Despite worldwide public-health campaigns recommending daily synthetic folic acid in the period immediately before and after conception to reduce neural tube defects, many women are not following these recommendations. Three public-health strategies exist for reaching the recommended daily dose-- supplementation, fortifying foods on a voluntary basis, and fortifying a staple food on a mandatory basis.
Countries should choose the policy that is best suited for their circumstances, state Monika Eichholzer (University of Zurich, Switzerland) and colleagues in their Review. The authors recommend that countries that do not have mandatory fortification (or not on a sufficient level) should intensify national campaigns to increase knowledge and use of supplements among women. Techniques such as adding intake recommendations to contraceptive packaging, use of celebrities in promotion programmes, and increasing access to inexpensive supplements should be considered. Promotion and funding of research on additional effective means to improve folic acid supplement use is essential, especially to reach the high percentage of women with unplanned pregnancies, state the authors.
In countries where mandatory fortification takes place careful monitoring and, if needed, policy adaptation should prevent any unintended consequences. Where there is voluntary food fortification and consumers have a choice, celebrities might again be useful in information campaigns, state the authors.
Dr Eichholzer states: "Despite the more effective prevention of neural tube defects by mandatory folic acid fortification many countries do not choose this option, in part because expected additional health benefits are not yet scientifically proven in clinical trials, in part because of feared, but until now not observed health risks, and because of the issue of freedom of choice. Thus additional creative public-health approaches need to be developed to prevent neural tube defects and improve the folate status of the general population."
Contact: Dr Monika Eichholzer, Institute of Social and Preventitive Medicine, University of Zurich, Switzerland. T) +41613633005 eichholz@ifspm.unizh.ch
Journal
The Lancet