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Pregnancy alcohol warnings drowning out messages on folic acid, flour should be fortified with key vitamin

Pregnancy alcohol warnings drowning out messages on folic acid,  flour should be fortified with key vitamin


  • The UK has a high rate of Neural Tube Defects (NTDs) like spina bifida
  • Folic acid reduces these defects significantly, but needs to be taken before conception as the neural tube closes in very early pregnancy
  • Many pregnancies are not planned, so fortification of flour with folic acid would be most effective way of helping women and their babies
  • 2015 National Diet and Nutrition Survey showed blood folate levels in UK women of reproductive age well below those recommended by WHO for NTD reduction
  • bpas urges UK health ministers to implement fortification as matter of urgency, as more than 50 countries around the world have done[1][2]


The UK has one of the highest rates of neural tube defects like spina bifida and anencephaly in Europe, with around 1,000 pregnancies affected each year. One of the most effective ways to reduce the incidence of these conditions is for women to take folic acid before they conceive, yet messages about the need to take these supplements prior to conception do not get the prominence as those aimed at reducing women’s alcohol intake before they try for a baby.  A recent study showed that fewer than one in 3 women in the UK take folic acid prior to conceiving, which may in part reflect the fact that around half of pregnancies are not formally planned. However, if flour was fortified with folic acid, the vitamin would already be present in foods consumed everyday – meaning that many more women would have sufficient levels of the vitamin in their blood when they became pregnant even if they had not taken supplements.

Spina bifida causes lifelong disability, while anencephaly is a condition in which where the baby’s skull and brain do not form properly and the baby dies shortly after birth. The majority of women (80%) make the painful decision to end what is often a much wanted pregnancy after such a diagnosis. Women in Northern Ireland in this situation are then forced to travel to England and pay for their abortion, as this care is currently denied them at home.

It is now nearly a decade since the UK’s Scientific Advisory Committee on Nutrition (SACN) first recommended flour be fortified, and the UK’s chief medical officers considered and approved that recommendation. The UK has been adding calcium, thiamin, niacin and iron to wheat flour for more than 50 years so both the principles and the mechanics of fortification are already in place. Fortification of flour with folic acid is supported by the Royal College of Obstetricians and Gynaecologists, the British Medical Association, and the Spina Bifida charity Shine among others. 

Countries which have introduced mandatory fortification, including the US and Canada, have seen a marked reduction in neural tube defects, with no evidence of adverse effects on the rest of the population.  The decision to fortify now lies with the health ministers of England, Wales, Scotland and Northern Ireland.

Clare Murphy, Director of External Affairs at the British Pregnancy Advisory Service, said:

“More can and should be done to raise awareness of the need to take folic acid when you are trying for a baby, as it has such a proven protective effect. But unplanned pregnancies are a fact of life – contraception fails, accidents happen – and it is simply unrealistic to expect all women of reproductive age to be taking folic acid on the basis that they might get pregnant. We urge health ministers across the UK to implement the fortification of flour with folic acid. This is 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. It is particularly heartbreaking to see women from Northern Ireland in bpas clinics – who after receiving this devastating diagnosis are expected to travel for abortion care that doctors cannot by law provide for them at home. There are politicians who have devoted themselves to restricting women’s access to abortion – how refreshing it would be if they would put the same energy into pushing for a simple measure which would do so much for the health of pregnant women and their babies.”


Notes for editors

The estimated annual cost saving of fortification to the taxpayer in the UK has been put at over £5m



For further information please contact the bpas press office on 0207 061 3377 or 07788 725 185 or press@bpas.org

About bpas

bpas is a charity which sees more than 70,000 women a year and provides reproductive healthcare services including pregnancy counselling, abortion care, miscarriage management and contraception, at clinics across the UK. It supports and advocates for reproductive choice. More information can be found at bpas.org.


[1]The World Health Organisation recommends red blood cell folate levels should be above 906 nmol/L in women of reproductive age to achieve the greatest reduction in NTDs


[2] Analysis of blood samples from the National Diet and Nutrition Survey published in 2015 found among UK women of reproductive age the median level was 535 nmol/L and the mean 614 nmol/L (Scotland mean 563, Northern Ireland mean 512, Wales mean 611)