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House of Lords Hansard
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Pregnancy: Folic Acid
23 January 2018
Volume 788

Question

Asked by

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To ask Her Majesty’s Government, further to the Written Answers by Lord O’Shaughnessy on 18 October 2017 (HL1779–HL1781), regarding the advice of the Scientific Advisory Committee on Nutrition in July 2017 on the mandatory fortification of flour with folic acid to reduce pregnancies affected by neural tube defects, whether they have made a decision on that advice.

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My Lords, the Government welcome the advice of the Scientific Advisory Committee on Nutrition, and I am aware of the noble Lord’s long-standing interest in this subject. This is a complex issue and Ministers are considering it carefully. The Government will set out their position in due course.

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Does the Minister accept that this is not a campaign for fortification but an attempt to cut by half the number of pregnancies affected by neural tube defects, which lead to substantial numbers of terminations and of births affected by lifelong serious disability? If our preventive healthcare is world class, how come the UK has twice the United States of America’s rate of such pregnancies? Have the Government yet replied to the letter of December last from the Scottish and Welsh Governments, supported by the Department of Health in Northern Ireland and the UK Chief Medical Officers, backing the advice from the scientific advisory committee and asking for urgent action?

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My Lords, as I said, this is a complex issue. Apart from the SACN’s view recommending mandatory fortification, we have to remember that, as it pointed out, it can agree to it only if there are restrictions on voluntary dietary fortification and voluntary restriction of folic acid in other products, such as breakfast cereals, whose manufacturers actively push the fact that they put folic acid in their products. It is important to ensure that there is no increase in the number of people with intakes above the recommended amount. On the letter, the Secretary of State replied as follows on 20 December:

“I fully understand your desire to proceed with mandatory fortification of flour with folic acid. I have therefore asked my officials to prepare advice that I will consider in the new year”.

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My Lords, does the Minister agree that the reason why the United States has a low instance of spina bifida is that it adds folic acid to food? It has not come to any harm yet, and it has been doing it for many years.

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My noble friend is right, but the United States adds it not only to white flour but to quite a lot of other products. It is voluntary from state to state. There has been an important study in the Republic of Ireland which I will tell noble Lords about very quickly so they do not shout “too long”. The Republic of Ireland was going to add folic acid to white flour when it was discovered that blood samples showed that high intakes of folic acid in Ireland were mainly due to the existing practice of voluntary fortification of various foods by the industry. The FSAI anticipated that folic acid food fortification would continue to increase due to health claims being authorised by food. They are likely to prompt more food businesses to fortify their products so that they can make a claim.

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My Lords, I am not sure what the complexity is with this issue. The scientific evidence is quite clear that folic acid supplementation reduces the incidence of neural tube defects because of the interaction between a gene and the environment. It is a weak mutation of a gene that causes neural tube defects, and folic acid supplementation—I use that word—reduces the risk by supressing that gene interaction. The science is clear, which is why many hundreds of countries use folic acid supplementation. It also might explain why we have different incidences of the neural tube defect in different populations—because of the interaction between the gene and the environment.

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I do not disagree with anything that the noble Lord says, but that is why the Secretary of State has said that he is looking at this very carefully and will come back in the new year.

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It is the new year!

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I am well aware that it is the new year. I must point out that this is not just about fortification of white flour. We must remember that quite a lot of people do not eat white flour, particularly in the ethnic community. If we do do this, it is also important that there is public consultation to make sure that businesses are willing to do the voluntary intake of folic acid into flour.

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My Lords, more than 80 countries around the world follow this procedure of fortifying white flour with folic acid. There is no scientific or medical evidence from anywhere in the world to contradict the conclusion that it is wholly beneficial to pregnant women. There is no point in the Government saying that pregnant women can make a decision when they know they are pregnant, because that is too late for it to work. I am not talking to the Minister personally when I say this, as I think she might have a different view from her colleagues, but is she really challenging this overwhelming burden of medical and scientific evidence—or is it just mulish obduracy?

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No, it is not mulish obduracy. The Secretary of State is minded to look at this again and has asked officials to draw up a plan because we are listening to what everybody says. Your Lordships will just need to wait to see what the Secretary of State comes out with.

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My Lords, could the Minister tell the House when the Government last ran a campaign to remind women to take folic acid before they became pregnant and how many women were targeted? Do the Government foresee any future efforts to increase the number targeted, and if not, what responsibility do the Government have towards babies born with neural tube defects?

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As I think was mentioned earlier, 50% of all pregnancies are unplanned, so the health education messages are provided in a range of settings, targeting women of child-bearing age. There is the Healthy Start programme, through which free vitamin vouchers are offered to pregnant women on low incomes, who will receive certain benefits. The NHS Choices website provides healthy lifestyle advice during pregnancy, including on the importance of folic acid supplementation, and there is the NHS Start4Life information service. Early in pregnancy, a midwife will provide information about nutrition and diet, including supplements such as folic acid and vitamin D, as well as lifestyle advice.