Public Health expert, Dr Randall on his observations from the fact finding visit in Chattisgarh (in Hindi)
KEY FINDINGS OF THE FACT FINDING VISIT
The following is an Executive Summary of a Fact-Finding Report on Fortified Rice Distribution in various government food schemes in the state of Chhattisgarh, after visits to four districts of the state (Kondagaon, Bastar, Surguja and Korba) and interactions with scores of entitlement-holders/”beneficiaries”, frontline workers of various line departments, PDS dealers, medical experts, and senior government/executive functionaries at state and district level. The fact-finding visit organised by Alliance for Sustainable & Holistic Agriculture (ASHA-Kisan Swaraj) and Right To Food Campaign (RTFC) was during June 13th to 15th 2022, and included a seven member team (two of whom are medical doctors).
a. Community Rejection Initially: During the fact finding, at several places the team found that, communities initially rejected the fortified rice quite strongly. While some of this is linked to fears around “plastic rice”, some of it was lack of preference. In one location, it was adverse effects that made the community give up consumption of fortified rice. In Kondagaon field visit, the team found that PDS beneficiaries refused to buy the fortified rice for one month. This is being sought to be overcome by the state government by aggressive publicity about the virtues of fortified rice without any messages put out on contra-indications related to iron-fortified foods.
b. FRK (fortified rice kernal) being discarded even now: The fact-finding teams found that even now, a significant number of people avoid eating the FRK being mixed natural rice in the PDS supplies. There are at least 3 ways that the chemical fortificants are getting discarded – one, by hand-picking during cleaning stage where women are able to recognise the FRK by color and appearance; two, when the rice is soaked in water when FRK floats up, it is removed; three, when extra water is drained out after the rice is cooked. This is happening in beneficiaries’ homes as well as in anganwadis. This puts a question mark on the efficacy of this approach, apart from this being a clear violation of the WHO guidelines. Efficacy questions arise for other medical reasons also, as a perusal of published scientific literature shows.
c. Adverse reactions reported after consumption of fortified rice: During the visits, adverse physical reactions were also reported in some locations from some people. Stomach ache was the common complaint heard; however, it is unclear if fortified rice was the reason.
d. Iron Fortified Rice being distributed indiscriminately and irresponsibly to unsuspecting and unknowing people: There is indiscriminate distribution of fortified rice even to contra-indicated patients – here, multiple issues emerge. (i) there has been no comprehensive screening of the population to identify sickle cell disease persons and thalassemia patients. Therefore, the question of patients following any medical advisories does not arise; (ii) even the patients who have been identified as such have been consuming fortified rice since no one warned them against the same; (iii) in many cases, the patients have no choice other than eat the iron-fortified rice, given their poverty conditions; (iv) even if both fortified and non-fortified rice is supplied separately to each household, maintaining this distinction in the cooking practices of the household, where two types of rice are to be cooked each day may not be possible; (v) even if this is indeed put into place by over-worked women in the households where cooking food has been made their gendered responsibility, such choices don’t exist for contra-indicated persons in anganwadi and school meals.
e. Non-Compliance to Statutory Food Safety Regulations: The teams also found that statutory labelling regulations are being flouted with regard to iron-fortified rice. F+ logo was not always there, nor were warning statements stencilled and labelled in all cases. Moreover, labelling was incomplete, where it was present. Importantly, compliance to labelling regulations does not mean anything much for the end consumer in this case for various reasons – in Chhattisgarh, PDS dealers, anganwadis and schools are made to return back the gunny sacks in which the rice has been supplied for government food schemes. Such rice is transferred into any bag and container from that stage on and supplied bags are returned. From that stage on, labelling holds no meaning, in that sense. Further, end consumers get their supplies in loose, and not in packaged labelled manner. The poverty, literacy and knowledge about contra-indicated conditions is such that even if all issues are addressed, patients may not be able to avoid fortified rice.
|Label is blurry and not useful since rice is given in loose form|
f. One-sided Incorrect Publicity by the Government: The fact-finding teams found that potential benefits of fortified rice were amplified through the government agencies as wall-writings, posters, banners, newspaper advertisements etc; on the other side, the PDS dealers, anganwadi functionaries and health department functionaries were not told about fortified rice supplies and no warning statements put out. No prior informed consent was obtained from beneficiaries before such large-scale distribution began even though Right to Know Your Food and Right to Informed Choices are basic rights when it comes to something as critical as food.
g. Chhattisgarh Government is supplying more fortified rice per person than other states – Safety implications unstudied, unknown: In Chhattisgarh, the PDS-based entitlements per person are higher than in other states, and all schemes (including PMGKAY) are right now supplying only fortified rice in the chosen districts. This could lead to iron over-dosing.
h. Layering of multiple interventions also leading to potential iron over-dosing: Chhattisgarh also has other schemes which seek to address malnutrition apart from the fact that it is supplying more quantities of fortified rice to its citizens. This includes fortified Take Home Rations, which incidentally also have iron added. Further micronutrient supplementation programs are also underway. In certain districts, jaggery and channa are supplied in the PDS. There is no evaluation of all the interventions comprehensively, to check for risks of iron over-dosing of vulnerable populations.
i. Concerns and Reservations amongst Government Functionaries too: It is noteworthy that the fact-finding teams have only encountered concerns and reservations expressed by various functionaries in the government, once detailed discussions on various aspects related to the intervention unfolded. The lack of debate and information about Rice Fortification is striking and disturbing.