Courtesy of Network for Consumer Protection - Iodine deficiency is a common cause of goiters, an affliction visible in this woman and child in Nothiya, Pakistan, a village on the outskirts of Islamabad. They were photographed in April 2010 by the Network for Consumer Protection, a health advocacy group.
LAHORE, Pakistan — At a bustling general store in Lahore, a major metropolitan center of culture and learning, people ask a lot of questions about one seemingly innocuous product: table salt.
If it contains iodine, about 40 percent of his customers spurn it, according to proprietor Muhammad Waqas Vicky. They won’t allow their families to consume what they call “mixed salt,” believing it causes infertility.
Iodized salt deficiency around the world
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“The majority among them are businessmen and religious people,” Vicky said from behind the counter. Pakistanis of all classes have been hearing about the alleged dangers of iodized salt for nearly two decades. But insufficient iodine in the diet can cause spontaneous abortion, stillbirth, goiters, mental retardation, birth defects and other developmental problems.
Anti-polio campaigns here have been the target of deadly attacks that stemmed from similar myths, but officials blame the iodine-related infertility rumors, at least in part, for a massive health crisis. Nearly half of Pakistan’s population of 200 million suffers from some form of iodine deficiency disorder, according to last year’s National Nutrition Survey, which was carried out by academics, UNICEF and Pakistan’s Health Ministry.
Various reports have linked manifestations such as lethargy and lower IQ scores to dampened national productivity, which can further harm a fragile country like Pakistan, consistently beset by economic crisis as it is.
How did this happen? Some experts see little mystery in the evolution of what has become one of Pakistan’s more bizarre, longer-running and destructive conspiracy theories.
Seventeen years ago, well-meaning government officials launched a maternal health initiative in the face of ever-rising birth rates. To this day, people remember a slide show on official Pakistani television — at the time the nation’s only channel — that pushed prenatal care and awareness of vital nutrients.
The next-to-the-last slide promoted one element in particular: iodine.
The final slide, officials recall, credited the initiative to the government’s department of primary health and family planning.
“There was a communication mistake,” Tariq Aziz, an expert on production of iodized salt, said of the 1995 broadcast. “People thought this was purely a family-planning initiative.”
After the public conflated iodine with government-enforced birth control, rumors took off about an international scheme to limit Muslim population growth through iodized salt. The falsehoods became especially potent in a society that prizes large families and where contraception use is low.
By 2001, a mere 17 percent of Pakistani households used iodized salt, UNICEF reported, compared with, say, Bangladesh, where the consumption rate was 78 percent.
Today as many as 30 percent of Pakistanis still won’t allow the dread element to reach their tables, according to Aziz, a Lahore-based official with the nonprofit Micronutrient Initiative, a Canadian-funded program that promotes more use not just of iodine but also vitamin A, zinc and iron.
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