Sumita Kale: Salt and free choice

In February, the Supreme Court admitted a PIL petition opposing the central government ban on the sale of non-iodised salt in the country. The ban on non-iodised salt has had a contentious history "" enforced in 1998, the NDA government lifted the ban in 2000 and now the UPA government has re-imposed it. The issues raised by the PIL bring out the clash between free choice and the government response to a health problem.

Iodine is a micronutrient, found naturally in the soil and water, which is crucial for human growth and development right from the foetal stage. Iodine deficiency disorder (IDD) leads to goitre, physical and mental retardation in children, frequent abortions in pregnancy, dwarfism and so on. IDD exists in every part of the country but hilly areas, where iodine has been leached out of the soil, are more prone to it than others. Iodised salt has been a proven method for reducing IDD and in 1984, a target was set for achieving universal sale and consumption of iodised salt by 1992. In 1992, the National Goitre Control Programme was re-launched as The National Iodine Deficiency Disorders Control Programme, shifting the focus from goitre to all health problems stemming from reduced iodine intake. The Tenth Plan stressed the universal adoption of iodised salt and almost all the states, except Gujarat and Kerala, have banned the sale of non-iodised salt.

Despite state bans being in place for more than a decade, RCH survey data from 2002-04 show that 44 per cent of households consume non-iodised salt and consumption is more in rural areas and by poorer sections. Salt is made mainly in Gujarat, Rajasthan and Tamil Nadu and transported across the country. Problems abound with monitoring iodine content during salt production and in transportation and storage, since iodine content reduces when exposed to heat, humidity and light. So another 24 per cent households use inadequately iodised salt.

Meanwhile, iodised salt consumption is high in endemic states in the Himalayan region. Nagaland, declared IDD endemic in the 1960s, is a success story with a programme focusing on the provision and proper storage of iodised salt and a diversified diet. While the iodised salt campaign has helped reduce IDD and goitre prevalence, factors other than iodine merit research in rural and tribal areas. AIIMS studies found reduced but high levels of neonatal hypothyrodism in some endemic districts, even after salt iodisation. Chandra et al (IJMR, 2005) found high prevalence of goitre and IDD in rural West Bengal despite satisfactory iodine intake; the role of environmental factors such as diet needs to be examined. It is essential to have a national district wise analysis, not just of iodised salt consumption, but of the current prevalence of IDD and goitre.

Can a countrywide ban on non-iodised salt be justified? Tamil Nadu with a ban has 52.5 per cent of households using non-iodised salt, while in Kerala, without a ban, 56.3 per cent of households consume adequately iodised salt. A ban conflicts with the right of choice for people who are not suffering from IDD and for those who need to reduce their iodine intake for medical reasons. Positive intervention in endemic areas, supplying iodised salt through PDS and spreading awareness would be much more effective than a ban. Prohibition is futile""it only increases the onus of monitoring, which the government does badly anyway.

The author works at Indicus Analytics and can be contacted at sumita@indicus.net