Fewer than one in five women in England took folic acid before becoming pregnant in 2024/25, according to research published in the journal BJOG, a decline that researchers say is quietly undoing decades of progress in preventing serious birth defects.
The findings, reported by WalesOnline, come weeks before a landmark public health change: from 13 December 2026, millers and flour producers will be legally required to fortify non-wholemeal wheat flour with folic acid, meaning the vitamin will be added to most bread, cakes and pasta sold in the UK.
A steady and worrying decline
The commentary, written by researchers at the University of Southampton, documents a consistent fall in preconception supplement use across every region of England except London. In 2021/22, 26.2 per cent of women took folic acid before pregnancy; by 2024/25 the figure had slipped below 20 per cent.
The NHS advises women trying to conceive to take 400 micrograms of folic acid daily, ideally beginning three months before pregnancy and continuing through the first 12 weeks. The vitamin supports the early development of a baby's brain, skull and spinal cord, and reduces the risk of neural tube defects such as spina bifida.
As the Express and Star notes, that advice remains unchanged even after fortification begins: women planning a pregnancy should still take a daily supplement, because the levels added to flour are not high enough to replace it.
Why timing matters more than campaigns admit
The central problem, the researchers argue, is one of timing. Most women have no contact with a midwife until a booking appointment at 10 to 12 weeks of pregnancy, by which point the neural tube has already closed.
Taking folic acid before pregnancy is one of the simplest and most effective steps women can take to support a healthy start for their baby.
Dr Danielle Schoenaker, NIHR advanced fellow at the University of Southampton and lead author of the commentary, said the decline in supplement use was therefore deeply concerning. Many people do not realise that the baby's brain and spinal cord begin developing very early in pregnancy, often before a pregnancy has been confirmed, she noted; waiting until after a positive test can be too late to gain the full protective benefits.
The planned fortification of flour is an important and positive development, she added, but it should be seen as part of the solution rather than the complete answer.
Fortification: necessary, but insufficient
Mandatory fortification has long been advocated by public health bodies, and the UK's move brings it into line with more than 80 countries, including the United States and Canada, that already add folic acid to flour. The Mirror reports that for the vast majority of the population, the low levels used in fortified flour are considered safe, while women trying to conceive are still advised to take a separate daily tablet.
Professor Keith Godfrey, a co-author from the University of Southampton, said a joined-up approach was needed: effective fortification at higher levels than currently mandated, better public education, accessible preconception care and targeted support for communities where supplement use remains low.
By helping more women take folic acid before pregnancy, he said, the country has an opportunity to reduce preventable health problems and give more children the best possible start in life.
An inequality story as much as a health story
The decline is not evenly distributed. Uptake is lowest among women in the most deprived communities, a pattern that turns what might look like a matter of individual choice into a question of public policy and inequality.
Lia Brigante, professional policy adviser at the Royal College of Midwives, said the statistics show how many women are never offered this information in time. With the right investment in the NHS workforce, she argued, every woman could be offered preconception advice as standard, rather than it being left to chance.
Fortifying flour will help reach women who would otherwise miss out, she acknowledged, but it is no substitute for a properly resourced system that gives every woman the support to decide what is right for her.
What the government should do next
The policy lesson is straightforward. Fortification is a classic liberal public health instrument: a low-cost, population-level intervention that protects those who cannot be reached by advice alone. But it works best when paired with clear information and equitable access to care.
The Southampton authors have called for renewed public health campaigns highlighting the benefits of the supplement and a firm rebuttal of misinformation circulating online, where anti-supplement sentiment has flourished in recent years. That means sustained funding, not a one-off announcement.
The authors also suggest the mandated fortification levels should be raised, a recommendation ministers should take seriously when the policy is reviewed after its December 2026 launch.
FAQ
When does folic acid fortification of flour start in the UK?
From 13 December 2026, millers and flour producers must by law add folic acid to non-wholemeal wheat flour, which covers most bread, cakes and pasta sold in the UK.
Should women still take folic acid supplements after fortification begins?
Yes. The NHS continues to advise women trying to conceive, and those in the first 12 weeks of pregnancy, to take a daily 400-microgram folic acid supplement, as the amounts in fortified flour are not sufficient on their own.
Why is taking folic acid before pregnancy important?
The baby's brain and spinal cord begin developing very early, often before a pregnancy is confirmed. Starting folic acid only after a positive test can be too late to prevent neural tube defects such as spina bifida.