Context

• Despite economic progress and sustained public health efforts, anaemia remains a major public health challenge in India.
• Affecting over half of Indian women and nearly three-fourths of children, it contributes to maternal mortality, intergenerational malnutrition, impaired cognitive development and economic losses.
• The revised 7X7X7 Anaemia Mukt Bharat (AMB) strategy addresses prevention, screening, treatment, dietary diversification and behavioural change.
• However, Double Fortified Salt (DFS), containing both iron and iodine, remains underutilised despite its potential to reduce iron deficiency and advance Viksit Bharat 2047.

The Promise of Fortification

• Double Fortified Salt (DFS) as a Population-Level Intervention
  • DFS combines iron and iodine in an everyday food consumed by households across income groups and geographical regions.
  • It offers a convenient way to deliver essential nutrients without relying entirely on regular supplementation or dietary changes.
  • India's Universal Salt Iodisation programme provides an established foundation, with approximately 95% of households consuming iodised salt.
  • Building on this infrastructure, DFS already reaches an estimated 76 million people across four States through government safety-net programmes.
• Scientific Evidence and Public Health Benefits
  • Research supports DFS as an effective intervention against iron deficiency. A global review indicates that it can reduce anaemia by up to 21%.
  • Trials in Bengaluru, Darjeeling and Punjab, alongside implementation in Uttar Pradesh, have demonstrated improvements in iron status.
  • When manufactured according to validated specifications, DFS is acceptable to consumers and can help reduce iron deficiency.
  • The Food Safety and Standards Authority of India (FSSAI) has established standards for DFS, while its inclusion is mandated under PM POSHAN and the Integrated Child Development Services (ICDS) programme.

Economic Viability and Manufacturing Capacity

• DFS is highly affordable, costing an estimated ₹14–₹20 per person annually. Its estimated benefit-cost ratio of 4.2:1 reflects potential gains from improved health and labour productivity.
• India possesses the manufacturing capacity, established fortification technologies and laboratory infrastructure necessary for large-scale production and quality assurance.
• DFS therefore combines affordability, scientific effectiveness and scalability, making it a promising public health investment. 

What the Barriers Are?

• Institutional Challenges and Uneven Implementation
  • DFS adoption remains uneven, primarily because of institutional and administrative barriers, rather than technological limitations.
  • Although recommended under PM POSHAN and ICDS, its integration into the Public Distribution System (PDS) varies across States.
  • The PDS reaches approximately 800 million beneficiaries, offering an extensive channel for distributing fortified salt to vulnerable households.
  • Nationwide adoption requires dedicated financing, stronger Centre-State coordination, political commitment, wider commercial availability and consumer awareness.
  • A central flagship scheme could promote uniform implementation, strengthen distribution networks and ensure equitable access across States.
• Regulatory Safeguards and Integration with Existing Policies
  • DFS must complement, rather than replace, existing interventions under Anaemia Mukt Bharat.
  • It should operate within a robust regulatory framework that ensures product quality, appropriate monitoring and nutritional safety.
  • Implementation must align with sodium reduction goals. Fortification should improve the nutritional quality of salt already consumed without encouraging increased salt intake.
  • Moreover, anaemia has multiple causes. Thalassaemia and sickle cell disease require appropriate screening and clinical management.
  • Iron supplementation is not universally suitable, particularly when iron deficiency has not been established.
  • DFS must therefore complement medical screening, dietary diversification and targeted treatment.

Potential to be a Global Model

• Building on the Success of Universal Salt Iodisation
  • India's success with Universal Salt Iodisation demonstrates how scientific evidence, government policy, distribution infrastructure and public awareness can address widespread nutritional deficiencies.
  • Nationwide DFS adoption could build on this experience by using existing distribution systems to reach vulnerable populations efficiently.
  • India's approach could provide a valuable model for low- and middle-income countries seeking affordable solutions to iron deficiency.
• Advancing Anaemia Mukt Bharat and Viksit Bharat 2047
  • The revised AMB strategy offers an opportunity to strengthen preventive nutrition.
  • DFS can support this objective by improving iron intake while complementing supplementation, screening and treatment.
  • Effective implementation will require reliable quality control, adequate funding, public awareness and regular monitoring.
  • These measures can help maximise benefits while safeguarding public health.

Conclusion

• Anaemia remains a serious health and economic challenge in India, particularly for women and children.
• DFS offers an affordable, evidence-based and scalable preventive intervention.
• The priority is to overcome implementation barriers by integrating DFS into the PDS, strengthening quality assurance and ensuring equitable access.
• With appropriate safeguards and sustained government commitment, DFS can advance Anaemia Mukt Bharat, improve productivity and support Viksit Bharat 2047, while establishing India as a global model for combating nutritional deficiencies.