About Prevention

About Prevention

Spina Bifida is a Preventable Birth Defect

The prevention of Spina Bifida is Simple, Affordable and Proven.

The predominant cause of spina bifida and anencephaly is a lack of adequate folic acid (vitamin B9) in the mother’s diet prior to conception and during the first month of pregnancy.  As early as 18 days after fertilization, the spinal cord begins to develop.

Food fortification has been shown reliably to be the safest and most effective way to prevent spina bifida.

By fortifying food with folic acid, we can reach almost all women of child-bearing age and prevent nearly all folic acid-preventable spina bifida and anencephaly.  With only about 60 countries currently mandating food fortification, there is huge potential to prevent these types of birth defects in 100 or more remaining countries.


Since 1998, the mandatory fortification program implemented in the U.S. provides about 1/3 of the Recommended Daily Allowance of folic acid – a perfectly safe level.  The vitamin is simply added to the grains as they are processed.  In addition to preventing spina bifida, folic acid fortification has also eliminated folate deficiency anemia and may have resulted in important reductions of first strokes.


Adding folic acid to refined grains in the U.S. is affordable and cost effective.  The cost in the U.S. is about 1 cent per person per year and is estimated to save $150 in care for every dollar spent.


A double-blind randomized clinical trial by the British Medical Research Council in 1991 proved scientifically that sufficient folic acid prevents spina bifida and anencephaly.  Since many women do not get enough folic acid in their diet, the Center for Spina Bifida Prevention recommends food fortification.  Adding folic acid to centrally processed foods has been shown to be highly effective in preventing spina bifida in the United States, Canada and approximately 60 other countries.  It can be added to grains (wheat, corn, and rice) during the milling process – easily, safely, and cost effectively.

The time has come to take the solution world-wide

The solution doesn’t need any more research.  The science is proven.  Fortification is inexpensive and safe.  Our sister organization, Food Fortification Initiative (FFI) provides the technical expertise to the millers, but they cannot do their work without a mandate.  The only thing keeping this from being a global solution, to taking us from science to solution, is money.

The Center works with each country to identify advocates for fortification.  We supply a country coordinator, education and technical expertise.

Based upon the rate of occurrence of spina bifida and anencephaly, we estimate that we have prevented 35,000 babies per year from being born with these disabling and often lethal birth defects.  But another 200,000 per year are still being born, resulting in deaths or requiring ongoing medical and surgical care.  In the 25 years since it was proven that folic acid would prevent these conditions, over 5 million babies have been affected.  If another 25 years go by without addressing the problem, another 5 million unnecessary deaths and disabled babies will be born.

How to measure success

The Center can easily monitor the success of a program using blood folate levels of pregnant women.  The threshold blood folate level is known.  2015 World Health Organization (WHO) guidelines state that red blood cell folate concentrations should be above 400 nanograms/ml in women of reproductive age to achieve the greatest reduction of cases of spina bifida and anencephaly.

The 80/20 rule

It is true that some countries do not have a centrally processed food that can easily be fortified.  Yet the Center is focusing on the 80% which can be prevented, and studies can be continued in parallel which would address the other 20% of childbearing age women.  There is no reason to delay fortifying grains when doing so would contribute to preventing these defects in so many children.