Manila, PHILIPPINES — For more than two decades, the Philippines has mandated wheat flour fortification to help improve the nutritional status and overall wellbeing of its population. Despite this progress, there remains an opportunity to strengthen the program, further aligning it with global best practices. While wheat flour is fortified with iron and vitamin A, it lacks folic acid — a key micronutrient that prevents neural tube defects (NTDs) in newborns — due to its exclusion from the current national fortification standard. Additionally, the type of iron currently used for fortification is less bioavailable than other available forms, meaning it is not as effectively absorbed by the body.

The consequences are severe. Research shows that one in five Filipino women aged 15-49 are folate deficient and 23% of pregnant women suffer from anaemia. These deficiencies contribute to poor maternal and newborn health outcomes, increasing the risk of folate deficiency in pregnant women throughout their childbearing years, which can result in their babies being born with NTDs such as spina bifida and anencephaly.

A recent analysis revealed that fortifying wheat flour with folic acid could prevent approximately 3,000 cases of NTDs in the Philippines each year, translating to 202,111 disability-adjusted life years averted annually. Fortification could also generate an estimated USD $894 million in annual economic benefits and USD $24.5 million in public health system cost savings, alongside out-of-pocket medical expenditures.

“Nutrition International’s Cost of Inaction Tool shows that anaemia among women and adolescent girls costs the Filipino economy a staggering USD $213 million per year. This doesn’t include the 290,248 new cases in children each year, leading to an additional USD $406 million in losses,” said Kristin Hall, Senior Global Portfolio Director, Large-Scale Food Fortification, Nutrition International. “Food fortification is a proven, cost-effective solution, yet in the Philippines wheat flour is still without added folic acid – an opportunity we’re working to seize by advocating for global and regional-aligned standards to improve the health of all, especially women and children.”

Since 2023, Nutrition International, with support from Quantedge Advancement Initiative, has been implementing the Bridging the Fortification Gap in the Philippines project in collaboration with the National Nutrition Council (NNC), the Food Fortification Initiative (FFI) and the Iodine Global Network. The project provides technical assistance and advocates for a revised wheat flour fortification standard that aligns with World Health Organization (WHO) and Association of Southeast Asian Nations (ASEAN) recommendations. This includes adding folic acid and using a more bioavailable form of iron as a fortificant, strengthening regulatory monitoring, and building the capacity of government officials and flour millers.

More recently, Nutrition International has worked closely with the NNC to develop a policy brief that supports the revision of the Governing Board’s resolution that advocates for the inclusion of folic acid and bioavailable iron in the wheat flour fortification standard — an essential step toward policy change.

“Revising the wheat flour fortification standard will prove to be a key milestone in achieving better nutritional outcomes across the Philippines,” said Dr. Azucena M. Dayanghirang, Assistant Secretary and Executive Director, National Nutrition Council. “Through such collaborations, we can ensure that industry fortification practices are aligned with the global, regional and national guidelines to achieve meaningful public health impact.”

Ahead of the standard revision process, Nutrition International and the FFI collaborated with the NNC to host a series of workshops and consultations with key stakeholders, including flour millers. These sessions informed industry leaders about the proposed changes to the standard, their alignment with WHO and ASEAN guidelines and the potential public health impacts, and presented findings from the Department of Science and Technology Food and Nutrition Research Institute’s study on folic acid stability and retention. Discussions also gathered feedback and addressed concerns raised by millers, with a sub-technical working group convened to explore solutions. Recognizing the urgency of the situation, the NNC secretariat stressed the importance of fast-tracking the NNC Governing Board resolution to accelerate the revision process.

The proposed revisions present a significant opportunity to combat malnutrition, reduce the prevalence of anaemia and prevent neural tube defects, ultimately paving the way for a healthier future for the Filipino population.

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