Mandatory Fortification of Flour with Folic Acid to Prevent Neural-Tube Defects

Firm evidence from randomized, controlled trials that maternal periconceptional folic acid reduced the risk of neural-tube defects was published in the early 1990s. Despite promotion of periconceptional folic acid supplement use, no more than 50% of women take them and so mandatory fortification of a staple food has been considered by many countries as an important adjunct to any public-health approach for the prevention of neural-tube defects. Even 15 years after the confirming evidence, some countries have yet to commit to mandatory fortification and, in those that have, there is limited and poorly coordinated monitoring and evaluation of its effectiveness and safety.