The following is a statement issued by the Health for All Group, following an opinion piece that advocated for the national expansion of double-fortified salt (DFS) with iron and iodine to address India’s anaemia burden. In February 2026, the government of India withdrew its poorly-thought-out intervention of universal fortification of rice with iron under the Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY). The reason for withdrawal was apparently because a study by IIT Kharagpur showed that moisture, storage conditions, temperature, relative humidity and packaging material critically influence the shelf life of fortified rice kernels (FRK) and fortified rice (FR), leading to a reduction in micronutrients and shortening of shelf life, thus limiting the intended nutritional outcomes.It is astonishing and concerning that the government went ahead with pushing for largescale and universal fortification of rice with iron, folic acid and Vitamin B12 without even doing basic due diligence before implementation on that scale.Now, in October 2026, M.G. Venkatesh Mannar, a former Tata Trusts senior advisor and former president of the global company Micronutrient Initiative (now Nutrition International) and others have come up with another foolhardy proposition – double fortification of salt (DFS) with iron being added to iodised salt. The Hindu (and other major media) published these authors’ claims with little regard to the adverse implication of such suggestions.It must be made clear that any intervention must first do no harm. This principle seems to have been set aside by the government at the whims of vested interests hell bent on corporatised and commercialised ‘solutions’ to many of the country’s concerning public health problems.Although nutritional anaemia is one of the largest causes for anaemia in India, there are several other clinical conditions such as fibroids, abortions, multiple pregnancies, dysfunctional uterine bleeding (DUB), poorly managed abortions, hookworm infestations, chronic diseases, among other causes for it.Anaemia management, therefore, has to be done primarily by a functional and comprehensive public healthcare system where screening for inclusion and exclusion criteria is followed by appropriate interventions.Iron is not a benign mineralNutrients like iron, retinol, Vitamin D, niacin and folate are categorised as having small safety margins and, therefore, they require to be handled with care. Iron is a pro-oxidative element and can have adverse effects on biological systems even in moderate amounts.The body does not have a physiological mechanism to excrete excess iron, which means it is then stored in the liver and spleen, causing damage.Also read: The Politics on Our Plate: How Power and Inequality Shape What We EatIron-replete infants and young children who have received additional iron have showed decreased growth, increased illness (usually diarrhoea), interaction with other trace elements such as copper and zinc, altered gut microbiota to more pathogenic bacteria, increased inflammatory markers and impaired cognitive and motor development.The intake of iron through supplementation and fortification can increase ferritin levels with little effect on anaemia, and this increased ferritin has been associated with an increased risk of chronic metabolic diseases such as diabetes and hypertension.This could as well mean that any intervention with iron should not be universal, but based on clinical screening and exclusion of iron replete individuals and those who are at risk from iron formulations. A Cochrane review by Baxter et al. found that DFS has only a small positive impact on haemoglobin concentration and prevalence of anaemia and there is low confidence in the evidence for outcomes.A meta-analysis published in 2019 showed that fortification of rice with iron makes no difference to the risk of developing anaemia or iron deficiency. (Daba et al 2021; Mekonen 2024; McKay et al 2023).Clinical conditions that are affected by iron intakeIn the standard therapy for severe malnutrition and newly diagnosed tuberculosis, iron treatment is initially withheld because infectious agents seek out this mineral to multiply and thrive in the body.Other serious repercussions of high iron intakes are the worsening of malaria and other acute viral or bacterial infections. In Tanzania and Nepal, routine supplementation with iron and folic acid in a population with high rates of malaria was found to increase the risk of severe illness and death, with the risks far outweighing any immediate benefits. This led to a premature termination of the trial.Also read: Years After Giving Fortified Rice as Ration to the Poor, Govt Halts SchemeThe authors advocated for revision of current guidelines for universal supplementation with iron and folic acid. In addition, it is known that those who have sickle cell anaemia or thalassemia should not consume iron supplements.The presence of iron in salt can reduce the availability