Don’t undo what we got right: Why mandatory salt iodisation must stand

By Rajan Sankar

In August 2025, the Madras High Court delivered a ruling that has quietly unsettled India’s public health community. By quashing the ban on the sale of non-iodised salt for direct human consumption, the court has reopened a debate that India resolved decades ago through rigorous evidence and policy consensus. While the judgement invokes procedural issues, consumer choice, and commercial freedom, it risks undermining one of the country’s most effective and equitable nutrition interventions: mandatory salt iodisation.

Iodine deficiency remains the leading cause of preventable intellectual disability globally. It impairs cognitive development, reduces IQ, and limits productivity—effects that are irreversible and intergenerational. Salt iodisation, a simple and cost-effective strategy, has been globally endorsed as the most efficient way to eliminate iodine deficiency disorders (IDD). The World Health Organisation (WHO), UNICEF, and other development partners have long championed this intervention, calling it "one of the most successful public health measures in history."

India’s journey with salt iodisation began in the early 1960s, when national surveys revealed widespread goitre and iodine deficiency across states. In response, the government launched the National Goitre Control Programme (NGCP) in 1962 as an area-specific programme. This was later expanded into the National Iodine Deficiency Disorders Control Programme across the country, and in 1992 India adopted a policy of universal salt iodisation (USI). This mandate required all edible salt to be fortified with iodine, ensuring population-wide protection against IDD.

The impact was swift and measurable. By 1998–99 (National Family Health Survey-2), approximately 51% of Indian households were consuming adequately iodised salt. However, in 2000, the government lifted the ban on non-iodised salt, shifting to a voluntary model. The consequences were stark. The District Level Household Survey (DLHS-2, 2002–04) revealed a dramatic drop in coverage—down to 30% nationally, and even lower in vulnerable states like Uttar Pradesh (18%) and Bihar (17%).

The poorest households, least aware of iodine’s benefits and most constrained by price, were disproportionately affected. Recognising the damage, the government reinstated the ban in 2005. By the time NFHS-3 was conducted in 2005–06, coverage had rebounded to 51%, restoring momentum and reaffirming the importance of regulatory enforcement.

Today, India stands as a global success story. According to NFHS-5 (2019–21), 93% of Indian households consume iodised salt. This achievement reflects decades of coordinated effort—policy clarity, industry compliance, public awareness, and supply chain innovation. It is a shield against cognitive disadvantage for millions of children and a foundation for national development.

To jeopardise this achievement now would be a grave misstep.

Globally, more than 170 countries have adopted salt iodisation programmes, supported by WHO, UNICEF, GAIN, Nutrition International, and other partners. These bodies have consistently endorsed salt iodisation as a cornerstone strategy for eliminating iodine deficiency. The intervention is inexpensive, scalable, and universally applicable. It is especially critical in low-resource settings, where micronutrient gaps persist.

Salt iodisation is a classic “merit good”—its benefits are not immediately visible, and consumers may undervalue its importance. Left to market forces, iodised salt will not reach those who need it most. The argument for consumer choice must be weighed against the collective cost of inaction. When children are born with preventable brain damage, when workers underperform due to impaired cognition, and when public health systems bear the burden of avoidable disorders, the price of “choice” becomes untenable.

Mandatory iodisation is not about denying freedom—it is about ensuring equity. It is about protecting those who cannot protect themselves. Just as we regulate clean water, vaccines, and food safety, we must regulate iodised salt. The infrastructure is already in place: India produces over 20 million tonnes of salt annually, and only a third of this goes for human consumption. The country’s iodisation capacity is robust. What’s needed is political will and regulatory consistency.

The Madras High Court’s ruling must be appealed—not to stifle debate, but to reaffirm the primacy of public health. Legal interpretations must be informed by scientific evidence and social realities. Public awareness campaigns must be revived, especially in rural and underserved areas. Enforcement mechanisms must be strengthened to ensure compliance across the supply chain.

India’s success in reducing iodine deficiency is a testament to what smart policy can achieve. But success is fragile. It must be defended, not dismantled.

In the words of Nobel laureate Amartya Sen, development is about expanding freedoms. But those freedoms must include the freedom to grow, to learn, and to thrive. Mandatory salt iodisation is not a constraint—it is a catalyst. Let us not gamble with the cognitive future of our children. Let us protect what works. We’ve come too far to turn back now.

(Rajan is a public health and nutrition researcher specialising in maternal and child nutrition policy. He was formerly Director of Nutrition at Tata Trusts and Regional Representative of the Global Alliance for Improved Nutrition)