Folic Acid Fortification

Anna Turley Excerpts

Thursday 25th October 2018 Commons Chamber

[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.

[Anna Turley (Redcar) (Lab/Co-op)]

The Minister is being extremely generous in giving way; we are not allowing him to make much progress. May I take it from his last assertion about an upper limit that the consultation, which we welcome, is not so much about whether folic acid will be included in flour but about what the upper limit will be?

[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.

--- 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.