Zimbabwe is facing a severe micronutrient problem. The government’s solution – fortifying popular foods with those missing micronutrients – seemed fairly straightforward. Instead, it has sparked a war with the country’s food manufacturers, who have turned to the courts to stop the effort.

Among a number of worrying micronutrient shortages, at least 72 percent of the country’s children between six months and five years old suffer from an iron deficiency, according to the most recent government statistics. That rate is more than 60 percent in women between 15 and 49 years. And Vitamin A deficiency among that same group of women is at 23 percent.

The outcomes of these deficiencies vary, but they can be severe – ranging from night blindness to stunted growth to an increased risk of infection. In the current National Nutrition Strategy, the government links the deaths of 7,700 women and children each year to micronutrient deficiencies.

“I encounter a lot of children suffering from visibly wasting bodies and fluid retention problems,” said Edwin Banga, who runs the Food for Orphans Care – an orphanage in the rural Chimanimani district. “Food that is bare of micronutrients is definitely part of the cause.”

To address this crisis, Zimbabwe’s health ministry ordered the country’s 31 major food corporations to begin fortifying products like wheat flour, cooking oil and sugar with micronutrients by July 2017. Health officials said the move, which is in line with international recommendations, is the most efficient way to curb micronutrient deficiencies and their effects.

The food industry is fighting back, arguing that in economically depressed Zimbabwe it is prohibitively expensive to import the nutrients needed to fortify the food. Only one corporation has so far complied with the government order, according to Tafadzwa Musarara, the chairman of the Grain Millers Association of Zimbabwe (GMAZ), the largest food industry lobby in the country.

Now the health ministry is threatening to shut down the rest.

Delivering Nutrition

The government has pointed to several causes for the micronutrient crisis: people’s lack of knowledge about good nutrition, gaps in the distribution system that limit access to a variety of food, and a deteriorating health system that is slow to recognize early symptoms of these deficiencies.

Along with the preventable deaths, the government estimated in 2012 that micronutrient deficiencies have harmed the cognitive development of 900,000 children under five years old and were contributing to infections in 3.5 million people by weakening their immune systems and making it more difficult to stave off disease.

Health minister David Parirenyatwa has made reversing micronutrient deficiencies a priority – and he believes fortification is the obvious way to quickly do so. The strategy calls for sugar to be fortified with vitamin A, cooking oil to have vitamins A and D added and wheat and maize flour to have vitamins A, B1, B2, B3, B6, B12, folic acid, iron and zinc included.

The health ministry has turned to fortification, in part, because Zimbabwe has had success with this approach before, when its economy was roaring. In the late 1980s and early ‘90s, the government addressed low iodine rates, which can cause goiters and other health problems, by requiring manufacturers to fortify salt with the mineral.

“We achieved tremendous health benefits,” Anascaria Chigumira, the deputy director of public nutrition in the ministry of health, told News Deeply. Research published in the African Journal of Food, Agriculture, Nutrition and Development backs him up: Regular surveys of urinary iodine levels in school children have shown a steady increase in concentration from the early 1990s through the mid-2000s.

The health ministry’s new decree also draws support from longstanding policy recommendations by international bodies, including the WHO and the Food and Agriculture Organization. Their joint guidelines for food fortification point out that it “has the dual advantage of being able to deliver nutrients to large segments of the population without requiring radical changes in food consumption patterns.”

Parirenyatwa told reporters earlier this month that the move had the support of Zimbabwe’s cabinet. He also expects the country’s parliament to vote on the measure by the end of the year, though he said its approval is not necessary to enact the policy.

“Fortification is good for our children,” he said. “We want it done. Children and women are micronutrient-deficient. They can’t stay healthy and active. Grain millers won’t run away from our instructions.”

Except that is exactly what they are trying to do.

At What Cost?

Zimbabwe’s economy was hit hard during Robert Mugabe’s decades-long presidency. Under his leadership, the country was forced to abandon its currency and inflation skyrocketed. Mugabe stepped aside at the end of 2017, but the economy is still suffering. It is difficult for businesses to find foreign currency through official channels, and the price on the black market is often 40 percent higher than face value.

As a result, food factory owners say they simply cannot afford to import the fortification nutrients the government is requiring. GMAZ’s Musarara estimated it would cost the industry $14.8 million to import the machinery needed to fortify the foods, and an additional $7.25 million each month to buy the nutrients. There are no locally grown substitutes available.

GMAZ warned the government in May 2017 that the mandatory food fortification will either force them to raise prices on consumers who are already stretched thin or cause production to stall, resulting in “serious flour, maize and bread shortages.” In September, GMAZ took the government to the country’s High Court seeking to block the order because of the financial strain it would put on the food manufacturers, and to prevent potential repercussions in the form of higher prices or empty store shelves. The court has not yet set a date to issue a ruling on the request.

For nutrition advocates watching the debate, it comes down to a question of priorities.

“The government is haphazard in suddenly forcing the food [corporations] to add micro-vitamins to their products,” said Audrey Mangaliso, a volunteer nutritionist in Mutare, a city sitting on the country’s border with Mozambique. “But the levels of malnutrition among children, in rural districts especially, are spiraling into a crisis.”