The British Pregnancy Advisory Service (BPAS) released a statement yesterday advising that flour in the UK should be fortified with folic acid as a public health measure to reduce the incidence of neural tube defects, such as spina bifida, in developing pregnancies.

The UK has one of the highest rates of spina bifida in the EU, and the rate has remained static for thirty years. The effects of the condition vary depending on the defect itself. If the neural tube fails to close, it can result in anencephaly, where the skull and brain do not form: a fatal condition. Other variations of the condition can result in lifelong disability.

That folate supplementation reduces the incidence of neural tube defects, but in order to be effective, folate supplementation must be initiated before a women realises that pregnancy has occurred, as the critical period for neural tube defects occurs in the first two weeks, before a missed period occurs. Seven years ago, the Scientific Advisory Committee for nutrition endorsed mandatory flour fortification with folic acid, and this was approved by the chief medical officers. Countries which have already introduced this measure, such as Canada, have already seen a fall in the incidence of neural tube defects.

BPAS is a charity that advocates reproductive choice, aiming to reduce the incidence of unwanted pregnancy with the use of contraception and offer the choice to end them with abortion. They treat more than 60,000 men and women each year. Ann Furedi, chief executive of the BPAS, said:

“Unplanned pregnancy‘s a fact of life and often a wonderful and welcome surprise, but it‘s unrealistic to expect women to be taking folic acid supplements on the basis that they might conceive. The fortification of flour with folic acid‘s a straightforward public health intervention which could spare hundreds of women every year from the painful decision to end a wanted pregnancy after a diagnosis of a neural tube defect.

“Many politicians problematize abortion but show little interest in addressing some of the issues which result in a woman needing to end a pregnancy. Whatever our differences on abortion, we should all be able to unite behind a simple measure with huge benefits. We call on the UK‘s health ministers to make the necessary changes to protect the health of pregnant women and their babies and we urge them to do this as a matter of urgency.”

In the meantime, healthcare professionals involved in the provision of family planning and sexual health should be aware of the recommendation for 400mcg of folic acid to be taken preconceptually in low risk women who wish to become pregnant, and that high risk women: women with diabetes, women with a neural tube defect themselves or with a previous affected pregnancy, women with coeliac disease, women with a BMI greater than 35 and women taking folate antagonist drugs such as sodium valproate, should taken 5mg of folic acid whilst attempting to conceive.