Consultation on Options to increase folate intakes of young women
Tuesday 12 December 2006
This consultation, which ran from December 2006 to March 2007, sought comments on options for increasing the folate intakes of young women to reduce the number of pregnancies affected by a neural tube defect (NTD). The information submitted is being used to help inform Agency advice to Health Ministers on folate and NTDs.
All comments and views should be sent to:
Food Standards Agency
808c Aviation House
125 Kingsway, London
Tel: 020 7276 8928
Fax: 020 7276 8906
Responses are requested by: 13 March 2007
The Agency is consulting on four possible options designed to increase folate intake of young women. These need not be mutually exclusive, and could be developed in combination.
Option 1 - Continue with the current policy of advice to women
Option 2 - Increase the effort to encourage young women to take folic acid supplements (folic acid a synthetic form of the vitamin folate, used in supplements and as a food fortificant) and changes to diet to increase the consumption of folate-rich foods
Option 3 - Encourage industry to fortify more foods with folic acid on a voluntary basis
Option 4 - Recommend the mandatory fortification of bread or flour with folic acid
The Agency is keen to hear your views on which option you would prefer and why. Issues that you might like to take into account include the importance of NTDs, the likelihood of success and how practical is each option, as well as issues of how much each option would cost and how consumer choice would be affected. Views on how the impact of each option should be monitored are also sought.
The Agency will also take into account a range of other information, in addition to consultation responses, before its recommendation is finalised. This will include consumer research and the opinion of the independent Scientific Advisory Committee on Nutrition (SACN), which has carried out a scientific risk assessment on folate and health. The Committee looked at the impact across population groups and recommended the mandatory fortification of flour with folic acid as a way of reducing NTD-affected pregnancies, providing voluntary fortification of food with folic acid is controlled and guidance is given on the use of supplements containing folic acid. The SACN report was published as a draft for stakeholder comment in November 2005. It has now been finalised and published on 12 December 2006.
The Agency welcomes comments on the information in this pack, including a draft Regulatory Impact Assessment (RIA), which includes a cost benefit analysis, and the results of consumer research.
The Agency is keen to hear the views of consumers, health professionals, NGOs, academics and scientists, as well as industry, particularly the milling and bread making sectors.
The Scientific Advisory Committee on Nutrition (SACN) has published its report Folate and Health on the first day of this consultation. The Committee recommends that flour should be required to be fortified with folic acid, as a way of reducing the number of pregnancies affected by neural tube defects (NTDs) such as spina bifida.
The impact of mandatory fortification on the rest of the population, particularly the elderly, has been taken into consideration, and SACN has made additional recommendations to reduce the likelihood of any potential adverse effects. These include recommendations to control voluntary fortification of foods and for guidance to the general population on the appropriate use of supplements containing folic acid. Further information on the report, and on the role of folic acid in preventing NTDs, is provided in the accompanying document.
The Board of the Food Standards Agency discussed this issue at its open meeting in April this year, and agreed to consult on options for increasing folate intake of young women, including the fortification of flour as recommended by SACN.
The Agency Board will discuss the issue again in open session in 2007. The Board will consider the results of this consultation, including a revised RIA, and the outcomes of research the Agency has undertaken with consumers. At that meeting, the Board is expected to agree upon a recommendation to Health Ministers in all four UK countries.
The RIA outlines the options for increasing population folate intakes, which were agreed by the Agency Board in April 2006. It is important to note that whatever option is eventually agreed, it will still be necessary for women to take folic acid supplements to achieve an optimal level of protection from the risk of NTD-affected pregnancy. Current advice on the issue will therefore continue to be promoted by UK Health Departments.
The Agency has recently carried out deliberative research with a wide range of consumers to gather their views on the options. Deliberative research involves providing participants with information, and giving them time to absorb information and arguments. Small breakout groups are used to enable participants to discuss and exchange points of view. The principal benefit of using a deliberative approach is that it enables participants to reach informed, considered viewpoints at the end of the process. The results of this research are described in the accompanying document.
The Agency is conducting further qualitative research with mothers of young children - particularly from low-income households. This is because younger women and those on lower incomes are more likely to have a NTD-affected pregnancy (because these women are less likely to eat a balanced diet with good levels of folate, or take folic acid supplements).
The Agency has also carried out a review of approaches used, including in other countries, to increase folic acid uptake by women of reproductive age. The results of this review are described in the accompanying document.
The Agency is inviting your views on which - or which combination - of the four options detailed above should be recommended to UK Health Departments.
The Agency would therefore welcome your answers to these specific questions:
1. Which of the four options would you recommend, and why?
2. Are there particular reasons why you would reject any of the options?
3. How should the impact of your preferred option be monitored, in terms of both:
- the effect on folate intake among the target group, and any resulting effect on NTD rates
- the effect on population intakes (including among older consumers) and the prevalence of the symptoms associated with the potential risks of high folate intake?
The accompanying document contains a number of more detailed questions on which we would welcome your views. These questions focus on some of the issues that would be likely to arise if one or other of the options is eventually implemented. Not all of the questions will be relevant to all stakeholders (e.g. some are aimed primarily at industry groups or health professionals). It is unlikely therefore that you will wish to answer all of the questions, but any comments you do make would be very welcome.
This consultation has been prepared in accordance with the HM Government Code of Practice on Consultation, which states that a consultation must follow better regulation best practice, including carrying out an Impact Assessment (Regulatory Impact Assessment in Scotland). The assessment is included in the consultation documents.
We are interested in what you thought of this consultation and would therefore welcome your general feedback on both the consultation package and overall consultation process. If you would like to assist us to improve the quality of future consultations, please feel free to share your thoughts with us by using the consultation feedback questionnaire.
Publication of personal data and confidentiality of responses
In accordance with the FSA principle of openness our Information Centre at Aviation House will hold a copy of the completed consultation. The FSA will publish a summary of responses, which may include personal data, such as your full name. Disclosure of any other personal data would be made only upon request for the full consultation responses. If you do not want this information to be released, please complete and return the Publication of Personal Data Form. Return of this form does not mean that we will treat your response to the consultation as confidential, just your personal data.
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Publication of response summary
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If, after three months, the summary is still not showing, please contact the person who was responsible for the original consultation. Alternatively, you can contact the FSA Consultation Co-ordinator by email: email@example.com