ESA countries began fortifying foods in the 1990s, starting with salt and gradually including wheat flour, edible oil, maize flour, and sugar. Today, 21 of 26 countries mandate salt fortification, 13 wheat flour, 10 edible oil and maize flour, and 5 sugar. Despite this, deficiencies in iron, vitamin A, zinc, folate, and iodine remain widespread.
Governments, development partners, and private actors have invested in fortification programs, setting standards and supporting producers, but consumption remains insufficient to reduce deficiencies. Strengthening regional trade in fortified foods could help bridge supply gaps, improve access, lower costs, and expand consumer choice, though its potential is still underexplored.