The FAA Report

FAA Executive summary

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Contents:

Foreword

Acknowledgements

Introduction

Overview

Issues

Call to action

Appendices:

Biographies

IPSOS survey

References

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The FAA Report

FAA Executive summary

Introduction

Deficiency in folic acid among women intending to become pregnant and during the first 28 days after conception can lead to increased risk of neural tube defects (NTDs), which are among the most common of all serious birth defects that affect the baby's brain (anencephaly) or spine (spina bifida).

In the late 1990's [1996-99], the Health Education Authority's campaigning greatly improved general awareness of the importance of taking folic acid to aid the unborn baby's growth in early pregnancy - from the time women stop taking contraception until the end of the 12th week of pregnancy. Since its demise there has been little public health education to support the role of this essential nutrient for supplementation in this at-risk group.

Although there may be good overall awareness of the benefits of folic acid, evidence from a recent survey carried out by IPSOS revealed that there is still lack of understanding and confusion amongst consumers and healthcare professionals as to when to commence taking folic acid. This is compounded by recent developments, such as the increased efficacy of home pregnancy testing kits, where women are not seeking consultation from their GPs on pregnancy until the time of their first scan (at three months). As the neural tube is developed in the first 28 days of pregnancy, the intake of folic acid after six weeks will have limited benefit to the unborn baby.

Also, awareness does not necessarily drive change in behaviour. Eighty seven per cent of women surveyed said they understood the benefits of taking folic acid but just over half took this essential nutrient.³ In addition, the survey highlighted that as many as 40 per cent of women start taking folic acid later than six weeks, with only 28 per cent of women claiming to take folic acid when planning their pregnancy.3

There is an urgent need to take action to address these information and behavioural issues particularly amongst all women who are ovulating and are sexually active and healthcare professionals through education that is targeted, user-/gender-friendly, motivating and sustained.

The purpose of the meeting of Folic Acid Action was to discuss shared concerns around public and healthcare professional education on folic acid and to propose next steps to drive improvements for healthier pregnancies and babies. The first step involved reviewing levels of information amongst child-bearing women and identifying gaps in information provision. The next step was to produce practical guidance on how to overcome the issues and to identify the specific roles of the healthcare team, the government and society in general in doing this.

Fundamental to the panel meeting was a belief that greater education on the consequences of not taking folic acid at the optimal time will lead to better health outcomes.

The main recommendations arising from the meeting were:

• It is critical to communicate the simple, consistent, and sustainable message that folic acid can help to prevent up to 50 per cent of birth defect cases provided it is taken pre-conceptually and during early pregnancy^4,5 to the current and the next generation of child-bearing women. It is also important to reinforce the message that daily folic acid supplementation is essential because it is more bio-available than that found in the diet, and even a diet rich in fruit and vegetables provides less than a half of the 600µg daily amount of folic acid required.

• It is essential that all those providing support and advice on matters of pregnancy and contraception to women who are ovulating and sexually active, should provide consistent, relevant and Introduction SUMMARY 4 FOLIC ACID ACTION ROUNDTABLE up-to-date information in line with the recommendations, and emphasise to those women the importance of taking folic acid - three months pre-conceptually and up to at least the first 12 weeks of pregnancy - whilst avoiding any implication of guilt on the part of the mother.

• There is a greater need for collaboration between healthcare professionals, third parties, governmental organisations and industry to develop an ongoing and hardhitting health promotion strategy in relation to folic acid and to ensure that all women in the at-risk group have access to such messages and to free or affordable folic acid supplementation.

This report captures the key deliberations of the expert panel. In addition, the report includes a Call to Action to help drive improvements by key stakeholders.