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Health: Neural Tube Defects

Volume 792: debated on Wednesday 12 September 2018


Asked by

To ask Her Majesty’s Government what proposals they have to reduce the incidence of Spina Bifida and related conditions resulting from neural tube defects.

My Lords, the Government recommend that all women should take a daily supplement of 400 micrograms of folic acid while they are trying to get pregnant and during the first 12 weeks of pregnancy, when the baby’s spinal cord and spine are developing, to prevent spina bifida and other neural tube defects—NTDs. Public Health England has published resources for local maternity systems and runs the Start4Life campaign for parents-to-be to raise awareness of planning and preparing for pregnancy.

Half our pregnancies are unplanned. Is the Minister aware that in the United States of America there are three births with spina bifida per 10,000 live births? The NHS figure for England is six births per 10,000 live births—double. Is she aware that the United States officially put down the reason for their lower level since 1998 to the fact that they have fortified flour with folic acid based on the research of the UK Medical Research Council? More than 80 countries, all four chief medical officers and the Daily Mail support the policy, so why do we not get some action?

The noble Lord is right that around 55% of pregnancies are unplanned. No other EU country has fortified flour with folic acid, but a range of other countries have. The noble Lord mentioned one, the USA, where there has been mandatory fortification since 1998, as he said. There was an immediate and stable 28% reduction in NTDs and no clear evidence of an increase in the prevalence of B12 deficiency.

My Lords, neural tube defects occur in the first days to four or five weeks of pregnancy, often before the woman even realises that she is pregnant. The Government’s advice to women to take folic acid is not happening out in society. With the number of neural tube defects occurring, it has been estimated that the average lifetime cost to the NHS could be as high as £500,000. Even though some of these women go on to terminate their pregnancy, the emotional trauma to them of taking that decision is phenomenal and the emotional and physical difficulties in a family of coping with a defect that is completely preventable do not support the Government’s current policy.

My Lords, I fully understand the strength of feeling in the House about this important issue. The issue of the health of pregnant women and their unborn children is one that the Government take very seriously. I realise that noble Lords may have been hoping for a more definitive response from me today. All I can say is that the decision is with Ministers who are considering the issue very carefully.

My Lords, the evidence is clear for all to see. The number of neural tube defects in Canada halved in six years when flour was fortified with folic acid. Our own Scientific Advisory Committee on Nutrition concluded in 2006, again in 2009 and last year that what others have been doing for years, adding folic acid to flour, prevents neural tube defects. What is preventing Her Majesty’s Government taking the same decision?

The noble Baroness is right that the Scientific Advisory Committee on Nutrition—SACN—has recommended mandatory fortification of flour with folic acid since 2006. The Committee on Toxicity—COT—is currently reviewing the maximum recommendation level and has noted that negative effects are unlikely to occur at a level below the current value. However, its work is unlikely to be completed before winter 2018. I am sorry that there is nothing I can add to that.

My Lords, to my knowledge, my noble friend Lord Rooker has raised the issue with Ministers and in this Chamber probably 15 times. What are Ministers doing with it—leaving it at home? As someone who has given birth to a stillborn child, I say to the Minister that we should do everything we can to protect women from that trauma.

I entirely agree with the noble Baroness that we should do everything in our power to protect all women from all trauma. But I am afraid that I cannot add anything more other than to say that the decision is with Ministers and that I am hopeful that there will be an answer in the not-too-distant future.

My Lords, six months ago on 1 March, the Minister’s colleague, the noble Baroness, Lady Chisholm, said that,

“the Secretary of State is very keen to make progress and any delay is not intended”.—[Official Report, 1/3/18; col. 759.]

This is what we hear every six months—and every six months, 500 families are devastated by a diagnosis that means that 400 of them have an unwanted termination and 100 of them have a child with a lifelong disability. May I make a helpful suggestion? I know that the Minister understands both the science and the morality of this. Why not have a public consultation on the issue? If the Government cannot make up their mind, let other people say what they think and see the evidence.

As always, the noble Baroness has some insightful views. She is right that there is significant support for the mandatory introduction of folic acid supplements. Indeed, the devolved Governments are very supportive of folic acid. However, there is not yet universal support for mandatory fortification, partly due to public acceptability because of the possible adverse effects of very high folic acid levels in some people, which can mask vitamin B12 deficiency. However, I personally will take back the strength of feeling in this House, and hopefully we can look forward to an outcome in the not-too-distant future.