James Reilly (Dublin North, Fine Gael) | Oireachtas source

I thank Senator Cáit Keane for raising this important issue. By so doing, she will raise awareness of it, particularly among young women.
It is important that women take folic acid long before they consider conception. General practitioners, who tend to be the first point of contact with the health system for young women in early pregnancy, will always advise taking folic acid. In some respects, however, the horse will have bolted at that point.
The Department of Health is keenly aware of the association between folic acid intake and neural tube defects. While such defects are not completely preventable, I accept the Senator's point that folic acid intake is an extremely important element in preventing neural tube defects and the pain, suffering and difficulty such defects cause to the individuals affected and their families. I note also the costs that arise for the State. This awareness is reflected in the health system's multifaceted approach to the issue, which includes educating women as to the benefits of folic acid in terms of reducing the chance of neural tube defects, promoting the use of folic acid supplements, and encouraging women to eat plenty of folate-rich food, such as spinach and watercress.
The paper to which the Senator refers, Neural tube defects in the Republic of Ireland in 2009-11, points to an increase in neural tube defects in Ireland from a rate of 0.92 per 1,000 to 1.17 per 1,000 between 2009 and 2011. It notes a very low intake of folic acid supplements among women at the peri-conceptional stage and recommends a review of public health policy on folic acid fortification, folic acid supplementation and pre-conceptional care.
The issue of folic acid food fortification was considered by the Department of Health in 2006 and 2007. A proposal to fortify bread with folic acid was examined in depth but was ultimately rejected following advice from the Food Safety Authority of Ireland, FSAI. The FSAI's advice was based on the following facts. First, in certain cases, excessive folic acid can act as a growth promoter of cancerous cells. Second, in 2007, at the time as its analysis, the Food Safety Authority of Ireland considered that there was sufficient folic acid available in foodstuffs. Finally, in 2007, the number of neural tube defects appeared to be in decline.
The Department of Health recognised the importance of ensuring a safe level of folic acid intake across all subgroups of the population. For this reason, the Department decided not to proceed with the planned folic acid fortification of bread products in favour of pursuing a more targeted approach through awareness campaigns such as the Health Service Executive's promotion of folic acid intake in its health pregnancy pack, of which more than 80,000 copies are distributed annually. Notwithstanding this, however, the Food Safety Authority of Ireland has continued to monitor folic acid levels added to food and food supplements marketed in Ireland. In this regard, I have been advised by the FSAI that it considers that we currently have adequate quantities of folic acid in the food supply through the voluntary addition of folic acid to various foods.
The issue of folic acid intake is much broader than simply food fortification. The recent report claims that only 13.7% of the women surveyed took folic acid supplements during the pre-conceptional phase, while 49.2% did not take supplements at any stage. This illustrates a possible lack of information and education among women on this subject. It is clear the Senator's concern is to ensure we take a multifaceted approach to this issue and I accept it is one that we need to address. Our endeavours in this area will be helped by the results of the current study by the Food Safety Promotion Board - safefood - on folate status and compliance with folic acid supplement recommendations among pregnant women. The results of this study will help to inform our policy further and will assist us in adopting a more targeted approach. We need to focus our efforts on those who need more folic acid, rather than exposing the whole population to the risk of excessive folic acid.
Prevention is always better than cure. For this reason, I will ask the Food Safety Authority of Ireland to review this matter urgently when new studies are to hand and to make further recommendations. I thank the Senator again for raising a critically important health issue.