Malaysia: Committing to Wheat Flour Fortification

Photo: Woman selling food in the marketplace. (Dennis Sylvester Hurd/Flickr)

The Malaysia Ministry of Health (MOH) demonstrated renewed dedication in 2022 to scale up and strengthen wheat flour fortification.

Previously, mandatory fortification of flour with iron and folic acid only applied to government subsidized 1 kg packages of flour. There were also voluntary regulations in place that allowed millers to add thiamin, niacin, and riboflavin. In 2023, the MOH will release regulations mandating that wheat flour sold in bags 25 kilograms and under be fortified with iron and folic acid. Millers can choose to also fortify with thiamin, niacin, and riboflavin per the previous voluntary regulations. The new regulation will come into effect in 2025, after a two-year grace period.

Making fortification mandatory is one step toward ensuring that millers comply with fortification guidelines and that consumers are able to access flour fortified with micronutrients. Expanding fortification to flour sold in larger packages means that fortified flour will be used by businesses making and selling wheat flour foods – increasing the number of people who have access to fortified flour and the lifesaving micronutrients they contain. About half of the wheat flour in Malaysia is distributed in 25-kilogram bags or under; FFI estimates that the new regulation will lead to at least 15 million more Malaysians being reached by fortified flour.

Commenting on the proposed regulation, Malaysia Health Minister Khairy Jamaluddin said it “will ensure that the level of iron and folic acid in wheat flour is in line with the World Health Organization (WHO).” By including iron and folic acid at WHO-recommended levels, fortification is more likely to have a positive impact on health, particularly for women and their unborn children. These efforts on the part of Malaysia’s government are evidence of a growing recognition of the power of fortification to transform the country’s health. It is also a recognition of FFI and its partners’ persistence in providing advocacy and technical support, which began in 2006.

In August 2022, FFI virtually attended an MOH hosted meeting. This meeting was held to increase awareness among the wheat flour industry (millers as well as food processors using flour) so that they could begin preparing for scaling up fortification following the new regulation. FFI and UNICEF Headquarters staff collaborated to present on the global status of wheat flour fortification, its costs, and its best practices. FFI and UNICEF also answered millers’ questions, including how to verify whether flour is fortified. The new regulation was accepted and no millers expressed opposition to mandatory fortification at the meeting.

A shortcoming of the new regulation is that it does not apply to flour sold in bulk (bulk trucks and containers) and purchased by large-scale food processors such as noodle and biscuit manufacturers. Large bulk shipments make up nearly 50% of the flour consumed in the country. Malaysia is one of the only countries in the world that uses food packaging size to define its parameters for food fortification. FFI and UNICEF both recommend, depending on the results of a planned public health evaluation of fortification’s impact on the population, that the MOH consider expanding mandatory fortification to all flour consumed in the country, regardless of packaging size, for maximum health benefits.

Before 2022, FFI and partners’ efforts to help Malaysia scale up fortification had stalled despite years of advocacy and technical assistance. The Malaysian government’s renewed focus on fortification is an example of the country’s commitment to improving nutrition and how persistent advocacy by FFI and its partners can build future programs.