UK government says no to mandatory fortification of flour with folic acidBrussels 25 March 2016 // It now seems clear that the UK government has decided to reject mandatory fortification of flour with folic acid, despite repeated recommendations to do so from the UK's Food Standards Agency and the SACN. In response to Oral Questions in the House of Lords earlier this week, the Parliamentary Under -Secretary of State for the Department of Health, Lord Prior of Brampton, stated that Government ‘currently have no plans to introduce the mandatory fortification of flour with folic acid’. 



Mandatory fortification has already been introduced in many countries across the world with the aim of increasing intake of folate in women both before pregnancy, and during early the first 12 weeks of pregnancy to help to reduce the risk of neural tube defects (NTDs) such as anencephaly and spina bifida. NTDs develop during the first 28 days of pregnancy, before many women are even aware that they are pregnant, which is why it is so vital that women have adequate intakes of this essential vitamin BEFORE they become pregnant. Currently one in every thousand pregnancies in the UK is affected by a neural tube defect.

Ground-breaking research by Professor Nick Wald in his 1991 Medical Research Council Study proved that timely intake of folic acid in the correct dose could prevent the risk of NTDs by up to 72%. Since then, many governments have  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.  Although folates do occur naturally in some food sources, such as green leafy vegetables, some fruits and eggs etc., it is practically impossible for women to get enough folate from diet alone to support a pregnancy, which is why all women who could get pregnant are advised to take a supplement containing 400mcg folic acid, and to continue doing so until the 12 week of pregnancy. However, despite the policy recommendation, there is very little communication of this vital public health message, and consequently the prenatal uptake of these supplements is low, and the number of affected pregnancies remains stubbornly high. 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 getting pregnant.

As over 50% of pregnancies in the UK are unplanned, ensuring that women are getting enough folic acid at the crucial time becomes an even greater challenge.Currently In the UK, fortification of foods with folic acid in the UK is carried on a voluntary basis, with folic acid being added to some breakfast cereals and bread products. However, new concerns are now being raised as many of these manufacturers have already reduced the number and levels of fortified products in expectation of the government approving mandatory fortification.           

IF is extremely disappointed that the UK government is not embracing the opportunity to help protect many more pregnancies, including those that are particularly vulnerable as a result of nutritional deficiency, UK population the health benefits of increased folic acid consumption, through the fortification of flour. It is no longer acceptable for the UK government to do nothing in response to this important public health issue, and IF calls on the Government to commit to a robust national NTD risk reduction strategy to improve awareness and uptake of preconceptional folic acid among all women of childbearing age. As the potential pool of women that could become pregnant is in constant flux, it is vital that a long term, sustainable commitment is made, not merely a short-term awareness raising activity. 

IF regrets that despite working towards the recommended mandatory fortification of flour with folic acid in the UK for more than 15 years, no progress has been made towards implementing this policy. Contrary to what the UK government have decided, the Scottish government is now considering acting independently of the UK, adding folic acid to flour in order to reduce the number of pregnancies that are affected by these severe lifelong conditions.

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