of iodine, leading to a resurgence of goitre, pregnancy complications, developmental delays and birth defects in newborns. Furthermore, without proper preparatory and storage techniques, the iron within DFS can oxidise and thus become less bioavailable and the visual and organoleptic properties can decrease. This can lead to people opting for non-fortified salt, affecting iodine levels.An oversimplified solution to a complex problemIndia has multiple nutritional deficiencies and our children receive inadequate nutrition. National Family Health Survey 6 (NFHS-6) for 2023-24 shows that only 15% of children aged 6-23 months receive an adequate diet. The Comprehensive National Nutrition Survey (CNNS, 2016-18) found that 35% of children under five were stunted and 33% were underweight.Moreover, 18% of the children under five were deficient in Vitamin A, 19% in zinc, 14% in B12, 14% in Vitamin D, and 23% in folate.Percentage of stunted children below age 5 in NFHS-5 (2019-20) and NFHS-4 (2015-16).The proper management of nutritional anaemia requires, apart from iron, several nutrients such as protein, Vitamin C, B complex, Vitamin A, zinc, selenium, magnesium, copper, etc. If haemoglobin levels of a population have to be improved, foods that provide all of these nutrients are essential.Also read: Food Politics that Stigmatise Meat-Eaters Violate the Principle of Equal Respect For DiversityIn spite of adequate evidence since the 1960s and 70s about the important role of nutrient dense foods and accessible, evidence-based healthcare in the prevention and management of anaemia and several other nutritional deficiencies, this is being wilfully ignored. Nutrient dense foods are being criminalised locally while exports of these same foods continue unchallenged.Very little is being done to address food availability, diversity and affordability – minimum wages, equitable land distribution, better employment and job opportunities or even making nutrient-dense foods available at lower costs or at subsidy. Fortification will only increase food costs and dependence on corporations, while reducing the shelf life of foods and taking away food sovereignty from communities.India’s food politics and the barriers to consuming iron-rich foodsThe bioavailability of iron in iron-rich foods is higher in organ meats and red meats than from plant sources such as grains and vegetables. Ascorbic acid or Vitamin C in foods such as amla (Indian gooseberry), lemon, orange, guava, etc., considerably enhance the absorption of dietary iron.In fact, the presence of even small quantities of meat and Vitamin C in a meal enhances the absorption of iron from both plant (non-haem) and animal (haem) food sources.Amla (Indian Gooseberry) Juice is rich in iron and vitamins. Credit: Deviselvam, CC BY-SA 4.0, via Wikimedia Commons. Egg curry. Credit: SnapMeUp, CC BY-SA 4.0, via Wikimedia CommonsAs with most plant-based foods, cereals and millets contain anti-nutritional factors such as phytates, tannins and oxalates which reduce the bioavailability of iron. So consuming DFS or fortifying these food groups – especially with iron – is a wasteful intervention.Several reports and studies provide irrefutable evidence that diversity of food is where India is most lacking.Therefore, the larger ethical question is whether a population that is largely sustained on cereals, with inadequate consumption of most other foods such as pulses, legumes, fats, oils, eggs, meat, milk, fruits and vegetables should continue to be denied these nutrient dense foods and instead subjected to supplements, fortification, tablets and potions.As health systems researcher Seye Abimbola states, there is a serious problem of ‘gaze’ at the heart of academic global health that is difficult to name but creating entrenched power asymmetries in global health partnerships between researchers in high income countries (sources of funding and agenda) and those in middle and especially low income countries (where the research is conducted or applied).He suggests that such papers be labelled “written with a foreign pose for a foreign gaze” along with conflict of interest statement. He also draws focus on the local expert using language that is directed for the foreign gaze that erases nuance, meaning and a local context.Dr Sylvia Karpagam is a public health doctor and Dr Veena Shatrugna (Deputy Director (Retd.), National Institute of Nutrition and Steering Committee Member, Right to Food Campaign.)With inputs from Swetha Dandapani; Teena Xavier, independent public health professional; Siddharth Joshi, independent researcher and policy analyst; Jerald Dsouza, secretary of the Social Justice and Ecology Secretariat, New Delhi; Anil Dsouza, director at Loyola Vikas Kendra in Mundgod; Akhila Vasan, public health researcher; Radha Gopalan, Food Sovereignty Alliance, India and Prof. Mohan Rao, former professor at the Centre of Social Medicine and Community Health, JNU.The statement has been edited slightly for style.