Hildegarde Naughton (Galway West, Fine Gael)
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Thank you for your query in relation to Folic Acid Supplementation. As indicated in a previous written response issued in October 2023, the recommendations of the 2019 DOH Folic Acid Supplementation Report remain under consideration by the Department.

Critically, it is recognised that as dietary intake of folate remains sub optimal In Ireland, all women considering pregnancy take a 400-microgram (mcg) supplement of folic acid per day when planning a pregnancy and for the first 12 weeks of pregnancy.

One key recommendation given in the report was to consider the requirements for food fortification with folate, and this has been identified as an action in Phase 2 of the First 5 Strategy Implementation Plan 2023-2025. A range of issues such as food consumption patterns and preferences, supply chain issues, resources and timing involved need to be deliberated before any further consideration could be given to mandatory food fortification.

The issue is further complicated by the lack of any national mills in Ireland and reliance on the UK for up to seventy per cent of its flour supply. After undertaking a public consultation on the proposal to introduce mandatory fortification of UK flour with folic acid, the UK Government and devolved administrations decided to proceed with the mandatory fortification of non-wholemeal wheat flour and legislate on this basis in 2021. However, fortification has still not been implemented in the UK due to regulatory concerns with respect to meeting adequate nutrient levels for other vitamins and minerals in the flour supply.

Fortification of flour in Ireland is conducted on a voluntary basis. The voluntary addition of vitamins and minerals to foods is regulated by means of Regulation (EC) No 1925/2006, which aims to ensure that fortified foods are safe, and to allow for the proper functioning of the internal market. This regulation permits the addition of folic acid to foods in compliance with its rules.

The ‘mandatory addition’ of vitamins and minerals for public health reasons, such as the fortification of staple foods with folic acid, is not covered by this regulation. The European Commission does not envisage the harmonisation of the mandatory addition of nutrients, such as folic acid, across the EU. It is up to Member States to decide if they wish to introduce alternative measures such as mandatory food fortification with folic acid.

In addition, the labelling of a compound food containing a fortified ingredient must comply with the provisions of Regulation (EU) No 1169/2011, to ensure that it shall not be misleading for the consumer.

In the event of any proposal to revise existing legislation a regulatory impact analysis would need to be conducted. Before any policy position is finalised on folic acid fortification, stakeholder consultation would need to be carried out on a national basis. Once a policy position has been formed, the Department would need to notify the Commission via the Technical Regulation Information System (TRIS) system of Ireland’s intention to introduce fortification of flour with folic acid. Ireland would be required to demonstrate that evidence-based analysis, public stakeholder consultation and cross Government collaboration had taken place to justify why Ireland is considering mandatory fortification. To give an estimation of predicted timelines, the consultation process is still ongoing in the UK, two years post announcement of mandatory fortification.

With this in mind, in the short-term, other actions are needed to optimise both Folic Acid supplement use and dietary folate. It is recommended that all women considering pregnancy take a 400-microgram (mcg) supplement of folic acid per day when planning a pregnancy and for the first 12 weeks of pregnancy. This is described in The Nutrition in Pregnancy, national clinical guideline that was developed in 2019 to promote the link between good nutrition during pregnancy and a favourable pregnancy outcome.

Under the phase 2 of the First 5 strategy implementation plan, it has been identified that parents, families and communities will be supported to engage in and promote positive health behaviours among babies and young children, starting from the pre-conception period. Enhanced integration and communication of Folic Acid supplement advice will continue under several relevant programmes being operated by the Health and Wellbeing Division, Primary Care, Obstetrics and Gynaecology and Sexual Health services.

All four recommendations in the Folic Acid report are being considered by the Department to improve intake of Folic acid in the reduction of neural tube defects in Ireland.