Spina bifida is a neural tube defect that is one of the most common severe birth defects in the world. The main cause is a lack of folate vitamin in the diet, and in 1991, the UK’s Medical Research Council halted a trial of folic acid supplementation early because it was obvious that the supplement was preventing a large number of cases. At the time, the trial’s authors concluded: “public health measures should be taken to ensure that the diet of all women who may bear children contains an adequate amount of folic acid.”

The United States was relatively quick to act, mandating flour be fortified with folic acid in 1998, followed by around 80 countries worldwide. Countries with mandatory fortification have seen a drop in neural tube defects of between one third and one half. But not the European Union nor, until recently, the United Kingdom.

The European Union concedes: “There has been no real progress in preventing NTDs in Europe since folic acid supplementation was shown to be an effective preventive measure.”

Finally, the UK has put forward proposals to fortify white flour, but many doctors say they could do much more. Europe is still to act.

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