International Federation adds support to those calling for mandatory fortification in the UK

December 21, 2015   World

International Federation for Spina Bifida and Hydrocephalus | Source

folic acid The International Federation for Spina Bifida and Hydrocephalus (IF), once again urges the UK Government to respond positively to the repeated recommendations of the Scientific Advisory Committee of Nutrition (SACN) and a growing number of medical experts.         

As the international umbrella organisation for all those affected by Neural Tube Defects and Hydrocephalus, IF has become increasingly concerned about the worldwide lack of action and importance being placed on the primary prevention of Neural Tube Defects (NTDs). The organisation will demonstrate its commitment, by launching the first ever global prevention initiative to tackle the issue in 2016. With a highly regarded team of international experts, IF plans to use the knowledge and experience gained over the last 20 years to support other countries in developing prevention strategies to address NTD prevention as a global community.


Since the landmark 1991 study by the Medical Research Council proved that preconceptional supplementation with folic acid could reduce the incidence of NTDs by up to 72%, the UK Government has recommended that all women who might become pregnant should take a daily 400 mcg supplement of folic acid to reduce the risk of their pregnancy being affected by an NTD. Globally, an estimated 300,000 babies per year develop a neural tube defect, with around 5,000 pregnancies in Europe being affected. Thousands of cases could be prevented if more women were aware of the importance of getting the right amount of folic acid at the right time, BEFORE they get pregnant. 

NTDs occur during the first 28 days of pregnancy (before many women are even aware that they are pregnant), which when coupled with the fact that over half of all pregnancies globally are unplanned poses obvious difficulties in promoting preconceptional supplementation policies alone. The addition of mandatory fortification would help to protect thousands more pregnancies.  

IF’s Global Prevention Programme Manager, Martine Austin said:

‘In light of the number of unplanned pregnancies globally, and widespread poor intake of folic acid during the critical preconception period, policies that simply promote supplementation with folic acid are not enough to significantly reduce the risk of NTDs, and do not fully reach the target population. The addition of fortification will also help to address health inequalities, and offer greater protect to those pregnancies at most risk, as a result of poor dietary habits and low socio-economic status. A combined strategy of supplementation and fortification is essential if we are to ensure that the maximum number of pregnancies is protected. IF’s commitment to the new Global Prevention Initiative will help to ensure that countries and associated organisations all over the world are supported to take positive action.’

The USA, folic acid has been added to grains and breakfast cereals since 1998, resulting in approximately a 33% reduction in the number of pregnancies affected by Neural Tube Defects, with no detrimental effects on the population as a whole.  Since then, 81 countries around the globe now have a mandate to fortify at least one industrially milled grain with folic acid (the most recent addition being Nigeria). Globally there has been an average reduction in affected pregnancies of 46% where folic acid fortification has been implemented. Despite such positive evidence of benefit, Europe continues to resist, resulting in a continuingly high number of pregnancies being affected, unnecessarily. 

IF President Margo Whiteford said:

‘IF calls on the EU to implement forthright policy propositions that will contribute to the effective reduction of NTD through increasing awareness, and folic acid food fortification and supplementation plans.
IF proposes the creation of an international policy for mandatory food fortification to actively encourage all countries to adopt this measure’.

IF’s Secretary General (and Board member of the Food Fortification Initiative) Lieven Bauwens said:

‘In many countries, mandatory folic acid fortification demonstrated that blood folate concentrations are increased and NTD reduced. Nowadays, to neglect to fortify with folic acid in Europe is incomprehensible. Half of pregnancies are unplanned, so supplementation alone also has not been an effective approach. The implementation of these recommendations is essential for the primary prevention of these serious birth defects such as spina bifida, this is why IF has committed to a global prevention programme in 2016.’