Written Statement: Government’s decision to introduce mandatory fortification of flour with folic acid to help prevent foetal neural tube defects

I am today announcing the Government’s decision to introduce mandatory fortification of flour with folic acid to help prevent neural tube defects developing in pregnancy, by raising the folate levels of women who could become pregnant. The UK government and devolved administrations conducted a public consultation in 2019 on the issue of mandating folic acid fortification. Our joint response is published today and confirms that we will proceed with fortification of non-wholemeal wheat flour, which is the most used type, and is almost universally consumed in one form or another.

Neural tube defects are birth defects of the brain, spine, or spinal cord, and the rates in Wales appear high compared to many other areas of Europe. They happen in the first few weeks of pregnancy, often before a woman even knows that she is pregnant. The two most common conditions caused by neural tube defects are spina bifida and anencephaly. These can be devastating conditions and the Welsh Government is fully aware of the effect these have on the individuals themselves and their families.

There is strong evidence that many neural tube defects can be prevented by increasing a woman’s intake of folic acid, which is why existing pregnancy advice to women who are trying to conceive or who are likely to become pregnant is to take a daily supplement of 400 micrograms of folic acid until the 12th week of pregnancy. However, we know that around half of pregnancies are unplanned. Even in those pregnancies that are planned, many mothers do not take folic acid supplements or modify their diet to increase folate intake before conception and up until the 12th week of pregnancy. An estimated 90% of women aged 16 to 49 have a folate status below the level recommended to reduce the risk of a pregnancy affected by neural tube defects. Attempts to increase folate levels through education on the need to take folic acid supplements have had limited effect.

The Scientific Advisory Committee on Nutrition (SACN) recommend mandatory folic acid fortification of flour to improve the folate status of women most at risk of NTD-affected pregnancies. Mandatory fortification has successfully reduced rates of NTDs in 80 countries, such as Australia, New Zealand and Canada.

Nearly 1,500 responses were received to the consultation, with 2% of respondents reporting living in Wales. Of these, 68% were in favour of the option we are mandating.

We intend to implement this change on a UK-wide basis and will now commence detailed discussions with stakeholders on the precise details of the fortification and labelling requirements, and agree the appropriate lead-in times. In order to minimise impacts on industry, this will be co-ordinated as part of a wider review of The Bread and Flour Regulations 1998.

Following those discussions, and in coordination with the progress of the review of the wider Bread and Flour Regulations, we will consult on the draft legislation to implement this policy, and include a full impact assessment on mandatory folic acid fortification.