Preventing neural tube defects with folic acid: nearly 20 years on, the majority of women remain unprotected.

Many countries, including the USA and Canada, have implemented fortification of foods with folic acid, however the British Government only issues advice that supplements should be taken before and after conceiving. In this study, information was collected from women attending antenatal clinics to understand current levels of compliance with health advice and to investigate what is driving womens' behaviour. Eighty-nine percent of women consumed supplements but only 31% took folic acid prior to conceiving. Hence, the vast majority are starting too late to prevent neural tube defects (NTDs). Educational achievement, income and marital status emerged as the most significant factors influencing non-compliance. GPs and midwives were the main catalyst for women starting folic acid, however, 81% of these women started post-conception. When asked why they took folic acid, the majority of women did not mention the association with NTDs. Forty-one percent of women who did not take the supplements at all were unaware that it was recommended that they should. Fortification of UK food products offers a major public health opportunity. In the absence of fortification, gaps in the public health message need to be addressed. GPs and midwives cannot be relied upon alone to educate these women.