Call to Action for a WHO Resolution on Prioritising Mandatory Food Fortification with Folic Acid

6 January 2023

Join the Call to Action for a WHO Resolution on Prioritising Mandatory Food Fortification with Folic Acid

According to a recent publication in The Lancet Global Health 

Over half of preschool-aged children and two-thirds of non-pregnant women of reproductive age worldwide have micronutrient deficiencies“.

Neural Tube Defects (NTDs), including Spina Bifida, are birth defects affecting the brain and the spinal cord early in the pregnancy, often before the pregnancy is detected. They occur when the neural tube fails to close, resulting in malformations of varying severity. NTDs are thought to afflict at least 20 out of every 10,000 births globally. Folic Acid/Vitamin B9 plays a vital role in the early development of the neural tube. Its deficiency among women of reproductive age significantly increases the prevalence and risk of NTD affected pregnancies. This makes the need for mandatory food fortification of folic acid even more essential. Food fortification is a process where micronutrients are added to commonly consumed foods to enhance their nutritional value. Decades of evidence have shown that mandatory fortification of staple foods is the most effective and cost-efficient way to lower the prevalence of congenital malformations such as spina bifida, anencephaly, and other neural tube defects, as well as iodine deficiency disorders such as congenital hypothyroidism. Fortification with micronutrients such as iron, zinc, and vitamin A, strengthens immunity to disease and significantly increases energy and productivity, among other effects.  

Large-scale food fortification (LSFF) entails processing widely consumed foods, including flours, rice, cooking oil, and salt, to add essential vitamins and minerals. Almost everyone consumes these foods and condiments, thus fortifying them is a cheap and highly efficient way to boost nutrition for large populations. Food fortification programs have a proven global record of success over the past 30 years. Over 160 countries have implemented salt iodization, virtually eliminating iodine deficiency and goiter in much of the world. In total 90 countries have implemented cereal grain fortification programs and over 30 fortify oil, margarine, and ghee, reducing the prevalence of folic acid, iron, vitamin A, vitamin D, and zinc deficiencies, especially where these programs are mandatory and well implemented and enforced.

Reducing the prevalence of NTDs is essential for achieving health equity and reducing child and infant mortality and morbidity. The prevalence of NTDs is not distributed equally across the globe, with rates in low- and middle-income nations being significantly higher. As a result, the communities with the highest rates of Spina Bifida and other NTDs also have lower availability and accessibility to essential health services, which has fatal results when medical intervention would have otherwise ensured survival.

A global action to end micronutrient deficiencies is urgently needed. 

The International Federation for Spina Bifida and Hydrocephalus calls on all relevant stakeholders to support a global action that includes the following recommendations:

  • To develop and implement mandatory fortification programs of vitamin B9 in staple foods for the prevention of NTDs;
  • To make mandatory fortification of staple foods with vitamin B9 a global priority;
  • To raise awareness of NTDs, combat stigma associated with them and of effective rights based prevention strategies which respect the dignity and rights of persons with disabilities among all relevant stakeholders including government officials, health professionals, civil society and the public;
  • To ensure that mandatory fortification programs adhere to international standards and guidelines;
  • To promote and strengthen primary prevention of NTDs through food fortification by involving all relevant actors. In particular, ensuring that the development of the policies is done in accordance with article 4(3) of the UN Convention on the Rights of Persons with Disabilities by consulting persons with disabilities, including persons with NTDs, and their representative organisations in the development of policies relevant to them, including policies for the primary prevention of NTDs.

In light of the above, it makes it even more significant for IF to support the proposed WHO resolution put forth by the Government of Colombia, which asks all member states to improve and implement large-scale food fortification (LSFF) in accordance with WHO recommendations

The International Federation for Spina Bifida and Hydrocephalus together with the Global Alliance for Improved Nutrition, the Micronutrient Forum and other international partners are working together to collect signatures for a community letter in support of this resolution that will be shared with members of the Executive Board of WHO. 

The letter is a vital step in supporting this important resolution, which will aid in the global prevention of micronutrient deficiencies.

With your support by co-signing this letter, you will join IF and other international partners in advocating for this important resolution that will help to  improve and implement large-scale food fortification (LSFF) with vitamin B9 (folic acid) to reduce the risk of Spina Bifida, Anencephaly, or Encephalocele.

See the full sign-on Letter here

Hildur Önnudottir
Policy Officer, [email protected]