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Mandatory fortification of flour with folic acid: an overdue public health opportunity

Glen F Maberly and Fiona J Stanley
Med J Aust 2005; 183 (7): . || doi: 10.5694/j.1326-5377.2005.tb07078.x
Published online: 3 October 2005

The scientific benefit is clear, but translating this into practice requires advocacy

Fourteen years ago, randomised controlled studies in the United Kingdom1 confirmed observational studies from Australia,2 the United States,3 and elsewhere, showing that an adequate intake of folic acid by women at around conception prevents most neural tube defects in their babies.4 These three countries now (i) have government-sponsored public health campaigns which encourage women of childbearing age to increase their daily intake of folic acid; (ii) have food standards permitting the food industry to voluntarily add folic acid to cereal and other foods; and (iii) have health benefit claims related to the prevention of birth defects. In 1996, the US (along with Canada) introduced mandatory fortification of virtually all wheat flour products. Despite recommendations by the National Health and Medical Research Council in Australia and other scientific bodies and scientists in the UK, mandatory fortification has yet to be introduced in these countries.


  • 1 Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  • 2 Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, WA


Correspondence: 

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  • 3. Centers for Disease Control and Prevention. Spina bifida and anencephaly before and after folic acid mandate — United States, 1995–1996 and 1999–2000. MMWR Morb Mortal Wkly Rep 2004; 53: 362-365.
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  • 9. Food Standards Australia New Zealand. Fortification of food with vitamins and minerals. Available at: http://www.foodstandards.gov.au/whatsinfood/fortification/index.cfm (accessed Aug 2005).
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  • 12. Fenech M. Chromosomal biomarkers of genomic instability relevant to cancer. Drug Discovery Today 2002; 7: 1128-1137.
  • 13. The Flour Fortification Initiative website. Flour fortification practices database. Available at: http://www.sph.emory.edu/wheatflour/Training/Data_Evaluation/Tracking.html (accessed Jun 2005).
  • 14. National Institute of Clinical Studies. Evidence-Practice Gaps Report, Volume 2. Folic acid. Encouraging periconceptional use of folic acid supplements. Available at: http://www.nicsl.com.au/resources.ashx/knowledge.reports/28/Documents.50.File/6D06DD3566DF7679733161F7947E5C4A/1_folic_acid.pdf (accessed Aug 2005).

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