Neural tube defects are a type of devastating and often lethal birth defects that can be prevented when mothers take folic acid before and during early-pregnancy.
But neural tube defects arise during the 4th week of development, and with more than half of pregnancies around the world unplanned, folic acid supplements often reach pregnant women when it’s already too late. As a result, in countries such as the United States and Canada, folic acid is by law added to many commonly consumed foods, including bread, cereal, and rice.
In Nicaragua, the incidence of neural tube defects is roughly five times higher than in the United States. Working with fellow undergraduates in 2009 at UCLA, I brought the Nicaraguan Ministry of Health together with UNICEF, local researchers, and local non-profits to discuss the importance of fortifying rice with folic acid. One month after my team’s advocacy efforts, the Nicaraguan Ministry of Health issued a legislation requiring fortification of rice on a national level with folic acid and other micronutrients. The thrill of knowing that I could influence large populations through implementing change on a systems level was a large part of why I chose to enroll in Harvard Business School’s MBA program in addition to the MD I was pursuing Harvard Medical School.
One of the important lessons I’ve had to learn is that getting a law passed is very different from having a law implemented. Today, more than four years after the legislation was passed, several important challenges stand in the way of its ultimate implementation.
The technology to fortify rice is simple enough. Rice is ground into a flour, to which vitamins, minerals, and other chemicals are added, and this mixture is put into a pasta machine that produces tiny artificial grains of rice that are polished to look identical to ordinary rice. These “extruded” grains of rice, however, have 200 times more micronutrients than needed, and are then blended with ordinary rice in a 1:200 ratio at each rice mill.
Implementation of the program itself, however, is far more challenging. With over 40 rice mills throughout Nicaragua, many only producing small quantities of rice for local use, implementing a national rice fortification program requires significant coordination and oversight. And the rice industry is at best only modestly supportive of a rice fortification program. In a commodity market where competition is fierce and margins are razor thin, rice mills will be forced to either increase the price of their rice by 1% – risking volume declines – or to take a roughly 1% increase in cost, decreasing their gross margins significantly.
Purchasing the equipment to fortify rice in each mill can also be expensive: each mill is expected to require $5,000 in equipment and 10-15 hours in training, as well as routine evaluations by the Ministry of Health on the quality of its fortified rice. However, new technology funded by the Bill and Melinda Gates Foundation and the Program for Appropriate Technology in Health enables small rice mills to purchase the technology needed for rice fortification for just $500-$800, and trainings can be done regionally.
To address these challenges, I have recently formed a non-profit organization Rice Fortification Catalyst, and my team of Harvard undergraduates and faculty has launched a crowdfunding campaign to enable us to assist the Ministry of Health with implementation of the program. We are planning to make a trip to Nicaragua in January to bring together the major parties involved in a rice fortification system and to craft a proposal for major international funding bodies to assist with the initial stages of the rice fortification program. We welcome suggestions and financial contributions to this cause, and I’d love to hear from you if you’d like to get involved with us. You can visit our website at FortifyRice.org to learn more.
Our mission is to eliminate all preventable neural tube defects around the world, starting with Nicaragua. I hope that you’ll join us.