Folic Acid Fortification

Rebecca Pow Excerpts

Thursday 25th October 2018 Commons Chamber

[Nigel Adams]

My hon. Friend makes a perfectly plausible point from personal experience. Not everyone can see into the future and plan accordingly. A large number of pregnancies are unplanned, so I understand his point.

[Rebecca Pow (Taunton Deane) (Con)]

Will the Minister give way?

[Nigel Adams]

I will. I will get past my second paragraph at some point.

[Rebecca Pow]

When I was pregnant with my third child, I took folic acid supplements and ate lots of green vegetables, which contain folic acid. However, as colleagues have said, many people do not know that they are pregnant early enough to start doing that. Also, they might not have received the right advice from the medical profession. This consultation is important on those grounds, but will my hon. Friend also ensure that it is very wide ranging so that consideration can be given to all aspects, including the appropriate safeguarding of voluntary fortification by the food industry? Will consideration be given to coeliacs, who use gluten-free flour? This has to be a very comprehensive consultation if it is to be effective.

[Nigel Adams]

It does; my hon. Friend makes an incredibly important point. A number of foods already contain folic acid, and the consultation will have to take that into consideration. It will also look into what a safe upper limit is in that regard. This is why we want to ensure that the consultation is as thorough as possible.

[Nigel Adams]

I do not want to prejudge the outcome of the consultation, and I am sure that the hon. Lady would not expect me do so. It will have to take an upper limit into consideration; indeed, that will be an incredibly important part of the consultation. We want to ensure that the consultation is properly done, that it is thorough and that it can advise Ministers. We will be coming back to the House to report back on it.

I shall move on, if that is okay with colleagues. I think from the tone of the debate thus far that the announcement has been well received. We will be properly consulting on and considering all aspects of this very important issue. I note that many colleagues are well informed about it and that they are aware of the reason behind the calls for mandatory fortification, but it might be helpful to summarise again what we are trying to prevent. Neural tube defects are birth defects of the brain, spine or spinal cord. They happen in the first few weeks of pregnancy, often before a woman even knows that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. These are devastating conditions, and the Government are fully aware of their effect on the individuals themselves and their families. We have already heard the acute interest and strength of feeling on this issue from Members of this House and in the other place, including on what can be done to ensure that pregnant women have healthy pregnancies and give their unborn babies the best protection during the crucial early weeks of development.

Unless someone is pregnant or thinking of having a baby, they should be able to get all the folate they need by eating a varied and balanced diet. Existing pregnancy advice to women who are trying to conceive or who are likely to become pregnant is that they should take a daily supplement of 400 micrograms of folic acid until the 12th week of pregnancy. They are also advised to increase their daily intake of folate by eating more folate-rich foods, to which my hon. Friend the Member for Taunton Deane (Rebecca Pow) referred. Examples are spinach and broccoli, as well as foods voluntarily fortified with folic acid, including a wide range of breakfast cereals.

We know, however, that around half the pregnancies in the UK are unplanned. In those that are planned, it has been estimated that only half of all mothers took folic acid supplements or modified their diet to increase folate intake. This has led to calls for the mandatory fortification of flour with folic acid so that women can get it from dietary sources other than foods that naturally contain it. Successive Governments have not considered that mandatory fortification of flour with folic acid to be the best way to protect public health and have instead promoted the use of folic acid supplements as a part of a wide range of pre-conception and post-conception advice to women of childbearing age. However, we are now taking the opportunity that this consultation presents to seek the public’s opinion on this proposed important change.

My colleague the Minister with responsibility for public health responded to a Westminster Hall debate in May 2018 that was secured by the hon. Member for Pontypridd (Owen Smith), who has campaigned tirelessly on this issue. In his response, the Minister confirmed that the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment—I shall refer to it as COT from now on—had agreed to take forward for further consideration the issue of tolerable upper limits for folate. COT published its interim conclusions in July 2018, but it has yet to finalise its detailed review. In summary, COT concluded that the potential masking of pernicious anaemia was still an appropriate and relevant endpoint on which to base a tolerable upper level, but that the level at which this effect started to occur was unclear. It concluded that further analysis of the data was necessary, but that the upper level would not decrease—that is, it would stay at 1 microgram a day or could be increased—as there was no convincing evidence that masking occurred at levels of intake below 1 microgram a day.

COT has discussed this again at this week’s meeting, and as soon as the outcome of its consideration becomes available, it will inform Ministers’ thinking in respect of the Scientific Advisory Committee on Nutrition’s recommendations on the mandatory fortification of flour and about folic acid advice generally. We will reflect that outcome in the consultation document, together with whether we need to take any other action, such as discussions with the industry on removing folic acid from products that are currently voluntarily fortified, such as breakfast cereal. We will also be working closely with colleagues in the Department for Environment, Food and Rural Affairs on the consultation, its responses and any resulting conclusions.

[Rebecca Pow]

It goes without saying that it would be worth examining the results of tackling anaemia by fortifying flour with iron and of tackling tooth decay by putting fluoride in toothpaste. Similar things have been influenced by approaches to general health, and we could learn great lessons from such examples.