This study, commissioned by the Global Alliance for Improved Nutrition (GAIN), examines how regional trade can strengthen access to fortified foods across Eastern and Southern Africa (ESA). Covering 26 countries and five key fortified food vehicles—salt, edible oils, wheat flour, maize flour, and sugar—the report analyzes current production patterns, trade dynamics, and systemic barriers limiting cross-border exchange. While ESA is largely self-sufficient in salt and shows potential for regional trade expansion in edible oils, intra-regional trade remains limited for wheat flour, maize flour, and sugar due to structural constraints, protectionist measures, and logistical challenges. The study identifies three categories of barriers: systemic trade barriers (high transport costs, customs inefficiencies, foreign exchange constraints), food-vehicle specific barriers (limited production capacity, tariffs, divergent certification requirements), and fortification-specific barriers (inconsistent micronutrient standards, lack of mutual recognition systems, limited border testing capacity). Despite differing stakeholder views, many see regional trade as a pathway to improve food security, reduce costs, increase availability of fortified products in underserved areas, and build collective resilience. The report proposes strategic opportunities including developing a QR-code verification system for faster customs clearance, strengthening local fortified edible oil value chains, and launching innovation challenges to improve nutrient-preserving packaging. Overall, it highlights trade facilitation as a promising, though politically and technically complex, lever to combat micronutrient deficiencies in ESA.