Food fortification is a popular strategy for addressing ‘hidden hunger’, and staple foods are seen as promising if unproven vehicles for the delivery of essential micronutrients to the poor in developing countries. This paper examines wheat flour fortification with iron in Pakistan as a case of technocratic optimism in the face of institutional constraints. An evaluative framework based on the analysis of the entire value chain can provide a reality check on technocratic optimism. Poor people base their preferences for different types of flour on price as well as perceptions of nutritional value. Many of these flour types are not covered by fortification programmes. Fortification interventions meanwhile have attempted to leverage public-private partnerships in a segment of the wheat flour value chain which is beset with regulatory weaknesses. This paper illustrates why technical interventions should support, rather than ignore, a broader agenda of reforms in food policy.