The opportunity

More than 90% of the Ethiopian population uses iodized salt.

The Government of Ethiopia made salt iodization mandatory in 2011. The country is self-sufficient in salt production and most of the population currently consumes adequately iodized salt regularly.

Folate insufficiency, however, is very high. Most people in Ethiopia do not regularly eat food that is rich in folate or vitamin B9, and between 60% to 100% of women have insufficient folate – with wide disparities across regions – putting them at greater risk for pregnancy impacted by neural tube defects (NTDs). Consequently, NTD rates in Ethiopia are very high, with hospital-based studies reporting a prevalence up to eight times greater than other African countries.

Children with NTDs are often critically ill and may have severe disabilities, which causes stigma for both children and caregivers. The burden of care often falls on mothers or female caregivers, and results in financial distress and psychological pain and stigma for the families and the affected child.

Large-scale food fortification provides an opportunity to reach large numbers of a population, especially those in vulnerable situations, with essential micronutrients to which they may not otherwise have access. Double-fortified salt with iodine and iron is currently used in other countries, such as India, and has proven effective in reducing rates of iron-deficiency anaemia.

Our solution

Developing a new product – salt fortified with both iodine and folic acid – and introducing it to the Ethiopian market.

Folate/Folic Acid

Folate/Folic Acid



Since 2019, we have been working with partners including the University of Toronto, the University of California at Davis, ReachAnother Foundation, and the Ethiopian Public Health Institute to support the development of salt double-fortified with iodine and folic acid (DFS-IoFA). This project will see the formulation and process tested with local salt producers in Ethiopia and improve the evidence base of the benefits.

The evidence of the benefits, acceptability, and sustainability of the product will support the creation of the analysis, modelling and tools necessary for decision-makers to develop the standards and policies to regulate DFS-IoFA.

All activities will be gender intentional and will take an intersectional approach by exploring how age, ethnicity, and the socio-economic status of women influence their ability to access, purchase or consume DFS-IoFA in sufficient quality and amount.

The impact

Protecting the population from neural tube defects and iodine deficiency disorders.

This project will test and establish the benefits of DFS-IoFA and help to design a strategy to introduce the product to the Ethiopian market, gradually replacing iodized salt and improving access to folic acid for women across the country. This will improve women’s folate status and reduce the prevalence of folate-deficiency anaemia, while helping to protect pregnancies from iodine deficiency disorders and neural tube defects.