Paddy Burke (Fine Gael)
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I welcome the Minister for Health, Deputy Reilly, to the House.

Caít Keane (Fine Gael)
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I thank the Minister for coming to the House to respond to the motion I raise on the Adjournment, which is an important one relating to folic acid in the diet of pregnant and pre-pregnant women. It was a cause of alarm to many that a new study has found a rise in neural tube defects in babies, mainly spina bifida, since 2009. That is a worrying trend and should be considered in a policy review of the fortification of food with folic acid. It is important to educate people, in particular pre-pregnant women, of the importance of folic acid in their diet.

Folic acid is a form of vitamin B but it cannot be made by the body and must be taken either in dietary form or as a supplement. The dietary form of folic acid is preferable but supplements must be considered for those who do not get it their diet. Foods rich in folic acid reduce the risk of having neural tube defects. The incidence of neural tube defects is higher in Ireland than in any other European country. The relative deficiency of folic acid in our diet contributes to the situation. The information is from a new study but such facts have been known for years. The recommended intake is 400 mg and sources include leafy green vegetables such as cabbage or cauliflower. For those who do not get folic acid through their diet, it is vital that they are aware they must take it in supplement form if necessary.

The new study by Professor Michael Turner from UCD’s centre for human reproduction has found that there has been an increase in neural tube defects in this country. There is clearly not enough awareness of the significance of folic acid in the diet of pregnant women or those who intend to become pregnant. At least one case a week of neural tube defect arises in newborns in Ireland and the trend must be reversed. One must take into account the suffering for the families of children who are born with a neural tube defect. Health economics must be taken into account as well as the suffering and social effects. The burden of the disease that falls on the child, the family and also on the health system must be examined.

The study in question in UCD and the HSE Eurocrat Register concluded that the recession could have an impact on women's ability to get folic acid naturally in food such as fruits and vegetables, especially women from a lower socio-economic background.

Education for young girls, pre-pregnant women and mothers is vital to ensure they receive sufficient folic acid, whether naturally through foods bought in shops or otherwise. More than 50 countries, including the United States, have mandatory folic acid fortification in foods such as flour. The Government reversed a decision on food fortification in 2008 owing to a falling rate of neural tube defects. However, the rate is increasing again and stands at more than one case per week, which is too many. A new study has revealed that the number of cases increased from 70 in 2009 to 87 in 2011, which is a significant increase, especially as the condition is preventable. It is possible that these 87 children would have been born without neural tube defects if their mothers had taken folic acid either prior to pregnancy or in the early months of pregnancy. The Government must not ignore this issue. I ask the Minister to review current policy on adding folic acid to food and to initiate a public health campaign to promote pre-conception folic acid intake. As I noted, 50 countries have a mandatory folic acid fortification policy.

James Reilly (Dublin North, Fine Gael)
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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.

Caít Keane (Fine Gael)
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I thank the Minister for his reply and look forward to further information on this issue when a second study has been published. I was not aware until this morning that this week is the inaugural Nourish Ireland Week. It is strange the event does not deal with folic acid, although it addresses many other nutritional issues such as eating disorders, fussy eaters, food allergies and intolerance, managing type 2 diabetes, healthy eating, labelling and so forth. While the Irish Nutrition and Dietetic Institute is responsible for Nourish Ireland Week and the folic acid issue is the responsibility of the Food Safety Authority of Ireland, all bodies that deal with food education and awareness, including all schools, should promote folic acid intake. I look forward to the further study to which the Minister referred and the Government's response to it when published.

James Reilly (Dublin North, Fine Gael)
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Senator Cáit Keane has done a significant service in raising awareness of this issue. I undertake to discuss the matter with my ministerial colleague, the Department of Education and Skills, Deputy Ruairí Quinn. No girl should leave secondary school without understanding the importance of folic acid if she becomes pregnant later in life and wishes to increase her chances of having a perfectly normal baby.