Given the acres of newsprint devoted to the issue of female reproductive health, it is astonishing so little attention is paid to a small measure that could make a huge difference for some women and their children.
We could cut the number of babies born with serious birth defects by 40 every year through the simple act of telling food manufacturers to add a cheap supplement to one or more of the most common foods they make.
That translates into hundreds of people not having to live with spina bifida, with its lifelong burden of deformity, incontinence or even paralysis, or many other even more severe birth defects.
It’s a no-brainer, of course. Or, at least, it should be.
A decade ago, a Government-appointed committee called for the mandatory fortification of bread with folic acid, the mineral that can prevent up to 70 per cent of neural tube defects. Ireland had, and still has, one of the highest rates of such defects in the world.
Since then, nothing has happened to make this public policy. Eighty other countries have introduced mandatory fortification but Ireland is stuck on the merry-go-round of repeated reviews and consultation.
Things have gotten a lot worse since 2006. At the height of the boom, you could buy a wide range of products to which manufacturers had added folic acid on a voluntary basis. Often this was done for marketing reasons, to position an item at a higher price point, but the happy side effect was that folic acid intake rose in the general population. As a direct consequence, the rate of babies born with serious birth defects dropped from year to year.
Economic effects
Then the economy tanked and consumers went in search of value in their food shopping. Niche products were out as manufacturers pared costs to the bone. The number of items containing folic acid shrank and consumers were far less likely to buy them anyway. Voluntary fortification stopped working.
Ireland is blessed with two State-funded food agencies but it took a small team of researchers at Dublin City University (DCU), headed by a placement student, to spot what has happening. They identified the declining availability of fortified products and the change in shopping trends, and pointed out that the rate of birth defects had started rising once again.
In a mainstream supermarket, its survey found, there were up to 100 products containing folic acid. But in Lidl, increasingly the choice of value-conscious consumers, just one food item was supplemented.
Mandatory fortification
The
Food Safety Authority of Ireland
(FSAI), the expert State body in this area, did get its scientific committee to review the issue, and that report was published last May. It said the mandatory fortification of bread or flour with folic acid represented the most effective way of reducing Ireland’s high rate birth defects.
This was sent to the Minister for Health as a recommendation. Incredibly, though, the committee came up with a second recommendation, to continue with the current policy of voluntary fortification of foodstuffs. In tandem with this, women of childbearing age would be advised to take folic acid supplements.
Effectively, the authority came up with two contradictory policies. Civil servants and politicians had their excuse for doing nothing.
That is what has happened since, aside from a low-key campaign by another food body, Safefood, to raise awareness through social media.
Various arguments have been put up against mandatory fortification. Sure, can’t women just take supplements?
Yes. And women do take supplements – middle-class women who are actively trying to get pregnant. But up to half of all women have unplanned pregnancies. Further, women from deprived backgrounds are far less likely to be on folic acid before or during their pregnancy. They are therefore more at risk of having a child with a serious birth defect. Supplementation is a class issue.
It is also claimed the measure would be hard to implement given so many foodstuffs are imported. The argument is unconvincing but in any case it could be overcome by requiring the fortification of a common home-produced product such as milk.
The FSAI has in the past raised concerns about the very young and the very old in the population possibly receiving too much folic acid. It is important these concerns are addressed but with proper regulation other countries have shown it is possible to introduce mandatory fortification and make it work.
It is difficult to understand why mandatory fortification, first called for by Senator (and medical doctor) Mary Henry in the 1990s, has not been introduced. Perhaps it comes down to our prevailing light touch approach to food health issues. How else to explain the continuing delay in introducing a sugar tax, or an effective salt-reduction policy, or mandatory calories posting in restaurants? Even the long-promised reforms to alcohol marketing and retailing are perennially around the corner.
It is hard to avoid the conclusion that where the interests of consumer health clashes with those of Big Food, industry always wins out.
Paul Cullen is Health Correspondent. Jacky Jones is on leave.