A milestone achievement to protect our future with salt
Dr Rudaba Khondker from the Global Alliance for Improved Nutrition (GAIN) speaks about recent industry and regulatory progress in promoting the Iodized Salt Act, helping to combat vitamin deficiencies and improve health in Bangladesh.
Micronutrient deficiency remains an enormous public health challenge in Bangladesh and across the globe. The economic damage and lockdowns brought by COVID-19 have only made the problem worse. Micronutrient deficiency is a lack of the essential vitamins and minerals required for healthy growth, development and functioning. Iodine is one of these essential nutrients, but other deficiencies are also common in Bangladesh today, including vitamin A, vitamin D, vitamin B12 and zinc. The health impacts of these deficiencies can be severe and include blindness, bone disorders, exhaustion, anaemia and an impaired immune system.
Food fortification, the practice of adding one or more essential nutrients to a widely consumed food or condiment, is part of the solution, as is a diverse diet that is rich in fruits, vegetables, and animal-sourced foods. Just as salt iodisation is an incredibly impactful intervention to fight iodine deficiency, fortifying cooking oil with vitamin A, dairy products with vitamin D, and wheat flour and rice with single or multiple micronutrients, helps to reduce deficiencies and micronutrient malnutrition across entire populations.
Iodised salt solution
In June 2021, as the coronavirus pandemic continued to surge around the world, the Parliament of Bangladesh took action to protect the health and future of its nation from another critical threat. The passage of the Iodised Salt Bill, 2021 will protect millions against debilitating goitres, promote thyroid health and strong bones, and save the brains of young children from the devastating impacts of iodine deficiency, the world’s leading cause of permanent, preventable mental impairment.
The new law strengthens Bangladesh’s salt iodisation programme by making iodisation mandatory for all edible salt, including processed foods, and establishing new enhanced penalties for production, importation or selling of non-iodised salt.
“Tackling malnutrition starts with the decisive supporting action of visionary government leaders; as a business, I am pleased by the move by government, and I am happy to contribute to ending malnutrition in our country,” said Md Nurul Kabir, President of the Salt Mill Owners’ Association.
Salt iodisation is the oldest public health initiative in Bangladesh, established under the 1989 Iodine Deficiency Disease Prevention Act, which makes it mandatory for all edible salt to be iodised. The 1989 law was instrumental in driving remarkable progress in the consumption of iodised salt in Bangladesh and achieving an overall decline in goitre, from 47 percent of Bangladesh’s population in the mid-1990s to below six percent today.
Unfortunately, the availability of adequately iodised salt for human consumption in Bangladesh remains low. According to the most recent Bangladesh National Salt Iodization Survey (NSIS) conducted in 2015, only 50.5 percent of Bangladeshi households had access to adequately iodised salt. Over the years, the Government of the People’s Republic of Bangladesh has invested in efforts to reduce the gaps in the nation’s salt iodisation programme to make it a success. Emphasis has been placed on strengthening regulatory enforcement mechanisms, coordination between government and the private sector, and improving resources devoted to implementation of the 1989 law to make the programme effective.
Over the last five years, a broad group of concerned and committed stakeholders representing the Government of Bangladesh, the salt industry, civil society, academia and development partners such as UNICEF and Nutrition International, has joined forces in response to these survey results, forming a supportive coalition that shepherded the new Iodized Salt Act to passage in June 2021. The Global Alliance for Improved Nutrition (GAIN) is honoured to have been a part of this national effort that has achieved a result we can all be proud of.
“I applaud the Government of the People’s Republic of Bangladesh and the key stakeholders for setting the agenda, mandates, legislation, standards and the private sector for the viability, feasibility and success of the fortification programmes. For sure, millions of people will continue benefitting from this,” said Dr Rudaba Khondker, the country director of GAIN Bangladesh.
As we confront the COVID-19 pandemic, good nutrition and overall health are more important than ever. We have come a long way, but our experience with Bangladesh’s 2021 Iodised Salt Bill shows that even more progress is possible when we work together. For example, according to the 2011-12 National Micronutrient Survey, one in every five children in Bangladesh suffers from vitamin A deficiency, risking blindness and an impaired immune system. It is required that all edible oils in Bangladesh must be fortified with vitamin A. However, an assessment of edible oil brands in Bangladesh, conducted in 2017-18, found that 65 percent of edible oil on the market that is sold in bulk from large drums is neither adequately fortified nor safe to consume, as the drums used to transport and store the oil prior to sale are non-food grade, non-labelled and unhygienic. This is a challenge that must be tackled with urgency and unity to find the legal, policy and regulatory solutions to sustain progress and rapidly address the areas where we are falling short.
Bangladesh demonstrated its leadership for nutrition through strong commitments at last month’s UN Food Systems Summit and will do so at the upcoming Tokyo Nutrition for Growth Summit, where food fortification will be featured as a cost effective, sustainable way to make nutritious food available and affordable to all. As our country and the world faces a pandemic and climate crisis that have pushed nutritious diets further out of reach for many, especially the most vulnerable, food fortification is one way we can step up to these challenges together.
About the author
Dr Rudaba Khondker is a medical doctor with expertise in paediatrics and with fifteen years’ experience working in leadership and advisory roles in humanitarian, post-conflict and development contexts in Africa, Asia, and the Pacific.
Rudaba joined GAIN Bangladesh in 2014 as Senior Advisor and Project Manager for GAIN’s largest programme in Bangladesh – the Maternal, Infant and Young Child Nutrition (MIYCN) programme – supported by the Children Investment Fund Foundation (CIFF). Rudaba has been working closely with GAIN’s partners – BRAC, Renata Limited and Social Marketing Company (SMC).
Prior to joining GAIN, Rudaba worked for many international organisations, including BRAC, Concern Worldwide, GOAL, Right to Play, Save the Children and UNICEF. In her leadership roles, she has worked closely with governments, UN agencies, civil society organisations and diverse development partners, global networks and the private sector. With a key emphasis on children and women, Rudaba has worked in a range of countries including Afghanistan, Bangladesh, Ethiopia, Kenya, Mozambique, Pakistan and Tanzania. She has extensive experience in integrated programming that encompasses innovative and rights-based approaches to keeping children safe and integrating development through sport and peace in core programming of education, health, nutrition, child survival, sexual and gender-based violence, HIV and AIDS.