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30 Years is Long Enough

Bowl of flour with wheat on top

Today, Tuesday 20th July 2021 marks 30 years since the UK Medical Research Council’s funded research was published, showing that supplementing the diets of women before, and during, the early stages of pregnancy with folic acid substantially reduced the chance of that pregnancy being affected by Neural Tube Defects (NTDs), such as spina bifida and anencephaly.

Spina Bifida Hydrocephalus (SBH) Scotland have long lobbied for the fortification of flour with folic acid and on this, the 30th anniversary of crucial research being published, we, alongside Shine, the spina bifida and hydrocephalus charity that works across England, Wales and Northern Ireland, have written to Ministers across the UK asking when an announcement on the 2019 UK Government consultation will be given.

Since the publication of this report in 1991, there have been ongoing recommendations for mandatory fortification of appropriate staple foodstuffs with folic acid. The Scientific Advisory Committee on Nutrition (SACN), has repeatedly recommended fortification of flour with folic acid. In 2017 Food Standards Scotland advised that fortification should be undertaken with a joint approach across the UK and following this a joint letter was sent from the Scottish and Welsh governments to the then UK Health Secretary, Jeremy Hunt, urging him to take action and introduce mandatory fortification of flour with folic acid on a UK wide basis.

A UK- Government consultation on mandatory fortification of flour with folic acid concluded in September 2019 and an announcement on the outcome has yet to be made.

The on-going delay in introducing this measure has led, and will continue to lead, to stillbirths, neonatal deaths, disability and avoidable terminations of pregnancy, as well as thousands of individuals facing a lifetime of complex and severe, yet avoidable, health and lifestyle challenges (which also incurs a massive financial implication on the already burdened NHS resources).

From September onwards, after parliamentary recess, SBH Scotland and SHINE will be supported by UK and Ireland’s medical royal colleges, doctors and medical students, dieticians and people whose lives have been affected by spina bifida and anencephaly in attempting to push this up the political agenda and would welcome any support you can give us in sharing our message across our social media channels.

The need for government action is long overdue. The continuous occurrence of preventable birth defects is a tragedy that should no longer be tolerated.

For further information or to discuss involvement in the fortification campaign please contact Clare Cogan Turner, Communications Manager via EMAIL

Find out more about our campaign to date.

New stats reveal 91% of UK women have insufficient folate levels to support a reduction in neural tube defects

A study carried out on behalf of Public Health England and the Food Standards Agency which has been published today (16 March 2018), has revealed as many as 91% of women of childbearing age (16 – 49) in the UK are at increased risk of a neural tube defect (NTD) affected pregnancy due to a folic acid deficiency.

image of flour and wheatFolic acid has been found to be essential in the reduction of NTDs such as spina bifida in unborn babies. The report, which assessed the diet, nutrient intake and nutritional status of the general population, supports this by stating that increased folic acid intake through supplementation has been shown to reduce the risk of pregnancies affected by NTDs, if taken before birth.

Spina Bifida Hydrocephalus Scotland (SBH Scotland) has long advocated for the fortification of flour with folic acid to help reduce the number of NTDs. The charity welcomes the findings and calls on the UK Government to take steps to introduce legislation which makes fortification of flour with folic acid mandatory.

Chief Executive of Spina Bifida Hydrocephalus Scotland Andy Wynd MBE said; “With this report finding there’s a further increase (91%) in the number of women in the UK not receiving the adequate levels of folic acid, it again supports our ongoing calls for the mandatory fortification of flour.

“Foods such as lentils and dark green vegetables produce naturally high levels of folate, and it is already added to some foods, including breakfast cereals. However, it is through the fortification of flour where the real benefits are seen, with other countries recording up to 70% reduction in NTD pregnancies following the mandatory fortification process.

“We believe flour fortification would produce similar results in the UK and with overwhelming evidence to support it, we, once again, ask the UK Government to make fortification of flour a reality.”

Scotland specific issues

Scotland has more live births per head of population with spina bifida than anywhere else in the UK. Possibly due to religious and cultural differences, only 45% of pregnancies are terminated in Scotland as compared with around 80% in the rest of the UK.

Taking daily folic acid supplements, at the correct recommended dose* (0.4mg) three months prior to conception, could reduce up to 70% of these pregnancies from being affected and lower both the number of those born with the condition and the number of pregnancies terminated.

Children born with spina bifida often have paralysis in the lower limbs, urological, neurological and orthopedic problems which often become more significant throughout life. Fortification of flour would reduce the number of babies born with this lifelong disability. Find out more about folic acid and flour fortification on the Spina Bifida Hydrocephalus Scotland website www.sbhscotland.org.uk/folic-acid

*Some females have an increased risk of a pregnancy being affected by an NTD and should be taking a higher dosage of folic Acid

Find out more about our flour fortification campaign

Summary of results from National Diet and Nutrition Survey Rolling Programme.

Those affected by any of the issues associated with spina bifida or hydrocephalus, can call the SBH Scotland Family Support Service helpline on 03455 211 300 or email them.

Are Scotland taking the next step?

Folic acid in flour - Ministers ask for advice on next steps.

Public Health Minister Maureen Watt has written to Food Standards Scotland for advice on how Scotland could fortify flour with folic acid.

The advice will be used to help ministers decide how to pursue the policy on a Scotland only basis. The Scottish Government’s preference is for a UK wide solution, but the UK Government has so far failed to commit to the measure despite repeated requests.

The Welsh and Northern Irish governments have also publically backed the fortification of flour.

The Scottish Government believes mandatory fortification of flour with folic acid is the best way to reduce neural tube defects like spina bifida in unborn babies. Folate levels are low across the UK by international standards – particularly so in Scotland.

Ms Watt wrote again to UK Public Health Minister Jane Ellison on November 11 last year to ask the UK Government to consider mandatory fortification. However, she again failed to commit to the step.

Ms Watt said:

“Our consistent position is that UK-wide mandatory fortification of flour is the best way to reduce neural tube defects. However, despite repeated requests it’s clear that the UK Government has no intention of doing so at this time.

“I have therefore asked Food Standards Scotland to provide some detailed advice on how we could do this on a Scotland-only basis. This advice will then be used to allow us to make a decision on what our next steps should be.

“There are far too many babies being born with Spina Bifida in Scotland – particularly in our more deprived communities. Folic acid is tasteless, entirely safe within recommended intake levels and is already included in many foods like breakfast cereals.

“There are 78 countries around the world that already have mandatory fortification of flour. The USA has done it for the past eight years, with no adverse effects on health. By joining them we can help to save many families from the heartbreak of being told their baby has Spina Bifida.”

Ross Finnie, Chair of Food Standards Scotland said:

“As Scotland’s independent public food body, we will be happy to provide the Scottish Government with the advice that has been requested. Such advice will fit well with our statutory duty to improve the diet of the Scottish population. The advice we provide will enable the Scottish Government to determine the best way forward to reduce neural tube defects. In doing so, we will draw on the previous body of advice provided by the Food Standards Agency as well as taking account of any new evidence and advice from the Scientific Advisory Committee on Nutrition.”

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