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Health: Neural Tube Defects

Volume 769: debated on Monday 21 March 2016


Asked by

To ask Her Majesty’s Government whether they will bring forward measures of preventative medicine to reduce the numbers of stillbirths, abortions and live births of babies with serious lifelong disability due to neural tube defects.

My Lords, the Government are looking at all aspects of preconception health and preventive medicine. We currently have no plans to introduce the mandatory fortification of flour with folic acid. We plan shortly to engage with relevant stakeholders to identify other measures that can promote good preconception health, including how to redress the low blood-folate levels of women, which can lead to neural tube defects.

The Minister’s Answer is clearer than some of the others, but we now know that the answer is no; that is what he has told us. English Ministers are knowingly doing nothing, basically. They know that half of all women who become pregnant are taking supplements, and only a small percentage of them actually take the correct amount. Moreover, does the Minister know that some food manufacturers are starting voluntarily to reduce the folic acid in their products, which they were going to do on the basis of mandatory levels being introduced following scientific advice? The Government are therefore relying on 80% of pregnancies being sponsored abortions as a management tool. That is the reality of what we are dealing with in England at present. Is this not like English Ministers having a polio vaccine and refusing to use it?

My final point is this. Does the Minister accept that it has never really been made clear that there is a direct and indisputable link between neural tube defects, lifelong serious disability in babies who are born alive and folate vitamin deficiency? It was the UK that told the world this in 1991, and 83 other countries have thanked us by using the policy to reduce the number of abortions and babies born with lifelong disabilities. The Minister should be ashamed of the situation he has been forced into by his colleagues.

My Lords, I am not going to argue the science, because the link between folate levels and neural tube defects is fairly well proven. Although our decisions should be informed by scientists and doctors, I do not think that they should be determined by them. The balance between individual responsibility and state responsibility is best left to political judgment.

My Lords, given that the Minister accepts the link between a lack of folic acid in the diet and neural tube defects, why will he not look again at the advice from, for example, the Royal College of Obstetricians and Gynaecologists, the Food Standards Agency and the BMA that we should be putting folic acid into food products, as is done in many other countries, including the United States of America?

Fortifying bread with folic acid is not a silver bullet that would cure all babies with neural tube defects. The estimate is that it would have an impact on between 15% and 30% of babies. Some 965 babies suffer from neural tube defects a year, so we are talking about fortifying flour for the whole population in order to reach about 120 babies.

My Lords, is the Minister aware that we have debated this issue many times and that the view around the House has been almost unanimous that something should be done to deal with this problem? Why, therefore, is it not done? On a previous occasion, I clearly remember someone saying that if you do not want the supplement you can have bread that is specifically made without the additives. In that way, the ordinary population can be catered for. Of course, women need the supplements before they get pregnant, not afterwards, when it is already too late.

My Lords, speakers in this House have by and large very much supported the views of the noble Lord, Lord Rooker—I entirely accept that. But I do not think that the case has been made outside this House perhaps as strongly as it has in other areas. If we are going to change the way we produce white bread in this country, a much stronger and broader case has to be made.

But, my Lords, it is not just in this House, is it? It is in the Scottish Government, who I understand are now laying out plans to introduce fortification. They are supported by the Administrations in Northern Ireland and in Wales. Why is England taking this isolationist view when across the world it has not been taken? Is it correct that Sir Nicholas Wald, the leading scientific expert in this field, was granted an audience with the Minister for Health in Scotland, but not in England?

My Lords, I cannot answer the latter question, but I will try to find out and write to the noble Baroness. She is right that Scotland is considering this and looking at the practical issues around implementation. She is right that other countries in the world—I think 50—have done this, but many others have not, including all European Union countries.

My Lords, I realise that the noble Lord is in the hands of his scientific advisory committee and cannot say anything without it, but I ask him to draw to its attention the fact that it may be using outdated research evidence if it believes that adding the small amounts of folic acid to bread has the same metabolic effect as taking 1 milligram of tablet a day. It does not. The very remote possibility that there is danger in taking 1 milligram of tablet a day is eliminated completely if you add it to food and take it during the day. Will he draw that to the committee’s attention and ask it to think again?

I will certainly draw that point to the attention of the SACN. It would be surprising if it was not already aware of that fact, but as I said I am addressing not really the science but whether it is right or proportionate to fortify bread for everybody to reach such a small number of people.

My Lords, the noble Lord made it clear that this is a political decision, for which we should be grateful. He also made it clear that the Government have decided that it is not going to happen. But does he accept that a 30% improvement is actually a large, positive outcome? The fact is that the voluntary approach that this Government have been wedded to is simply not working. If the answer is no, and if the voluntary approach is not working, what, then, will the Government do?

My Lords, the evidence given by the SACN is that it affects between 15% and 30%. My honourable friend in the other House, Jane Ellison, is bringing together a round table of all stakeholders interested in preconception health to discuss this matter.

My Lords, does the Minister think that the resistance to this is in the general public or among the food producers? My discussions with many young women across the country do not give me the impression that it is among the general public. If it is among the food producers, of course they would be resistant if it does not benefit their profits. Where does the Minister think that attitude is, and can he advise us where we should put our energies in order to change it?

My Lords, I am not aware that the food industry is opposing the introduction of folic acid into white bread flour, but I will investigate that and write to the noble Baroness.