Birth defects prevented by fortifying bread and flour with folic acid

Around 200 cases of debilitating brain and spine defects in babies every year will be prevented by fortifying non-wholemeal wheat flour with folic acid.

New legislation being introduced today will require millers and flour producers to fortify non-wholemeal wheat flour with folic acid from the end of 2026. 

Folic acid deficiency is a leading cause of neural tube defects, which can cause a large number of serious and debilitating conditions to babies in the womb, including spina bifida.   

Flour is already fortified with calcium, niacin, thiamine and iron to improve public health. The move to include folic acid will reduce neural tube defects by 20% in the UK and improve the health of pregnant women. It will also deliver savings of around £20 million to the NHS over 10 years and boost the economy by more than £90 million over 10 years.

Andrew Gwynne, Minister for Public Health and Prevention, said:   

“Shifting care from sickness to prevention is one of the leading ambitions in our 10 Year Health Plan, as we work to make our NHS fit for the future. 

"These measures are a simple and effective intervention to improve health outcomes in babies, giving them the best start in life.” 

Baroness Merron, Minister for Patient Safety, Women's Health and Mental Health, said:   

“Fortifying bread and flour with folic acid will help reduce neural tube defects and give women greater peace of mind throughout their pregnancy.   

“This government is determined to support women and turn around maternity outcomes so every child can live a long, happy and fulfilling life.” 

The NHS recommends that women who are trying for a baby take folic acid supplements for around three months before getting pregnant, and for at least 12 weeks after becoming pregnant. This recommendation will remain in place after the new regulations on flour are brought in.

It is estimated that half of all pregnancies in the UK are unplanned. The new regulations will help provide women with a higher baseline intake of folic acid, better protecting their babies in all scenarios. 

 Professor Chris Whitty, England's Chief Medical Officer, said:  

“The fortification of flour is a simple and effective way to help to reduce cases of neural tube defects, although it is important that women who are pregnant or intending to become pregnant continue to take folic acid supplements before and during the first 12 weeks of pregnancy.” 

The government is continuing to engage with the food industry to support them to implement the changes, which will apply to the whole of the UK. Wales, Scotland and Northern Ireland will introduce their own regulations in due course. 

Minister for Food Security Daniel Zeichner, said:

“When it comes to public health, prevention will always be better, and cheaper, than a cure.

“Fortified flour has been providing our country with a public health boost for 80 years and this latest collaboration across government will help give the nation's children a strong start in life.

“We are grateful to industry for their efforts to support a smooth transition, with manufacturers having a 24-month transition period to adjust their processes."

NOTES TO EDITORS 

The new measures will deliver the NHS £20 million in reduced costs over 10 years. This is in addition to £571 million in benefits to society through an increase in live births, as well as £54 million due to increased labour market participation and £39 million due to parents prevented from leaving the labour market.

This work forms part of a wider Defra review of the Bread and Flour Regulations 1998 conducted under the Food Compositional Standards and Labelling (FCSL) UK Common Framework, working collaboratively with the devolved Governments and Department of Health and Social Care. 

It included a UK-wide public consultation with the proposals also notified to the World Trade Organisation, fulfilling international obligations.   
 

The key changes include: 

• Technical amendments to clarify requirements and definitions, to ensure consistency with other food standards legislation including increasing minimum levels of nutrients and updating specification criteria, enabling understanding and compliance. 
• Update to the compositional rules of wholemeal flour, removing barriers to compliance while maintaining consumer protection. 
• An exemption from fortification requirements for small-scale millers (producing less than 500 metric tonnes of flour per annum). This removes disproportionate burden on smaller scale producers without compromising the public health outcomes of the policy. 
• Introducing the use of improvement notices. This is a more proportionate and efficient way to address non-compliance and reduces risk of excessive costs associated with court time when criminal proceedings are brought. 

The amending regulations published today in England ensure our rules are robust and fit for purpose, with the changes designed to lead to improved public health outcomes, protect consumers, support industry and assist enforcement authorities.   

ANNEX: 

Professor Ian Young Chair of SACN:

“The Scientific Advisory Committee on Nutrition (SACN) welcomes this important initiative which will reduce the number of lives adversely affected by neural tube defects. SACN has consistently recommended folic acid fortification since 2006, alongside on-going monitoring and continued encouragement for women to take folic acid supplements before pregnancy. SACN is delighted to see these being implemented.”

Kate Steele, CEO of Shine, the charity that provides specialist support for people whose lives have been affected by spina bifida and hydrocephalus, said:

“After more than 30 years of campaigning,  Shine can finally celebrate the introduction of this very important public health initiative.  

“It will improve the health of the general population across the UK but, more importantly, mandatory fortification will reduce the number of babies affected by spina bifida, a lifelong, complex disability.   
It also means that fewer families will be given the devastating news that their baby has anencephaly and will not survive.  

“I am so very grateful to everyone who has kept mandatory fortification of flour with folic acid on the government's agenda, especially Lord Jeff Rooker and Shine's Head of Health, Gill Yaz. Collectively, we have made our long-awaited goal a reality. It will make such a difference to so many lives!”