Folic Acid Fortification

Owen Smith Excerpts

Thursday 25th October 2018 Commons Chamber

[Nigel Adams]

We will be encouraging all stakeholders, as well as the public, to take part in the consultation. I will certainly look into the matter that my right hon. Friend has raised and ensure that someone writes to him.

[Owen Smith (Pontypridd) (Lab)]

Given the evidence that neural tube defects such as spina bifida emerge between the 18th and the 28th day after conception and that most women are not taking folic acid supplements in accordance with the Government’s guidelines before conception or during their first trimester, does the Minister agree that supplementation alone does not work?

[Nigel Adams]

The hon. Gentleman takes a keen interest in this matter and has done some extraordinary work on it. He makes an important point. This is why awareness is crucial for all women of childbearing age, including those who are not pregnant but might be considering becoming pregnant.

--- Later in debate ---

[Owen Smith (Pontypridd) (Lab)]

It is a pleasure to speak in this welcome debate on a welcome Government intervention. I start by paying tribute to the hon. Member for Winchester (Steve Brine), the Public Health Minister. He is not here today, but he has been excellent in listening to the evidence on this case in recent months, and he moved decisively to announce the consultation on Tuesday. As the Under-Secretary of State for Housing, Communities and Local Government, the hon. Member for Selby and Ainsty (Nigel Adams), said, the consultation is welcomed on both sides of the House and, indeed, by the scientific community not just in the UK but across the world.

I pay tribute to the right hon. Member for Belfast North (Nigel Dodds), my co-chair of the all-party parliamentary group on folic acid fortification. He has spoken with great bravery and sincerity about his family’s experiences, and he and many others have played a far more important role than I have in bringing home to Members the importance of this change.

I also pay tribute to Shine, and particularly to its current chief executive Kate Steele. The charity does wonderful work to support individuals and families with spina bifida and neural tube defects, and it has played an excellent role in campaigning for fortification.

Lastly, I thank Lord Rooker. He campaigned on this issue long before I and many others did. In truth, he has been the leading advocate in Parliament for this change over a long period. This is a proud day for him.

Obviously there will be some controversial questions. The Government are proposing a big public health intervention, and it is right that they are consulting, but the Public Health Minister was right to say on Tuesday that the evidence is overwhelming and that he is convinced by the evidence.

I will spell out the scale and gravity of these conditions in the UK to bring it home to Members, and to those who might read or watch this debate. We now all know that neural tube defects are the failure of the spine to close at either end, and they happen early in pregnancy. Neural tube defects can lead either to spina bifida or anencephaly.

Anencephaly occurs in 40% of neural tube defects and is fatal. Children with anencephaly do not survive, and often they die very quickly after birth. Spina bifida is where the spinal cord does not properly form, which obviously leads to poor mobility, poor bladder control, bowel issues, often learning disabilities, mental health problems, physical health problems and lifelong disability. It is an extremely grave condition.

Neural tube defects affect around 1,000 pregnancies each year in our country. In this country, two foetuses a day are aborted following the diagnosis of a neural tube defect, and two children a week are born with such birth defects.

[Anna Turley]

My hon. Friend is making an extremely powerful case, for which I am grateful. Does he agree that one of the most frightening statistics is that young women under the age of 20 are five times less likely to take folic acid supplements? That strengthens the case for mandatory flour fortification.

[Owen Smith]

From memory, I believe that just 6% of women aged under 20 supplement their diet prior to or, indeed, during pregnancy. It is clear that this particularly affects younger women, perhaps because they have not yet read the literature, gone to classes or otherwise been informed. The other reality is that there is a much lower level of folate among women from working-class and black and ethnic minority backgrounds, which is another fundamental reason for addressing this in the manner proposed.

Shine estimates that the cost of caring for people with spina bifida and other neural tube defects is around £500,000 over their lifetime, but the point is not the financial cost to the NHS or to the taxpayer; the human cost to families and individuals is what counts. In this awareness week for spina bifida and hydrocephaly, Shine has been highlighting some of those human examples.

