In an opinion piece published in the journal BMJ, Professor Sir Nicholas Wald criticised the outgoing government, warning that its failure to fortify all flour and rice with sufficient folic acid would lead to avoidable birth defects.

He urged the new Labour-led government to “do substantially better” by “making fully effective fortification a health priority”, adding that political parties and politicians needed to rise to the challenge in passing this “acid test”.

Referring to the previous government’s proposal to fortify just one type of flour – non-wholemeal wheat flour – at an “inadequate” level, Wald said: “This will prevent only about 20% of neural tube defects (NTDs), much less than the 80% that could be prevented with fully effective fortification. There is simply no scientific basis to justify this partial remedy.”

The comments echo similar sentiments to those made last year in which Wald, a professor of preventive medicine at University College London, highlighted the need to fortify all types of flour and rice with folic acid, adding that: “The issue here is fully effective fortification rather than just effective fortification.”

€35m cost of each baby born with a neural tube defect

At the time, Wald was supported by leading medics, who warned that the UK’s NHS could be paying out €35 million (£30 million) for each baby born with a neural tube defect.

Dame Lesley Regan, professor of obstetrics and gynaecology at Imperial College’s St Mary’s Hospital Campus and honorary consultant in gynaecology at Imperial College NHS Trust, told The Independent: “[W]e are seeing now that children that have been damaged or who are born damaged… because of, for example, a neural tube defect…

“Their lawyers are basically ensuring that they will have payouts for the rest of their life, and rightly so, because if I was a mother who had delivered a baby with a severe neural tube defect, I would want that help and support.”

She added: “So, we’re talking about, for a single baby, payouts of £30 million over a life course. This is just not sustainable.”

According to the British Pregnancy Advisory Service (BPAS), the UK has one of the highest rates of NTDs in Europe, with around 1,000 pregnancies affected each year. These defects, including anencephaly and spina bifida, occur when a baby’s brain and spinal cord fail to develop normally.

They are a major reason for late-stage terminations, and can cause miscarriage, stillbirth, and neonatal death, as well as harm to the mother. Many children with spina bifida endure lifelong disability.

Women wanting to conceive are advised to take a folic acid supplement before and during early pregnancy to help prevent NTDs, but evidence shows that most women either do not take them at all or take them too late for them to be effective.

Folic acid fortification at more advanced stage in other regions

Across Europe, folic acid fortification remains voluntary; manufacturers are given the option to fortify their products but there is no government requirement to do so.

Apart from the UK, Ireland is the only country in the European region to have made substantial progress in fortifying certain foods with folic acid. The country has debated mandatory folic acid fortification of flour, but it remains at the proposal stage, with no plans for implementation.

In Africa, countries such as Nigeria have mandated the fortification of wheat flour with folic acid as part of a broader micronutrient fortification programme. Similarly, South Africa has been fortifying maize and wheat flour with folic acid since 2003.

“Some of the most distressing presentations of foetal alcohol syndrome include learning disability, plus major behavioural problems,” said Gareth H Jones, a retired psychiatrist, in response to Wald’s opinion piece.

“Severe alcohol dependency is commoner in poor and disadvantaged communities, such as in South Africa, and impoverished diets have little micronutrients essential for foetal development.

“Some mothers may not be able to maintain sobriety, so we hope that folate fortification may diminish any damage.”