A Recipe to Fight Vitamin A Deficiency in India: Add Mustard and Stir?
by Ramanan Laxminarayan, Jeffrey Chow, Eili Klein, and Paula Tarnapol Whitacre
Have you had your vitamin A today? You need it for such essential processes as growth, vision, and resistance to infectious disease. Chances are, you don't have much to worry about. Most adults who consume dairy products, meat, and vegetables on a regular basis are okay, as these products either contain or are fortified with vitamin A or beta-carotene, a precursor to vitamin A.
But worldwide, the situation is quite different. Vitamin A deficiency (VAD) is a significant cause of blindness and death, especially for children and pregnant and lactating women. According to the World Health Organization, an estimated 250 million preschool-age children in more than 100 countries are vitamin A deficient. Of these, between 250,000 to 500,000 lose their sight each year as a result, and more than half die within 12 months. VAD also increases the risk of dying from diseases such as malaria and measles: estimates suggest that it contributes to the deaths of 1.2 to 3 million children annually. Approximately 7.2 million pregnant women in developing countries also suffer from VAD, which means their infants are likely born in an already compromised state.
Beyond the immediate impact on families, VAD also has a financial impact on a country. Poor nutritional status can reduce a country's gross domestic product by 2 to 3 percent annually, according to the World Bank. In addition, VAD and other nutritional deficiencies can result in significant outlays when treatment of otherwise preventable illnesses strains overburdened health systems. Conversely, improving a person's nutritional status can increase his or her lifetime earnings by at least 10 percent, which can make a considerable difference to a country's economy as a whole.
India has some of the highest rates of VAD in the world. Each year, it is associated with the deaths of 330,000 children in India alone. Although vitamin A status has improved in the past few decades, a survey by the National Nutrition Monitoring Bureau indicates that 57 percent of Indian children- 35.4 million children- were vitamin A deficient in the late 1990s. Data also suggest that while VAD affects both rural and urban households, it generally results from malnutrition.
Getting Public Health Programs Working
Over the past few decades, as the link between VAD and mortality and morbidity have become better understood, countries and international organizations have developed three main approaches to boost vitamin A levels: periodic supplementation of young children with high dosages of vitamin A; fortification of commonly eaten foods with vitamin A, often with other micronutrients; and other food-based approaches such as nutrition education and promotion of home vegetable gardens.
These approaches have had results, but, as the numbers show, they have not solved the problem.Moreover, supplementation, the most commonly used intervention, is on the decline, because it has often been implemented alongside polio immunization campaigns that are winding down in many countries.
Experiences in India with these three interventions illustrate how difficult it is to get public health programs working on the ground. Although the country launched one of the world's first supplementation programs to fight blindness in 1970, only a small percentage of children now receive the recommended twice-yearly dosages of vitamin A, and coverage varies greatly by state and by income level.
Supplementation programs in India also suffer from a lack of support from India's medical establishment- which, despite widespread evidence- has not uniformly endorsed vitamin A's link to mortality, and has displayed a preference for fortification and foodbased approaches over supplementation. Unfortunately, India's highly decentralized food-processing systems and varied diets hamper these other approaches, as well. Despite many innovative attempts and pilot projects with foods that range from rice, to tea, to fortified candies, less than one percent of food in India is fortified with vitamin A or any other micronutrient. India's low meat and dairy consumption increases the likelihood that people, especially the poor, will get enough vitamin A from their diet alone.
New advances in biotechnology have generated the possibility that foods genetically modified to express excess amounts of vitamin A may be an alternative. To assesses the potential of this approach, the U.S. Agency for International Development and the International Center for Tropical Agriculture asked RFF to look at one potential option: biofortification of mustard seed with vitamin A.
(This article is based on a new RFF report, Closing India's Nutrition Gap: The Role of Golden Mustard in Fighting Vitamin A Deficiency, by the authors. See www.rff.org/rff/goldenmustard.)
Why mustard? Cooking oil from pressed mustard seed is commonly used in northern India where VAD is most widely prevalent, especially among poor rural families that are often underserved by supplementation programs. Another advantage is that vitamin A is more easily digested when consumed with a moderate amount of fat, such as edible oil. In recent years, the Monsanto Company and The Energy and Resource Institute (TERI) in India- building on Monsanto's experience biofortifiying canola oil, a close genetic relative to mustard, with vitamin A- succeeded in expressing high levels of beta-carotene in mustard seeds. The technology involved is similar to that used to develop the better-known "golden rice." Once pressed, the biofortified mustard oil retains high levels of betacarotene, which is what gives the oil, like rice, its dark golden color. The fortified oil can provide far more vitamin A per serving than through traditional means.
However, after several years of laboratory work and very limited field trials, efforts to commercialize the technology have stalled, despite a pledge from Monsanto to license the technology without cost. RFF was asked to help determine whether further investment in the technology should continue. Two main questions were addressed: first, whether mustard production and consumption indicate its appropriateness as a vehicle to increase vitamin A intake; and second, whether biofortification costs, particularly compared with existing interventions, justify further investigation. If VAD-affected individuals do not consume mustard in sufficient quantities, especially children and women, or if the costs are unreasonably high, it is not worth exploring further.
The study did not take into account the political, social, and environmental questions that have been central in the debate about genetically modified foods worldwide, issues that policymakers cannot ignore. But it provides a piece to the puzzle as new ways aresought to improve nutrition worldwide.
Mustard from Mela to Mouth
As with many crops in India, mustard is grown primarily on a small scale, with most of the country's 40 to 50 million mustard farmers planting about five acres annually. Production, like consumption, is concentrated in the north. Farmers generally purchase new seed each year, typically atmelas (farm fairs), which also serve as a source of agricultural information. A number of public and private institutions also support producers and processors and are potential avenues to introduce information about "golden" mustard or even distribute seed.
About 90 percent of the mustard seed grown in India goes to make oil. Large manufacturers process the highest volume of oil (about 75 percent of the total annual production of about 2 million metric tons); small-scale facilities are more inefficient, although far more numerous. Although no reliable data exist about the extent of home production, anecdotally it is believed to be high.
Studies on similar types o