Bread and Flour Regulations (Folic Acid) Bill [HL]

Baroness Walmsley Excerpts

Friday 8th July 2016 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I strongly support the noble Lord, Lord Rooker, in putting forward the proposal that the UK mandates fortification of white flour with folic acid or vitamin B9, and I congratulate him on his Private Member’s Bill and his persistence in promoting this measure. Twenty-five years ago when I first stood for Parliament, I was given the advice by my noble friend Lord Maclennan of Rogart to never take no for an answer. The noble Lord, Lord Rooker, is doing exactly that. It is good advice.

There have been mountains of scientific evidence that this fortification works in preventing foetal neural tube defects, prevents a great deal of disability and distress and causes no harm, as we have heard. When will the Government stop stalling and take action? I do wonder whether they would have taken the same attitude if it was a matter of men’s health rather than that of women and babies. I wonder whether a woman Prime Minister would have a bit more understanding of the level of distress that is caused to women affected by this issue. Perhaps we should start a petition of all the thousands of women who over the years have had to have terminations for this reason, or given birth to children with terrible disabilities. Perhaps that might have some effect.

To my mind, five facts make the case. First, currently the folate levels in the blood of women in the UK of child-bearing age are below WHO recommended levels and risk NTDs.

Secondly, supplementing the diet with vitamin B9 can protect against neural tube defects that can be caused by a shortage of this vitamin. Thirdly, there are 1,000 cases—that is a lot of people—of NTDs in the UK every year, of which 800 are terminated and 200 are live births. The terminations and the live births cause parents great distress and cost the NHS a great deal of money, both for the terminations and for the lifelong services needed by the children. Fourthly, supplementation needs to take place, as we have heard, before the 27th day of gestation—long before most women know that they are pregnant. It really is nonsense to rely on the suggestion that women planning a pregnancy should take supplements when we know that half of all pregnancies are unplanned and so, if followed 100%, that would prevent, at most, only half the cases. You cannot rely on women taking supplements, because only 28% of women of childbearing age take vitamin supplements and, for women under 20—the age group least likely to plan their pregnancies—it is even lower, at 6%. Fifthly, the UK has the second-highest rate of unplanned pregnancies, behind only the USA. However, as we have of course heard, there they fortify their flour and have half the relative incidence of NTDs compared to us.

The problem is getting worse. The number of abortions due to NTDs has risen 40% in England and Wales in the four years to 2013, which is the latest figure that I have seen. The availability of terminations free on the NHS is not a cost-free option. Termination is not in the best interests of women, because it can cause great distress and present dangers to the woman’s health. It is also a very bad strategy for the NHS, because terminations cost money and, of course, there are some women who would never choose a termination, no matter what. It is like controlling conception with the morning-after pill. It is even worse than closing the stable door after the horse has bolted; it is closing the stable door after the horse has bolted, broken down hundreds of fences and broken all four of its legs.

On the other hand, it would cost the Government nothing to insist that, along with calcium, iron, niacin and thiamine, manufacturers must fortify flour with folic acid. As we have heard, the principle of fortification has been established since World War II. I think that the case is made. At a time when prevention of disease is more important than ever before to ensure the sustainability of the health service because of the growing demand and rising costs, it is perverse to resist the call of the BMA and all the other medical and scientific experts, as well as the noble Lord, Lord Rooker, to agree to this small but important measure. I hope that the Government will stop procrastinating and will act by supporting and giving time to this Bill.

--- Later in debate ---

[Baroness Flather]

What amazes me is that we are talking about nudging and not doing this or that, but we often have research on issues which are of great importance not only to the individual—as we have been talking about—but to the family and to the country. When a child needs lifelong care, surely it is not a good idea to not do anything about that. We seem to be going round and round, saying that we cannot be led by research, while the Government must have their policy. But what is the policy based on?

[Baroness Walmsley]

The noble Lord has just read out a list of the functions of government. Would he not add protection to that? We chlorinate all our water to protect people from water-borne diseases. Why not put folic acid in flour?

[Lord Prior of Brampton]

I will continue with the example that the noble Lord, Lord Hunt, gave, of alcohol. Clearly, the Government have the responsibility to put the science into the public domain. But should they ban people from drinking more than 14 units of alcohol a week or should they leave it to people to make that choice themselves, on the basis of the information that they have? That is the philosophy that lies behind the Government’s position on folic acid. It is also our thinking on how we address the scourge of obesity and lies behind the way we deal with our smoking and alcohol problems and behind all our prevention strategies. It is about doing all we can to help people make the right choice, but ultimately accepting, outside of extreme circumstances, that the final choice has to be made by them and not by the Government.

This is why the Government agree with the statement made by my honourable friend in the other place, Jane Ellison, when she said that the Government consider that a broad approach to the promotion of good pre-conception health needs to be taken to make sure every child gets the best start in life. On balance, the Government have decided that mandatory fortification is not the right way forward and therefore have no plans to introduce it in England.

We know that good pre-conception health, of both future mothers and fathers, can lead to healthier pregnancies and good infant health. By contrast, poor pre-conception health—for example due to diabetes, poor diet, obesity or smoking—can lead to poor pregnancy outcomes, including gestational diabetes, NTDs, premature births, and poor perinatal and infant mental health.

Many parents make few preparations to improve their health before pregnancy. That is why a more proactive approach which promotes good pre-conception health to reduce the risk of poor pregnancy outcomes for women and their families should be adopted. This is why my colleague Jane Ellison has set up a ministerial round table. She held her first meeting with interest groups on 13 June to help identify additional measures to promote good pre-conception health.

I recognise the tragedy of neural tube defects. I recognise the urgency and passion that lies behind this Private Member’s Bill but, at this time, the Government have decided that, on balance, we are against mandatory fortification of white bread with folic acid and therefore have no plans to introduce it in England. Instead, all our efforts will be directed at promoting good pre-conception health. I realise that that is a disappointing but probably not unexpected reply to the noble Lord, Lord Rooker, and to his colleagues who support the Bill. Of course, that balance may change over time. As the noble Baroness, Lady Hayman, said, he is a formidable opponent and I have no doubt that he will carry on pushing the case for fortifying with folic acid. In time, who knows where that argument will go but, for the time being, the Government’s position is that we will not support the Bill.