Queen’s Speech

Lord Rooker Excerpts

Wednesday 3rd June 2015 Lords Chamber

[Lord Rooker (Lab)]

My Lords, I wish to raise the issue of pregnancies affected by neural tube defects. Neural tube defects are serious birth defects that include spina bifida, and are a consequence of a vitamin deficiency.

It is well known that taking folic acid—vitamin B9—before conception reduces the risk of an affected pregnancy by over 50%, the exact percentage depending on the level of folic acid intake. Research on the issue by the Medical Research Council-funded study in 1991 has not been in question, and the United States of America changed its policy on folic fortification of white bread flour to mandatory in 1998 as a result of that UK research. Today, over 70 countries have mandatory fortification of flour with folic acid. The principle of fortifying part of the diet of a nation based upon science is not an issue. The United Kingdom has for decades been fortifying wheat flour—except wholemeal flour—with calcium, iron, niacin and thiamine. The cost is borne by the milling industry.

For many years, the Department of Health’s advice to women “planning pregnancy” has been to take folic acid supplements. The snag here is that the UK, to its international discredit, has the second-highest rate of unplanned pregnancies. The neural tube closes at 27 days, hence the Department of Health advice for women “planning” a baby. Many women are not aware of a pregnancy until after 27 days, by which time it is too late.

In 1996, the number of women in England and Wales taking supplements was 40%. In 2012, it was 28%. The Department of Health “advice” policy is not working. Affected pregnancies can be discovered at the 20-week scan, and around 80% are terminated. The use of this large percentage of terminations is the Department of Health “policy instrument” for dealing with neural tube defects—there are around 15 to 18 per week.

I was present earlier this year at a meeting of the All-Party Parliamentary Food and Health Forum, when, as the minutes record, the chief executive of Shine, the spina bifida charity, said:

“It looks to Shine as if the Government is avoiding acting. A senior civil servant told me that the Government’s view is that the issue of folic acid deficiencies leading to spina bifida is ‘well managed through terminations’”.

There are about three live neural tube defect births a week in England and Wales—that is 150 a year. In 2012 in England and Wales there were 908 affected pregnancies—only 28% of women were taking folic supplements.

Independent scientific committees such as the Scientific Advisory Committee on Nutrition and the Food Standards Agency have given advice to government to fortify white bread flour. Chief Medical Officers have come and gone, but they have never really collectively—there are four—taken the issue seriously to Ministers because they have always found something else to wait for by way of research; I will refer to two.

I arrived at the Food Standards Agency in 2009 after it had advised the Government that flour should be fortified, although I was aware of the issue from my days at Defra. I therefore knew of the claim that colon cancer would, or might, increase. Research was commissioned and in 23 March 2013 a paper by Vollset et al was published in the Lancet which found “no significant effects” of folic acid on the incidence of cancer on any specific site.

Folic acid in the form of supplements or fortification in flour is remarkably safe. More than 70 countries follow the fortification policy, and there have been some spectacular reductions in the number of babies born with disabilities, and of course reductions in terminations.

Earlier this year, the United States Centers for Disease Control and Prevention published an update on neural tube defects prevented by mandatory folic acid fortification between 1999 and 2011. Over the period, the number of births occurring annually without the defects that would otherwise have been affected is approximately 1,326. A long paper showed an overall reduction of 28% of affected births, and it estimated a net saving of more than $500 million in total direct costs for the affected births that were prevented. The United States still has a national birth defects prevention month and a folic acid awareness week. There have been substantial reductions in Chile, which has used a higher level of fortification than the US. Leading scientists say the Chile level should be used worldwide.

Turning to the second cause of delay, in response to a series of Oral Questions that I asked in 2014-15, the noble Earl, Lord Howe, indicated that the Government were awaiting the latest blood folate information from the national diet and nutrition survey. After a very long delay, the blood folate results became available at 9.30 am on Friday 20 March this year, showing that many women had low blood folate levels. The Government now have all the evidence they have been waiting for. Is the policy going to change? The UK has the highest level of neural tube defects in Europe, so neighbouring nations do not see a need for action. It is the UK population who are affected, so we need to act.

Taking the results of the US evidence I mentioned earlier and applying them to the statistics for England and Wales, scientists say that in the period 1998-2012 there would have been about 1,800 pregnancies without, instead of with, a neural tube defect. That is a very substantial potential reduction in distress all round.

Folic acid intake levels of 5 milligrams per day or more have no known adverse effects. While folic fortification is necessary to prevent neural tube defects, there is no need to set an upper intake level, and no need to limit voluntary folic acid fortification at the same time as instituting mandatory fortification.

During the recent parliamentary Dissolution period, I did not completely waste my time campaigning on electoral matters—I wasted a lot of it, but not all of it. I joined Sir Nicholas Wald and Sir Colin Blakemore on two visits, to the food supplement manufacturers trade body and to the Food and Drink Federation, to discuss the industry aspects of mandatory folic fortification. Sir Nicholas, of the Wolfson Institute of Preventive Medicine, led the Medical Research Council research in 1991, and more recently published, with colleagues, a study of more than half a million women who had been antenatally screened and had provided details on folic acid supplementation. It concluded that the current policy is failing and has led to health inequalities. Sir Colin, a former chief executive officer of the MRC, is professor of neuroscience at the University of London.

We genuinely believe that putting public health first and joining more than 70 other nations in fortification will take a major step towards ending the distress caused by the large number of avoidable terminations, stillbirths and cases of permanent serious disability in surviving children. A change will take time to implement, but Sir Nicholas, Sir Colin and I are ready to help Ministers in advocating and implementing such a policy.

On 19 May, I asked the reappointed Public Health Minister, Jane Ellison, whether she would meet me, Sir Nicholas and Sir Colin. If she does not want to listen to me, she should, I believe, meet the scientists. We are dealing with a vitamin deficiency-induced birth defect, and we are using abortions—more neutrally, terminations—of 80% of affected pregnancies as an instrument of policy. This cannot be right. It is not right and what is more, it need not happen.