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Here are our Frequency Asked Questions (FAQs).  If you have an additional question that we haven’t yet answered, please feel free to send us an email on our Contact Us page.


What is spina bifida or anencephaly?

Spina bifida and anencephaly are serious birth defects that occur when a baby’s spinal cord or brain does not develop properly during embryonic development.


What are the effects of spina bifida and anencephaly?

Anencephaly babies do not survive.  Babies born with spina bifida have a high risk of death early in their childhood, and those who live longer often require lifetime medical and surgical care.  Many spend their lives in a wheelchair.


What causes these defects?

A large proportion of spina bifida and anencephaly (50 – 90%) is associated with a lack of adequate folic acid in the mother’s diet prior to conception and during the first month of pregnancy. We refer to these cases as folic acid preventable-spina bifida and anencephaly or FAPSBA.


How can we prevent spina bifida and anencephaly?

FAPSBA are preventable by including folic acid in a woman’s diet prior to pregnancy. It can be added to grains (wheat, corn and rice) during the milling process – easy, safe and cost-effective.  The U.S. implemented mandatory folic acid fortification in 1998.  Since then, we have been able to prevent about 1300 babies per year from being affected by these birth defects.


How much folic acid do you need?

The scientific community recommends 400 micrograms (mcg) per day. Most daily vitamin pills contain that amount but many people do not take vitamin pills regularly.


How much folic acid is in fortified foods?

In the United States, folic acid is added to breads and cereals so that the average person gets 150 mcg per day.


What has been the effect of fortification in the U.S.?

The U.S. has fortified grains since 1998 and the incidence of spina bifida has been reduced from 10 per 10,000 births to 5 per 10,000 births.


Why has the incidence not gone to zero births of spina bifida in the U.S. if we fortify our foods with folic acid?

There are several reasons. Some people do not eat centrally processed foods. Although the great majority of spina bifida cases are due to insufficient folic acid, there are also other circumstances that can cause it – such as certain drugs, or diabetes.


Why don’t other countries fortify their foods if folic acid has been shown to prevent spina bifida?

The reasons vary. Lack of effective advocacy is one factor. In some countries, there are concerns over safety of the micronutrient, even though there is scientific proof that it is safe, not only at the level of 400 mcg, but also at 10 times that level.   In fact, for mothers who have already delivered a child with spina bifida, it is recommended that they take 800 mcg per day for any future expansion of their family. In yet other countries, political instability makes it difficult to get the mandate passed.


By fortifying foods, men and other demographics receive this amount of folic acid as well as women of childbearing age. What is the effect upon them?

This amount is totally safe for everyone. As mentioned above, most daily vitamin supplements contain about 3 times the amount one would receive with fortified grains. In the United States folate deficiency anemia has been effectively wiped out by folic acid fortification. And there is growing evidence that folic acid fortification is reducing first time strokes, which would benefit everyone.


Is it expensive?

No.  It is estimated that in the U.S. it costs one (1) cent per person per year to add folic acid to our grains.  Adding folic acid to refined grains in the U.S. has saved $508 Million each year in health care costs. For every dollar spent on fortification, we save more than $150 in related costs.


What needs to be done?

Folic acid fortification is urgently needed throughout the world!  Currently only 15% of FAPSBA is being prevented worldwide. Prevention through fortification is reaching citizens in about 60 countries that have added folic acid to their refined grains including the U.S., Canada, Australia and most of Central & South America. The majority of the world’s population has no protection against these defects.  More than 100 countries in Europe, Asia and Africa do not fortify, each year leaving about 200,000 children and their families to suffer from the mortality and disability caused by these birth defects.


What are the main challenges to global prevention?

The evidence that fortification works is established and unquestionable. However, there is a gap in carrying the evidence to the populations that benefit from it. Main challenges to using the knowledge we have lies in the political will of policy makers. Challenges arise due to competing interests from food industry or nutrition sciences who make a case of choice or individual behaviors rather than a policy. Each country is unique, and challenges have to be addressed accordingly. Having well-informed and passionate champions is a first step in overcoming these challenges. Our Centers aims at identifying and providing needed skill sets to these champions, who can bring change in their local environments that is sustainable.


What is the Center’s role in prevention?

With adequate funding, our Center will develop and support a program of in-country, science-based advocacy and technical assistance to industry and government. We are uniquely situated in a place with many strong partnerships and an ability to lead and bring prevention to every country. The Center will foster the necessary political will to require and implement fortification with folic acid and monitor effectiveness, preventing up to 90% of cases in high-burden countries.