Government’s decision to enrich non-wholemeal flour aims to prevent 200 cases of spina bifida annually, but experts call for broader measures

In a landmark move to improve public health, the UK government has announced plans to fortify non-wholemeal wheat flour with folic acid by the end of 2026. The decision aims to reduce the number of birth defects such as spina bifida, with an estimated 200 cases potentially preventable each year. The initiative is set to address a persistent health issue, particularly benefiting expectant mothers and women trying to conceive.

The government’s announcement follows years of advocacy from health experts who have long argued for the inclusion of folic acid in staple foods. According to the Department of Health, folic acid is crucial during the early stages of pregnancy, promoting the healthy development of a baby’s brain, skull, and spinal cord. As a result, the decision is expected to safeguard the health of unborn babies across the country.

However, despite this positive step, medical professionals continue to advise women who are planning a pregnancy or who are in the early stages of pregnancy to take folic acid supplements. The NHS currently recommends that women take folic acid for at least three months before conceiving and for the first 12 weeks of pregnancy. This advice remains crucial, as the fortified flour alone may not provide the optimal dosage needed during these critical periods.

The UK joins countries like Australia and Canada, where flour fortification with folic acid has been standard practice for years, leading to significant improvements in public health outcomes. By introducing this measure, the government aims to replicate similar successes, particularly as it is estimated that nearly half of all pregnancies in the UK are unplanned. Thus, fortification could serve as a crucial safety net, ensuring that even those unaware of their pregnancy receive some level of protection for their developing baby.

Despite widespread support, not everyone is satisfied with the government’s current plan. Critics argue that limiting folic acid fortification to non-wholemeal wheat flour excludes certain segments of the population. Professor Neena Modi, a leading expert in neonatal medicine at Imperial College London, expressed concerns that the policy does not cover gluten-sensitive individuals or those who primarily consume wholemeal products or rice-based foods. “This policy will disadvantage specific groups, thus adding to the existing health inequities in the UK,” Prof Modi emphasised, urging for a more inclusive approach.

Folate, commonly known as vitamin B9, is naturally found in foods like beans, lentils, and leafy green vegetables. While a balanced diet can generally provide adequate folate levels, research has shown that many people still fall short of the recommended intake, especially in the critical early weeks of pregnancy when the neural tube develops. This gap is what the government hopes to address by fortifying flour, ensuring a baseline intake for the population at large.

Currently, flour in the UK is already fortified with essential nutrients like calcium, niacin, thiamine, and iron to improve public health. The addition of folic acid will be another step towards enhancing nutritional standards. However, small-scale flour millers, producing less than 500 metric tonnes annually, will be exempt from this new regulation, reflecting a balance between public health and business considerations.

While the move is largely celebrated, some experts believe that extending fortification to other staple foods could have a more comprehensive impact. They argue that including folic acid in products like rice or wholemeal flour would further reduce disparities and improve outcomes for a wider range of dietary preferences.

The government’s independent advisory body, after extensive review of the evidence, concluded that fortifying flour with folic acid is the right course of action to protect public health. This decision is part of broader efforts to reduce neural tube defects, which can result in severe disabilities or even be life-threatening.

As the UK prepares to implement this policy, manufacturers have been given a clear deadline of 2026 to comply with the new regulations. The grace period allows producers to adjust their processes and ensure the smooth integration of folic acid into their products. The government remains hopeful that this measure will lead to healthier pregnancies and significantly reduce the number of babies born with neural tube defects.

The conversation around food fortification and public health is far from over, with experts calling for continued dialogue on how to make nutritional benefits more inclusive. As the UK takes this step forward, it sets the stage for potentially expanding fortification strategies in the future to cover more foods, ultimately aiming for a healthier and more equitable society.