A file photo of normal and fortified rice. According to advocacy groups, all food products must carry warning labels so that vulnerable groups can avoid fortified foods.

The Food Safety and Standards Authority of India’s (FSSAI) draft notification on an amendment to remove crucial warning labels on iron-fortified food products for individuals with thalassemia and sickle cell anaemia has raised concerns.

Citizen and patient advocacy groups, who are challenging the FSSAI’s draft notification dated September 18, have urged the FSSAI to reconsider its decision. Currently, iron-fortified products come with a label stating “People with Thalassemia may take under medical supervision and persons with Sickle Cell Anaemia are advised not to consume iron fortified food products.” 

“The amendment to remove this warning label can put vulnerable populations with diseases where iron is contraindicated and who are on reduced iron diets at risk. This amendment is surprising given that the mandatory advisory was included into the statutory FSSAI regulations of 2018 after scientific discussions in statutory bodies of FSSAI Act 2006,. We are concerned about the way fortification is being promoted by the Union government as an effective solution to tackling malnutrition problems,” stated the petition that will be submitted to FSSAI and the Union Health Minister shortly. 

Health hazards

A 2022 NITI Aayog report had raised concerns over quality assurance and quality checks with regard to iron-fortified rice. This along with various studies citing the health hazards posed by iron-fortified food leading to iron overload have also been cited in the petition.

Namitha A. Kumar, thalassaemia patient advocate from Open Platform for Orphan Diseases, termed the FSSAI’s move as a dangerous precedent. “All food products must carry warnings on which vulnerable groups must avoid fortified foods. Taking off food warnings on edible products is unethical because it exposes vulnerable communities to unsuitable food products. It can be life threatening and highly toxic for a person with thalassemia to consume iron-fortified food products,” she said.

Gagandeep Singh Chandok, president of Thalassaemia and Sickle Cell Society of Bengaluru, said it will be a disaster for the community if the warning is removed. “Extra iron to thalassemia, sickle cell anaemia patients risks liver cirrhosis, cardiomyopathy, heart failure, hypothyroidism, hypogonadism, diabetes and delayed puberty,” he said. He pointed out that there have been cases of children developing iron poisoning after accidentally consuming iron supplements.

Surprising move

Kavitha Kuruganti from ASHA-Kisan Swaraj network, one of the groups that drafted the petition, said what is surprising about the omission of the cautionary label is that it coincided with a public interest litigation (PIL) seeking solutions for provision of non-fortified rice to those citizens who are contraindicated. 

“The statutory scientific bodies which had in fact strengthened the initial cautionary label seemed to have come under pressure from several processes initiated by other promotional Ministries. What is inexplicable is that when there is evidence of lack of safety as well as lack of effectiveness of this approach to tackling malnutrition, why is the government pushing this as a silver bullet,” she asked.

The policy decision to supply iron-fortified rice in such a large scale (with distinct potential for risk) without any scientific proof of its need and effectiveness, should be revisited, she added.