When we hear the word stunting, many of us will assume that it is problem of malnutrition in children under five. This is not entirely wrong because stunting is related to the quality of nutritional intake in the first 1000 days of life in children.. Based on the 2018 Global Nutrition Report (GNR), Indonesia is one of the countries experiencing a double burden of nutrition. Food fortification is included in the policy framework for accelerating nutrition improvement at 1000 days of life Government has fortified several staple foods to address these nutritional challenges.
Food fortification is not a new problem. During the Dutch administration in 1927, salt fortification was required and was only managed by the State Company (PN) Salt in Madura. In 1980, several foodstuffs began to be fortified: iodized salt, MSG with vitamin A, and wheat flour. However, MSG fortification was discontinued due to the issue of negative impact of MSG.
In 1994, Presidential Decree No. 69 of 1994 concerning Salt Iodization was issued. Then, the fortification of wheat flour was also required through the Decree of the Minister of Industry and Trade No. 153 of 2001, concerning Indonesian National Standard for Wheat Flour.
So, why is fortification important? It is because food fortification as one intervention to fulfill micro-nutrition for public, that has proven to be cost-effective. Micronutrient deficiencies which is like insufficient intake of iron, zinc, iodine, and vitamin A are known as hidden hungers. One of the impacts of lack of micronutrients is stunting.
The Medium-Term National Development Plan (RPJMN) 2020-2024 mentions the needs to increase quality and competitive human resources through accelerating the reduction of stunting. It is also necessary to strengthen economic resilience by increasing the availability, access and quality of food consumption through food fortification and biofortification.
In the Strategy for the Acceleration of Stunting Prevention, Food Security and Nutrition are included in Pillar 4. One of the indicators in this pillar is the policy to increase food fortification.
“The study proved that fortification is a very effective way to fulfil nutritional needs for the poor. So it is definitely effective, for example iron to reduce anemia, vitamin A in cooking oil can reduce the prevalence of vitamin A deficiency,” according to Director of Public Nutrition, Ministry of Health, Dhian Proboyekti at the International Workshop: The Role of Food Fortification and Biofortification, Monday (22/3). The workshop was organized by the Indonesian Nutrition Institute (IGI) and the Nutrition Foundation for the Development of Indonesian Food Fortification (KFI).
In Indonesia, fortification is divided into two categories, mandatory and voluntary fortification. Mandatory fortification is part of the government’s nutrition improvement program, while voluntary fortification is carried out by private enterprises, whose business objectives are not regulated by the government, except for food security requirements. Currently, several types of food have been subjected for mandatory fortification, salt fortified with iodine, cooking oil with vitamin A, and wheat flour with iron.
On the same occasion, Deputy for Human Development and Equality, Secretariat of the Vice President, Suprayoga Hadi said that fortification is one of the important factors in reducing stunting. So, it requires involvement of all stakeholders in its implementation. “We try to emphasize convergence in reducing stunting in the context of fortification, which is one of the backbones in accelerating stunting reduction,” Suprayoga said.
Convergence of stunting reduction involves ministries and central agencies that are responsible for 4th Pillar of the National Strategy of Stunting: Ministry of Agriculture, Ministry of Health, Ministry of Social Affairs, Ministry of Marine Affairs and Fisheries, Ministry of Industry, and National Agency of Drug and Food Control (BPOM). Suprayoga also encouraged local governments from provincial to village levels government to be more involved in this fortification program.
Suprayoga added, “Fortification has been included in the Medium-Term National Development Plan (RPJMN) 2018-2024, also included in 4th pillar of the National Strategy of Stunting. The category also has been determined, which is mandatory and voluntary fortification. So it has been stated from 2018. I think we just need to strengthen it.”
The implementation of mandatory fortification has been delayed as an impact of the Covid-19 Pandemic. The postponement was stated in Circular Letter (SE) of the Minister of Industry No. 5 of 2020 concerning Temporary Exceptions for the Addition of Fortificant Substances in Wheat Flour and Circular Letter of the Minister of Industry No. 6 of 2020 concerning Temporary Exclusion of Vitamin A and Provitamin A in Palm Cooking Oil. However, the relaxation ended on December 31, 2020, and the mandatory fortification of wheat flour and palm cooking oil was continued starting January 1, 2021.
Wheat flour and cooking oil are food products that are remarkably high in consumption in Indonesia. Most households use these staple foods in their daily diet, including poor households. With the obligation of fortified palm cooking oil and flour with additional fortification substances, feasibly that should be all families can fulfill their nutrition intake, including the poor, thus contributing to the overall stunting prevention efforts.
The benefits of fortification.
The important of Vitamin A fortification.