Iron, an important micronutrient
for normal body functioning and stamina, is deficient across the world and
severely affects women and children in developing countries as reported by WHO.
Common symptoms of iron deficiency lead to lower level of stamina, fatigue and muscle
pain, consequently decreasing productivity and hence, the standard of life.
Despite such serious consequences, dietary iron intake is low in several parts
of India, often due to ignorance and lack of awareness.
block in Tapi district in the state of Gujarat is one
such area. Most of the population is iron deficient with some even suffering
from sickle-cell anemia, a disease worsened when coupled with iron deficiency.
In Gujarat, 55.1% of non-pregnant women age 15-49 years are anemic (<12.0 g/dl) (NFHS-4). (Map credit: Anaka Aiyar)
Last June (2016), the Tata-Cornell Institute (TCI), in collaboration
with our partner agencies, introduced a home-fortificant in 15 target villages
in Songadh block. Branded under the label ‘Sfurti’ – meaning healthy – this powder, in addition to
iron, provides for other critical micronutrients such as folic acid and vitamins
A and B12. It is marketed in small sachets reasonably priced at Rs. 3, and if
mixed with 5 kg flour (wheat or rice), it satisfies the micronutrient needs of
the household. Owing to the lack of awareness around the importance of micronutrients,
a door-to-door mobile vendor marketing model was employed to sell Sfurti,
as well as create awareness about iron and other micronutrients, through
trained women self-help group members called ‘Sfurti Bens’ (Sfurti
Phase-1 of the project concluded on the 31st March, 2017.
Over the course of about 9 months, 5,500 households over 15 villages were
reached. What factors contributed to the intervention’s positive beginnings?
are a few key takeaways:
coverage (defined as at least one time buyers) grew over the period (albeit
slowly) reaching ~66% at the end.
level marketing efforts raised awareness and facilitated take up.
the absence of local government assistance, dairy cooperatives and women self-help
groups (SHGs) were important allies for outreach efforts.
workers (female community health workers) helped to build confidence in the
efficacy of Sfurti.
Outreach session in target village. (Photo credit: Jessica Ames)
However, feedback from across the
villages about Sfurti was widely varied – from people completely
dismissing Sfurti to people over-enthusiastically, and also incorrectly,
trusting Sfurti to be a solution for most of their health problems. A few
consumers in informal interviews reported implausible cosmetic changes such as softening or whitening of
their skin (in this region, fairer skin is considered a beauty ideal, and hence
an aspiration), reduction in hair fall, etc. Even in cases where the claims
were legitimate – such as increase in appetite or reduction in fatigue or joint
pains – often the claimed extent of improvement seemed dubious. This was
further corroborated by discussions with the doctors at the Primary Health
Centers who felt that the reported effects could be a placebo effect, if not
Another unintended yet interesting
effect was the increased sense of empowerment among the Sfurti Bens. Door-to-door marketing
for Sfurti gave these women an opportunity to engage with other
villagers, especially women, and consequently earn a politically elevated status
within the village. Some of these women even went on to win the Gram
Panchayat (local village level) elections. This is a particularly
interesting fact in the assessment of Sfurti. Since door-to-door sales
are driven more by the pitch than the product and a sense of respect being
attached to the Sfurti Bens, a strong underlying factor for increased
sales could be peer pressure. This connects back to why households reported
exaggerated and implausible effects. Although there isn’t strong evidence, nevertheless
it is possible that people are not actually consuming the powder, despite
Field coordinators training Sfurti Bens. (Photo credit: Jessica Ames)
Going forward, it is important to understand
why people choose to buy Sfurti (and continue to buy or opt out) and the many
factors which may influence decision making. If peer effect is a strong driver,
then it is imperative to go a step further and validate that they buy and
consume it. In the end, it is only beneficial if through the
consumption of Sfurti, people realize the value of micronutrients
through an (actual)
improvement in their health. It is a rather complex research question to crack,
but an interesting one.
Plans are afoot to conduct
household level interviews of a random sample of these villages. Food samples
from the households can help distinguish between actual consumers and mere
buyers. This coupled with trends in sales, interviews with Sfurti Bens
and information on the marketing efforts made during the period can help empirically
tease out answers to most of these questions.
Given, food consumption in most
rural areas is through the informal market, being able to answer what drives
people to voluntarily invest in consumption can help improve the status of
nutrition in these, often left behind, regions.
By Prankur Gupta
Gupta is a Master’s of Science student in Applied Economics and Management at
Cornell University’s Charles H. Dyson School of Applied Economics in
Management. His research with the Tata-Cornell Institute (TCI) focuses on
consumer behaviors in rural Gujarat.