Professors Carol Bower and Fiona Stanley
The Public Health Association of Australia has rated mandatory folate fortification – which led to a dramatic decline in neural tube defects – as one of the top 10 public health achievements of the past two decades.
The move, announced in November 2018, honoured the paradigm-shifting work of Professors Carol Bower and Fiona Stanley, who in 1989 made a landmark discovery about the vital role of maternal dietary folate in early pregnancy in reducing the risk of neural tube defects such as spina bifida.
Not content to establish the science – and determined to see that the whole WA population could have access to adequate dietary supplementation – they followed their research up with decades of dedicated campaigning and advocacy.
Their efforts paid off, leading initially to a health promotion campaign around the importance of folate. It’s estimated that about 4,000 Australian children have been saved from debilitating and deadly birth defects since health promotion efforts began in 1993.
When data collection showed health promotion wasn’t having the same impact in Aboriginal populations as in the wider Australian population, however, the researchers continued to push for changes in government policy to address the health needs of all prospective mothers and their babies in the community.
Partly in response to their continued advocacy, in 2009 Food Standards Australia New Zealand introduced national mandatory fortification of wheat flour for breadmaking. This change had a swift impact, resulting in a significant 14.4 per cent national decline in neural tube defects (NTD) such as spina bifida from 2011 to 2016, regardless of a mother’s culture, age, education or choice of hospital system.
“This drop in neural tube defects is seen across the country and is ‘spot on’ with our modelling for the level of fortification that has been introduced – so it is working as expected,” Professor Bower said.
Importantly, she said fortification reduced neural tube defects in the Aboriginal population by 68 per cent, with rates dropping from 2.43 cases per 1,000 births between 2007 and 2009, to 0.82 cases per 1,000 births between 2011 and 2016 similar to that of the non-Aboriginal population.
“In the Aboriginal population, health promotion to take folic acid supplements before and in early pregnancy had no effect. However, with mandatory fortification, the rate of neural tube defects has fallen to that of the general population,” Professor Bower said.
“That gap has now been closed between Aboriginal and non-Aboriginal rates of neural tube defects.
“One of the reasons for fortifying was that you reach everybody regardless of pregnancy planning, and it’s equitable because everybody gets additional folate if they eat fortified products.”