Rice fortification: Why no health warning for thalassemia, sickle cell patients?, asks SC

By A Representative
In response to a Public Interest Litigation filed by citizens challenging the government's iron fortified rice program, the Supreme Court has directed the Union government to respond to concerns raised which focus on the government’s noncompliance with their own warnings that caution patients of Thalassemia and Sickle Cell Disease to not to consume iron or to use it only under strict medical supervision. Although citizens had written to several government departments as well as some state food commissioners, they received no response.
Clause 7 (4) of the Food Safety and Standards (Fortification of Foods) Regulations, 2018 says:
“People with Thalassemia may take under medical supervision and persons with Sickle Cell Anaemia are advised not to consume iron fortified food products”.
The Government of India has been supplying iron-fortified rice in public safety net programs like PDS, mid-day meals, and anganwadis reaching crores of Indians.
As per the Food safety and Standards Authority of India’s (FSSAI) warning outlined in clause 7(4) of the Food Safety Act, and based on global scientific evidence, patients of haemoglobinopathies like Thalassemia and SCD are contraindicated to eat iron. Consuming iron could lead to adverse outcomes like organ failure for people with such conditions.
However, when the Alliance for Holistic and Sustainable Agriculture (ASHA) and the Right to Food Campaign conducted fact finding visits in two states, they found that iron rice was being distributed indiscriminately without any screenings or medical supervision and patients of haemoglobinopathies had no idea that the rice was harmful to them. The state governments had not been given any instructions by the center about this warning either.

Beneficiaries of state food schemes eating synthetic iron fortified rice are mostly poor citizens who rely on subsidized food

Given that the rice was being distributed in either loose form or cooked form in some schemes like the mid-day meals, there were no written or verbal warnings provided which were only poorly visible on gunny bags. Moreover, no alternative iron-free rice was being provided to such patients, it was found.

The beneficiaries of state food schemes eating synthetic iron fortified rice are mostly poor citizens who rely on state subsidized food and for whom iron fortified rice has become mandatory since they cannot afford to buy other (non-fortified) rice in the open market, the fact finding report said.

The scaling up of this programme came before a pilot scheme in 15 states was completed, or evaluated independently and rigorously. The evaluation of these pilots was due in late 2022 per an RTI response by the government, but no evaluation is available till date, it added?

The PIL petitioners have demanded that the government comply with clause 7(4) of the Food Safety Act and provide warnings that reach consumers directly. They also demand that non fortified rice is provided for patients with such contraindications.

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