As early as 1991, the Medical Research Council published a report recommending that white flour in the UK was fortified with folic acid (a B vitamin) as this had been shown in other countries to prevent neural tube defects (NTD) in foetuses. Mandatory fortification with limits on voluntary supplementation was backed by the Scientific Advisory Committee on Nutrition in 2006 and again 2017. The Committee on Toxicity has produced a report on safe upper limits for fortification, which will be used to guide the consultation process.
NTDs, such as spina bifida, cause moderate to severe disability leading to human suffering and higher health care costs. The prevalence of NTD pregnancies is 1.28 per 1000 total births (19% live births, 81% terminations and 0.5% stillbirths and fetal deaths ≥20 weeks’ gestation). A recent study estimated that more than 2000 NTD pregnancies could have been prevented since 1998 had the UK adopted flour fortification. Thus, the failure to act on this straightforward policy has resulted in a missed opportunity for those families affected.
According to the latest NDNS, 91% of women of childbearing age (16 to 49 years) in the UK as a whole had a red blood cell folate concentration below the threshold (748nmol/L) indicating elevated risk of NTDs.
We are pleased to have consulted on mandatory fortification of flour in the UK, following our joint letter with RCOG, SHINE and others to the minister, Seema Kennedy MP. Read the BDA's response to the consultation here.
We will look to engage with the consultation process regarding the implementation of this policy. We will also look to communicate the benefits of the policy and alleviate concerns about other impacts. We will continue to work with colleagues and partners, such as the Spina Bifida charity SHINE and the Royal College of Obstetricians and Gynaecologists (RCOG), who are were so successful in campaigning in this area.
Some members of the public will remain concerned about the possible impact of folic acid on those parts of the population where folic acid has no benefit in preventing NTDs (such as children or men). It will therefore be important to understand this policy and be able to communicate it to the public. Keep an eye out for the BDA's consultation response and any policy briefings on this page.