From the end of 2026, the UK government will require the addition of folic acid to non-wholemeal flour. This is an important step forward in public health; an intervention that could prevent up to 200 cases of neural tube defects annually as well as improving the health of pregnant women and their babies.
Why Folic Acid Matters
Folic acid is essential for healthy cell growth and development. For pregnant women, folic acid plays a critical role in the early stages of foetal development, particularly in forming the neural tube, which develops into the brain and spinal cord. An insufficient folic acid intake during pregnancy can lead to neural tube defects such as spina bifida and anencephaly—serious conditions that can result in lifelong disability for the child or even loss of life.
While women planning to become pregnant are encouraged to take folic acid supplements, about half of pregnancies in the UK are unplanned. This means that many women may not be taking supplements at the crucial time when the neural tube is developing, often before they even know they are pregnant. Fortifying a staple food such as non-wholemeal flour ensures that more women—and the population in general—have a better intake of folic acid, thereby reducing the risk of neural tube defects.
A Proven Public Health Measure
Folic acid fortification is not a new concept. Countries such as the USA, Canada, Australia and New Zealand have implemented similar policies with with positive public health outcomes. In the USA, for instance, neural tube defect rates dropped after folic acid was added to flour in 1998. This policy has been hailed as one of the most effective public health interventions in recent decades.
By adopting a similar strategy, the UK stands to achieve comparable benefits. The planned fortification could prevent up to 200 neural tube defect cases annually. Beyond these direct health benefits, the policy will also reduce the emotional and financial burden on families and the healthcare system.
Reaching Vulnerable Groups
One of the most main advantages of folic acid fortification is its ability to reach vulnerable populations. People from poorer backgrounds are less likely to take dietary supplements and may have diets that are lower in naturally occurring folate. Fortification ensures that everyone has access to an additional source of this vital nutrient, which can hep in reducing health inequalities.
Safety and Wholemeal Flour Exemption
Some people have expressed concerns about potential risks of folic acid fortification, such as masking vitamin B12 deficiency in older adults. However, evidence from countries with fortification policies shows that these risks are very low and far outweighed by the benefits.
Moreover, wholemeal flour will not be fortified under the new policy, as wholemeal flour is less commonly consumed and many people who choose it also prioritise less processed foods. However, those who consume wholemeal flour should be mindful of their folic acid intake and ensure this is adequate through other sources, including supplements or other products fortified with folic acid.
Looking Ahead
The move to fortify non-wholemeal flour with folic acid is a proactive approach to improving public health. By addressing one cause of neural tube defects, this policy will have a lasting positive impact on many families across the UK. It is a reminder of the power of preventive measures in public health when even a small change can make a large difference at a population level.
As we move toward the implementation of this policy, it is crucial to continue raising awareness about the importance of folic acid, particularly among women of childbearing age. Together, we can support a healthier future for mothers, babies, and society as a whole by supporting positive public health interventions such s folic acid fortification.