As explained in the previous section, micronutrient malnutrition is a serious nutrition
problem with negative consequences for public health and overall economic growth.
Consequently, different approaches have been pursued to control vitamin and mineral
deficiencies. Apart from fortification or supplementation, this also includes dietary
diversification and nutrition education. These are often considered preferable strate-
gies to improve the micronutrient status of populations (Scrimshaw 2000; Müller and
Krawinkel 2005; Thompson and Amoroso 2010).
Of these interventions, iodization of salt is considered to be a particular success,
since the number of iodine-deficient countries has been reduced by almost half since
2000 (Micronutrient Initiative 2009; WHO 2011e; Speeckaert et al. 2011). In addition
vitamin A supplementation has seen progress since the early 2000s (UNICEF 2007;
Micronutrient Initiative 2009; Hellen Keller International 2011). Other major inter-
ventions are iron fortification and iron supplementation programs, and more recently
the use of zinc supplements as part of diarrhea management (ILSI 1998; WHO 2001;
Micronutrient Initiative 2009). Yet, not least because of poor health infrastructure,
dispersed processing of foodstuffs that could otherwise be used for fortification, and
limited financial resources, these strategies do not necessarily reach vulnerable popula-
tions to a sufficient extent (e.g. Hagenimana and Low 2000; Müller and Krawinkel 2005;
Horton et al. 2011). Even for vitamin A supplementation, experience has shown that
too many barriers exist to make this intervention the primary approach for achieving
high coverage (Micronutrient Initiative 2009). On the other hand, dietary diversifica-
tion efforts are deemed relatively expensive and difficult to sustain on a large scale (e.g.
Unnevehr et al. 2007).
In other words, these measures are implemented with varying success and face hur-
dles such as low consumption of processed foodstuffs; difficulties with the supply, distri-
bution, or acceptance of supplements; the need for behavior change; hidden opportunity
costs for the beneficiaries; and a limited reach of projects. Moreover, most projects cause
recurrent annual costs that are difficult to meet regularly for developing countries.
Micronutrient interventions are nevertheless considered to be very cost-effective mea-
sures compared to other public health interventions, with supplementation and fortifi-
cation costing around US$10-$100 per DALY saved (Fiedler et al. 2008; Micronutrient
Initiative 2009; Meenakshi et al. 2010; Copenhagen Consensus 2011).
Rationale for Biofortifying Crops
Over the last years, biofortification has been added as a micronutrient intervention that
should be considered by decision makers. While initially only referring to breeding for