To help gauge the potential for scaling biofortified zinc wheat flour in Pakistan, a qualitative study was conducted with rural consumers to assess their experience with using this flour.  The study provided further evidence that efforts made by the CGIAR’s HarvestPlus program and its CGIAR and national partners to scale up zinc-biofortified wheat in Pakistan, will bear positive results.

This study was part of the Biofortification with Zinc and Iron for Eliminating Deficiency 2 (BiZiFED2) cluster Randomized Controlled Trial (RCT), funded by the United Kingdom Research and Innovation (UKRI) Global Challenge Research Fund (GCRF).

Zinc is a micronutrient that is vital for a number of physiological functions. It plays an important role in growth, reproduction, and the immune system. Estimates show that approximately 17 percent of the world’s population is zinc deficient, with a much higher prevalence in low- and middle-income countries. 

In Pakistan, according to the National Nutrition Survey, 18.6 percent of children under 5 years of age and 22.1 percent of women of reproductive age suffer from zinc deficiency. These statistics predominantly reflect rural socio-economically deprived communities with limited ability to access or afford nutritionally diverse diets. 

To help address zinc deficiency among vulnerable groups, Pakistan’s National Agriculture Research System (NARS), the International Maize and Wheat Improvement Center (CIMMYT), and HarvestPlus collaborated to develop a biofortified zinc wheat variety (Zincol-2016) which was released by the Pakistan Agriculture Research Council (PARC) in 2016. Two additional zinc wheat varieties have been released since then: Akbar19 and Nawab21. 

The trial was conducted in two neighboring remote communities located 30 kilometers east of Peshawar city in the Khyber Pakhtunkhwa. For both communities, the average household income is less than USD 10 per day, wheat is the staple source of food, and diets are low in animal-source foods. Five hundred households participated in the BiZiFED2 RCT. 

Participants were not aware of whether they had received control or biofortified flour, both collectively only referred to as “study flour.” Out of the 500 households, a total of 12 focus group discussions (FGDs) were conducted for the qualitative study component. Focus group candidates were eligible if they were participants in BiZiFED2 RCT or were part of the community Jirga^[1]; were over the age of 18; and could willingly give informed consent. 

Responses were collected corresponding to five broad themes (1) contribution to food security; (2) better sensory and baking properties than local flour; (3) perceived health benefits; (4) willingness to pay for the flour; and (5) importance of trusted promoters/suppliers. Each FGD lasted for up to one hour and the discussions were audio-recorded. 

In response to the second theme of better sensory and baking properties than local flour, participants acknowledged that the study flour was cleaner, had better fermentation properties, and produced better bread than the flour that they bought in their local market. This finding is important when considering the design of future intervention and evaluation studies, suggesting that both control and biofortified grains should be grown and milled similarly if participants are to remain blind to treatment allocation. The preference for study flour over market-bought flour may have been due to the short time between milling and distribution, or due to differences in milling practices, packaging, storage or re-packaging practices of the vendors and further studies should be conducted to explore this.

Similarly, the participants who received the study flour claimed health benefits. One of the respondents stated, “Our throats used to have a problem all the time, but since we have started this flour, we got rid of that (throat problem). When we were eating the common flour, we had to take stomach tablets in the morning but since we have started this flour, we don’t have any stomach problems, our stomachs are fine.” 

Additionally, due to the perceived health benefit, participants demonstrated significant willingness to buy biofortified flour even after the project ended. The participants were willing to pay a slightly higher price for biofortified flour due to optimal quality and the range of health benefits. 

One of the survey participants was quoted as saying, “The reason we will be buying this one is…even if this is ten or eight rupees (about USD 0.057) more expensive, then so be it, as we are protected from illness and problems that children would have….We are laborers and we would miss our work [because we are taking our children to a doctor]…. So we do not have to bother about those problems anymore, and that’s why we are using this flour, so if this flour comes out in the market, then we will be using it.” 

Participants who had access to land were eager to receive seed for the biofortified wheat variety so they could cultivate it themselves. Studies to assess biofortification costs are required, including additional production costs (e.g., for Zn-fertiliser), marketing and social behavior change programs and monitoring costs. In turn, affordability needs to be assessed including for the poorest households, and this can inform how to make scale-up sustainable.

The findings are also consistent with a previous study conducted in Pakistan in which participants tasted and rated chapati produced with biofortified wheat and conventional wheat very similarly in terms of sensory characteristics. This latest FGD study found that the participants gave better scores to the chapati produced with biofortified wheat in terms of appearance and aroma, while the conventional variety scored slightly higher in terms of taste and texture.

HarvestPlus kicked off the scaling process in Pakistan in 2015 by taking the lead in promoting zinc wheat breeding and release. After various groundwork efforts, government collaborations, and seed production initiatives, HarvestPlus collaborated with partners on a zinc wheat delivery program to take seeds, grains, and foods to market. HarvestPlus initiated a program to kindle demand and increase the supply of biofortified flour. 

HarvestPlus has established a scaling model which requires a wide range of policy approaches, technologies, standards, and incentives. Objectives like ensuring research and development for new, better seed varieties to keep the market interested and meet food industry demands, and continuing the drive in catalyzing larger seed volumes, have been put in place. HarvestPlus also emphasizes the importance of Government endorsement and support in policy documents for the early scaling of this biofortified crop. If all this is executed efficiently this will ultimately lead to a more nutritious food system.

In 2021, the number of Pakistani households growing zinc wheat more than doubled to 1.4 million, with three varieties of zinc wheat available in the market. HarvestPlus is reaching almost 13 million households around the world with biofortified crops for better health and nutrition. 

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^[1] A jirga is an assembly of leaders that makes decisions by consensus according to Pashtunwali, the Pashtun social code.