Health experts express concern over decreasing rates of folic acid supplement use before pregnancy in England, highlighting the need for improved public health campaigns and support ahead of mandatory flour fortification from December 2026.
Health experts are warning that England’s falling use of folic acid supplements before pregnancy could be undoing years of progress against serious birth defects. Recent NHS data cited by researchers at the University of Southampton suggest that fewer than 1 in 5 women are now taking folic acid before conception, down from 26% in 2020-21 to below 20% in 2024-25.
The concern is not only the overall decline but when women begin taking the vitamin. Folic acid, a form of vitamin B9, is most effective when taken before pregnancy and during the first 12 weeks, because the neural tube, which later develops into the brain and spinal cord, closes very early, often before a pregnancy is confirmed. By then, researchers say, it may already be too late to secure the full protective benefit.
This is not a new public health problem. Earlier studies in England had already shown that pre-pregnancy use was low and falling, with younger women, women from non-white ethnic groups and those living in more deprived areas least likely to take supplements as recommended. Other research has found that many women only start folic acid after finding out they are pregnant, even though neural tube defects can be prevented only if supplementation begins beforehand.
The issue comes as the UK prepares to mandate folic acid fortification of non-wholemeal wheat flour from December 2026. The Southampton team welcomed the move but said it should not be treated as a complete fix. Government advice has already warned that fortification alone will not provide enough folic acid for women planning a pregnancy, particularly those who may need clearer guidance, easier access to preconception care and stronger support to maintain supplement use. The authors are calling for renewed public health campaigns, better education and closer monitoring of both supplement uptake and birth outcomes.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