One example is of a young woman called Nicky, who had spina bifida. She could walk a little, but she used a wheelchair most of the time. She loved animals, and she volunteered at a local animal sanctuary and rode at weekends. At 18, before she intended to start a university degree in animal care, the shunt that controlled her hydrocephalus needed replacing. It went wrong, and she had three dreadful years of ill health during which she was largely housebound or hospitalised. She obviously could not continue with her education, and she died at 21.

That is not an uncommon case; unfortunately, it is all too common. There is no certainty, of course, that had Nicky’s mother supplemented her diet prior to conception, or indeed during pregnancy, Nicky would not have been born with spina bifida. However, we have known for almost 30 years of the clear evidence that there is a dramatically greater likelihood that Nicky would have been born without a neural tube defect had her mother had the requisite levels of folate in her system. As my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) said, it was in 1991 that the Medical Research Council first published the evidence showing a 72% reduction in the likelihood of conceiving a child with a neural tube defect if the mother supplements her diet with folic acid.

The history is interesting, because successive Governments have not responded to the evidence with fortification, on which this Government are now consulting. I make it clear that I think the last Labour Government should have done so. We did a huge amount through bold public health interventions. Smoking cessation is the best example, but there are myriad examples. The last Labour Government were very good at addressing public health needs. However, this is one area where they did not undertake to act and they should have done. The position our Government and successive Governments took was to move towards advice that diets should be supplemented with 400 micrograms of folic acid during and prior to pregnancy. As many people have said, the problem is that 40% of pregnancies are unplanned; only 30% of women take the right dose of folic acid even if they are supplementing; young women tend not to supplement at all, as my hon. Friend the Member for Redcar (Anna Turley) said; and working-class women and women from black and ethnic minority backgrounds have lower levels of folate because they do not supplement very often. Across the whole population, irrespective of demography, about 75% of women do not have the right levels of folate and therefore are at increased risk of giving birth to a child with a neural tube defect.

Other countries have been bolder than us. As the right hon. Member for Belfast North said, about 85 countries have chosen to introduce mandatory fortification, including America, Canada, South Africa and lots of countries in South America. It has not happened in Europe, but this will be another example of Britain leading the way in Europe.

[Nick Smith (Blaenau Gwent) (Lab)]

My hon. Friend has shown great leadership on this issue, and Shine has been a fantastic help to campaigners across the country on this issue. Does he agree that families in south Wales are glad the Government are moving on this but that they want this consultation to be completed much more quickly—as quickly as possible—because they think this important public health initiative should be brought in sooner rather than later?

[Owen Smith]

That is right. I understand why the Government need to consult. There has been a debate about the upper level of folate. As I may discuss briefly later, the evidence suggests that there is not necessarily any issue associated with an upper tolerable limit. A recent paper in January last year by Professor Sir Nicholas Wald, who did the original research in the early 1990s, very effectively debunked the notion that there is an upper tolerable level of folate. Other studies have done the same, but I am confident that that will come out in the consultation. The point my hon. Friend makes about families in his south Wales constituency and mine is well made. To illustrate that, using the 72% statistic, let me say that had the Labour Government introduced this measure in 1998, at the same time as the United States did, 3,000 babies would have been saved from being born with spina bifida or anencephaly.

There is no evidence from countries across the world that have undertaken this measure of ill effects in the population. There is lots of evidence to show that there are other ancillary benefits; one study in Norway has shown a diminution in the volume of autism in the population. There is huge scientific support for this measure, including from the Royal College of Obstetricians and Gynaecologists; the Royal College of Paediatrics and Child Health; the Royal College of Midwives; the British Maternal and Fetal Medicine Society; the Faculty of Sexual and Reproductive Healthcare; the British Dietetic Association; the Governments of Wales, Northern Ireland and Scotland; the chief medical officers in Wales, Scotland, England and Northern Ireland; Public Health England; Public Health Wales; the Food Standards Agency; and Professor Sir Colin Blakemore. The list goes on and on. Crucially, the Government’s own Scientific Advisory Committee on Nutrition has advocated this measure for the best part of 20 years. So it is a measure whose time has come. It will be enormously beneficial for our population, and if we in this House undertake to do it, we will contribute to saving hundreds of lives each year and thousands of lives over the years to come. I commend the Government for having the bravery and foresight to do it.