This chapter focuses on food fortification policy formulation and implementation with a public health purpose in mind, the barriers and the strategies to overcome them. A simple representation of food fortification policy development is a stepwise model consisting of scientific evidence production, adoption of policy option, policy application and assessments of impact. Key barriers within scientific evidence gathering stage include varied terminologies used, heterogeneity of recommended micronutrient values, the lack of reliable indicators of micronutrient status, lack of strong evidence of intake–status–health association and the lack of evidence of effectiveness of food fortification as a policy. Barriers to adoption of food fortification go beyond the scientific evidence to include assessments of technical feasibility, existence of the infrastructure to achieve the policy implementation, the regulatory and institutional framework, vested interests and stakeholder interactions, consumer base and ultimately economic consequences of fortification. Barriers to implementation of food fortification include technical constraints; socio-economic, infrastructural, political, and ethical considerations; and consumer acceptance. Barriers to monitoring and impact assessment are fragmentation of development of the monitoring framework and evaluation, budgetary constraints, lack of sensitive methods to enable attribution of the observed changes in micronutrient status to food fortification, inability to draw conclusions and corrective action from the evaluation and lack of leadership. Continuous investment into research, stakeholder interactions and clear commitment to public health nutrition goals are vital for the food fortification approach to emerge as an option for policy, globally.