are enabled to work together STRATEGY 4. Secure adequate human and financial resources at national and global levels both for national activities and for the network in total. STRATEGY 5. Monitor all national fortification programmes. FFI Strategies