Wednesday, 26 April 2006
Neural Tube Defects.
I welcome the Minister of State to the House because he will have a good understanding of this issue. He replied previously to a debate on the folic acid fortification of flour which I bring up every three or four years. However, I have proceeded no further.
It is known that folic acid fortification prevents neural tube defects such as anencephely and spina bifida. This issue has been discussed in this country since 1992. We have one of the highest incidence in the world of these serious congenital abnormalities. All babies with anencephely die, some with spina bifida die and those who survive face problems with incontinence, walking difficulties, which get progressively worse in some cases as they get older, surgical operations and other medical interventions to deal with their serious problems.
Since it became known that a diet high in folic acid helped to reduce the incidence of these conditions, there has been a public health campaign to encourage women hoping to conceive to supplement their diets with folic acid. Research carried out by O'Leary, McDonnell and Johnson of the then Eastern Regional Health Authority in 2000 on the uptake of folic acid, which was published in the Irish Medical Journal in June 2001, found that just 18% of women heeded the advice. While these were usually in the higher socio-economic classes, there was a high number of people in poorer areas, where diet might not be as good in respect of the general amount of folic acid one takes in and where 50% of pregnancies were unplanned.
I raised the matter shortly after the Department of Health recommended that something be done about it in the early 1990s. I raised it in 1998, 2000 and subsequently. On each occasion, I am more or less told "Live horse and you'll get grass." I pointed out in the debate in this House on 27 January 2000 that the Food and Drug Administration in the United States, which is a conservative body, recommended folic acid fortification of flour decades ago. The United States has achieved a 70% reduction in these very serious neural tube defects and the resultant disabilities.
The Food Safety Authority of Ireland backed such a move in 1998. I received a reply from the then Minister of State at the Department of Health, Dr. Tom Moffatt, which reads as follows:
I can assure the House that the Department of Health and I are committed to ensuring that no effort is spared to ensure that the number of babies born with neural tube defects can be reduced or eliminated altogether.
At the time, approximately 70 to 80 children were born in the country each year with one of these problems. The year 2002 is the most recent for which I can get figures. The perinatal mortality and morbidity figures take a little while to obtain. When these were published in December 2005, there was little or no change in the incidence of anencephely or spina bifida. Any change by way of a decrease might be ascribed to the fact that when women have an ultrasound scan early in the pregnancy, they know the baby has a neural tube defect, and it is more than probable that many of them who would otherwise have gone on to full term have abortions abroad. In practical terms, what this means is that in the five and a half years since I spoke on the matter in this House in 2000, several hundred children have been born in this country with neural tube defects when the figure could have been a few dozen if their mothers had been taking folic acid in fortified flour.
We have been waiting for a report on these recommendations for four years. The national committee on folic acid food fortification has met four, five or six times and we are constantly told it will recommend the fortification of flour, but we are waiting for the report, which has repeatedly been delayed. Meanwhile, as I speak, children in the womb are not protected. Why the delay?
The value of additional folic acid in dealing with cardiac disease is also well known. A high level of homosisteine in the blood due to a low level of the enzyme which reduces it is one of the genetic crosses of the Irish. That we bear this cross contributes to the high levels of heart disease in this country. Cardiologists appear to be ad idem that the fortification of food with folic acid would greatly help in preventing heart disease. Evidence that it may help in other conditions such as reducing the incidence of bowel cancer — another serious problem in Ireland — is less conclusive, but we know that neural tube defects could be almost eliminated and that cardiac disease would greatly reduce if we had the folic acid fortification which would help in both these conditions. I again ask the Minister of State why there is such a delay.
I am taking the Adjournment matter on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. I thank Senator Henry for raising this matter again as it provides me with an opportunity to outline to this House the position in this matter.
The national committee on folic acid food fortification, which held its first meeting in February 2005, is tasked with reviewing options for the fortification of foods with folic acid in view of the relatively high level of neural tube defects in Ireland. In carrying out this work, the committee is to address the broader aspects of implementing a fortification policy, including the technical issues regarding fortification, addressing risk and examining other reported health benefits that are linked to fortification. The Food Safety Authority of Ireland is acting as the secretariat to the committee.
The national committee is comprised of experts in this area as well as public health specialists and administrators. The committee is looking at three policy options, the first being structured voluntary fortification programme whereby flour millers or bakers would add a specific level of folic acid to bread. These breads would carry a special logo and label to enable consumers to choose bread with or without added folic acid. The second option is a mandatory fortification programme of some bread making flour or of all flour and the third option is the continuation of the current practice whereby a limited range of foods are voluntarily fortified with folic acid. This is combined with health promotion campaigns advising women who may become pregnant to take folic acid supplements.
As part of its work, the committee consulted widely and, following an analysis of all submissions received and having reviewed the scientific evidence available, the committee will make a policy recommendation to the Tánaiste and Minister for Health and Children. The work of the committee is well advanced and I am informed that its formal report will be submitted shortly. The work of the committee is fully documented on the website of the Food Safety Authority of Ireland and given that it commenced its work just over one year ago it has performed a complex task in a tight timeframe. When the report is received it will be considered with a view to implementing the eventual recommendations.
I know the response is prepared for the Minister of State but there is not one word in it which I could not have written down and brought here myself. One of the excuses I was constantly given is that the fortification would affect the confectionery trade with the United Kingdom. The United Kingdom has now introduced fortification of flour so that excuse is gone. I implore the Minister of State to have some sense of urgency brought to the situation because if one visited the National Rehabilitation Centre and saw young children and older people there with spina bifida, one would be ashamed to think that children with such conditions are still being born in this country. I am very disappointed with the reply and I hope the Minister of State will inform the Department of Health and Children.