Paddy Burke (Fine Gael)
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I welcome the Minister of State, Deputy Harris, to the House.

Colm Burke (Fine Gael)
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I also welcome the Minister of State. I raise this matter following a recent presentation by Professor Michael Turner, UCD professor of obstetrics and gynaecology. He explained how the incidence of neural tube defects, NTDs, varies from 0.05 per 1,000 in some parts of the country to six per 1,000 in others and that there are huge regional and population specific variations.

What is of concern to me is recent studies have shown that over the past four to five years there has been an increase in NTDs from 0.92 per 1,000 to 1.17 per 1,000. An analysis of 236 cases over three years found 45% had anencephaly, 49% spina bifida and 6% another medical condition which I cannot pronounce. Of the 94 babies born with spina bifida 90.4% survived the neonatal period. We have an increase in the number of NTDs compared to other countries. A UCD study found that of 564 women booking for antenatal care at the Coombe hospital, only one in four took folic acid for longer than 12 weeks before pregnancy, as is ideal. Women who planned their pregnancy or who were having their first baby were more likely to take pre-pregnancy folic acid.

It is extremely important to take folic acid pre-pregnancy and during pregnancy. Professor Turner highlighted the need for a new media campaign on this matter. He also made the point that with social media it should be possible to target the campaign at specific groups of people, and it does not need to be the usual massive campaign. We could do a very good campaign on this and there is a need to highlight it.

Another issue raised during Professor Turner's presentation was the fortification of food. The point was made that because food is imported from all parts of the world fortification of food may not necessarily work. I spoke to another medical colleague who said the one place it could be used is milk. One company, Avonmore, produces milk with added folic acid, but we need to plan for this. The number of cases over three years was 236, which is quite a high number. It also involves a huge cost and huge trauma for families and is something we need to look at. It is in this context I raise this issue.

Simon Harris (Wicklow, Fine Gael)
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I thank Senator Burke for raising this issue for discussion today. I am taking this matter on behalf of my colleague, the Minister, Deputy Leo Varadkar, who is unable to be here due to Government business. Neural tube defects, NTDs, include a range of serious congenital malformations as a result of incomplete closure of the neural tube within a month of conception. They include anencephaly, which is not compatible with life, to the more common forms of spina bifida and other forms which can be symptom free. Approximately 80% of infants with spina bifida survive, however, the condition is associated with varying degrees of disability. These include a poor ability to walk, problems with bladder or bowel control and hydrocephalus.

The level of neural tube defects varies from 0.05 to six per 1,000 births, however, this can change from year to year and there are regional and country variations. Neural tube defects are believed to be due to a combination of genetic and environmental factors. If one child has the condition or if a parent has the condition there is an increased chance that the next child may also be affected. It is now considered that not having enough folate in pregnancy also plays a significant role. There is evidence that many cases of NTD are preventable if the mother increases her consumption of folic acid before and during the early days of pregnancy. There are a number of sources of folate. Folate is found naturally in green vegetables, fruit, dairy products, eggs, seafood and grains.This is recognised in the Department of Health's healthy eating guidelines which have been widely disseminated and are available on the Department's website. The guidelines are due to be reviewed again this year.

Folate is also available as folic acid supplements. It is recommended that the optimal dose for supplementary folic acid relating to pregnancy is 400 mg orally a day. The supplement is readily available in pharmacies throughout the country. However, clinicians also recognise that women at increased risk of NTDs should take a higher dose per day which requires a prescription. The third source of folate is food fortification. At present fortification is voluntary in Ireland and includes a range of food products.

While the level of NTDs has fallen considerably over recent years, there has been an increase in 2009 to 2011 where the level is now 1.17 per 1,000 births. This trend is under active review and may relate to better case detection, a reduction in food fortification levels or a reducing trend in folic acid supplementation among women booking for antenatal care. In recognition of this, safefood Ireland has recently awarded a research grant to conduct an all-Ireland study to measure red cell folate levels in women booking for antenatal care in Dublin, Cork and Belfast. In addition, the Food Safety Authority of Ireland is preparing a report for the Minister of Health on food fortification with folic acid.

The HSE has developed a guide called Healthy Eating For Pregnancy which includes the importance of taking folate to prevent spina bifida. There is further advice on the HSE's website.The Department of Health is reviewing its national guidance on folate for women of childbearing age.

In July, safefood will launch a campaign entitled Babies: Know the Facts about Folic Acid. The campaign will be targeted at younger women who may be sexually active but not considering pregnancy, women who are considering pregnancy and women who already have a child but may have become complacent about taking folic acid. The key message of the campaign is to stress the importance of getting into the routine of taking folic acid every day irrespective of whether a pregnancy is being planned. As the Senator has suggested, it is mainly a digital campaign that uses social media. However, traditional communication channels will also be employed. Key partners include the Department of Health and the HSE in the Republic, and the Public Health Agency and the Department of Health, Social Services and Public Safety in Northern Ireland, pharmacists, GPs and public health practitioners, as well as the support group for Spina Bifida Hydrocephalus Ireland.

Colm Burke (Fine Gael)
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I thank the Minister of State for his comprehensive reply. I note the manner in which the issue is being dealt with by the Minister and the Department. I welcome the fact that a campaign will start in July. It is important to involve GPs in the campaign because they are the first point of contact when people are concerned about medical issues. I ask that a real effort is made to engage with general practitioners as part of the campaign. I also ask that information is shared between maternity units and GPs.

Simon Harris (Wicklow, Fine Gael)
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I thank the Senator for his comments. I am pleased to note that the HSE and the Department of Health have informed me that GPs are key partners in this campaign which is due to be rolled out this month. I shall pass his comments on to the Minister for Health. I also thank him for the timely opportunity to remind people of the importance of this issue in advance of the new advertising campaign.