No Spot Solutions: Vitamin A Supplementation in India

I read Wallace’s article1 with interest. Although it was a good article, Wallace missed the most salient argument in support of the antisupplemental side: half of Indian children have stunted growth because of macro-level undernutrition that is inclusive of total calorie intake and a host of micronutrients—a problem that India has made no substantial progress in addressing. Vitamin A is important but it is only one aspect, and in many ways a symptom, of a much bigger nutritional issue. Vitamin A does not directly stunt children’s growth. Addressing Vitamin A as a single issue with a spot solution is not necessarily the best use of resources. Our society, however, is fond of spot solutions. A 2007 Lancet article is a good example.2 The author starts out by describing the rampant child and maternal malnutrition in India as a holistic problem, including the very real issue of girls and women being undernourished because they do not get the first choice of food even within families that have the means to feed them. (I have seen the lack of first choice in even well-to-do families.) The author then focuses on the importance of iron tablets for expectant mothers as if that will cure the effects of maternal and child undernutrition. Although public health education of adolescent girls and mothers is mentioned, there is no mention of getting said young women and their children more food! With respect to vitamin A, there is another interventional alternative to supplementation called Golden Rice—rice genetically modified to have high vitamin A content. Its use and development is opposed in many of the same ways as vitamin A supplementation, as well as by all the arguments against genetically modified crops.3 My opinion is that it could be a useful tool in a holistic approach to the improvement of nutrition. Let’s work together to figure out how to feed the children and women of the world a diet that is adequate in calories and micronutrients.