“Folate before pregnancy”: the impact on women and health professionals of a population‐based health promotion campaign in South Australia

Abstract

Objectives To evaluate a South Australian campaign to promote and implement knowledge that taking adequate folate/folic acid in the periconceptional period can reduce the risk of having a baby with a neural tube defect. Design and setting The campaign, conducted in October 1994 – August 1995, targeted women of reproductive age and health professionals. Evaluation was by computer‐assisted telephone interviews undertaken by random dialling throughout the State before and after the campaign, and by self‐administered questionnaires to health professionals and women in the postnatal period. Participants Women of reproductive age and four groups of health professionals. Main outcome measures Knowledge about folate, folate‐rich foods and the periconceptional period; participation of health professionals in advising women about folate; use of periconceptional folic acid supplements; sales of folic acid tablets; and prevalence of neural tube defects. Results Significant increases in knowledge about folate followed the campaign, Health professionals and women in the postnatal period had higher initial levels of knowledge about folate, which also increased significantly. The proportions of women taking periconceptional folic acid supplements, and of health professionals advising women planning a pregnancy about folate, also increased significantly, and folic acid tablet sales doubled. Total prevalence of neural tube defects declined between 1966 and 1999 from a baseline of 2.0 per 1000 births to 1.1 per 1000 births (Poisson regression, P=0.03; average decline of 1.0% per year). Conclusions A short educational campaign with a limited budget ($40 000) can promote folate successfully, but alternative strategies such as food fortification are likely to be needed to achieve adequate periconceptional folate intake for a very high proportion of women.

Strategies to increase folate/folic acid intake in women: an overview

“…In South Australia, a short education campaign in the mid 1990s to encourage folate before pregnancy, targeting women of reproductive age and four groups of health professionals, met with some success. There were significant increases in knowledge and in the proportions of women taking periconceptional folic acid supplements (Chan et al . 2001).…”

Australian survey on community knowledge and attitudes regarding the fortification of food with folic acid

“…Despite these efforts, most women of childbearing age (and members of the broader population) are still not consuming enough folate (FSANZ, 2006a). Further, while the incidence of NTDs declined in the years coinciding with campaigns and voluntary fortification (Bower et al, 2004; Chan et al, 2001; Halliday and Riley, 2000), this has not occurred equitably across all of society (Bower et al, 2004, 2005), and has not been to the level considered possible when adequate folate is consumed periconceptionally by a high proportion of the target population (Lumley et al, 2004).…”

Case for mandatory fortification of food with folate in Australia, for the prevention of neural tube defects

“…It has been over a decade since firm evidence was published from randomized controlled trials (MRC Vitamin Study Research Group, 1991; Czeizel and Dudas, 1992) showing a protective effect of folate for the prevention of neural tube defects (NTDs). It has been over a decade since health promotion activities were instigated in several Australian states to promote an increase in folate intake periconceptionally (Bower et al, 1997; Chan et al, 2001; Watson et al, 2001), eight years since voluntary fortification of food with folate was allowed in Australia and New Zealand for the purpose of preventing neural tube defects (NTDs) (legislated in 1995), and over two years since the voluntary fortification policy was evaluated (Abraham and Webb, 2001).…”

“…Over this period, there has been an increase in the proportion of women (up to 30–40%) taking periconceptional folic acid supplements in Australia (Bower et al, 1997; Chan et al, 2001), and many foods (mainly breakfast cereals) are fortified (Abraham and Webb, 2001). Supplement use is strongly correlated with educational and socioeconomic status (Bower et al, 1997), although unpublished data from Western Australia indicate that consumption of voluntarily fortified foods is not.…”

“…There has been a fall in NTDs of about 30% in those states able to adequately monitor such trends (Halliday and Riley, 2000; Chan et al, 2001; Bower et al, 2002), from around 2 per 1000 before the promotion of folic acid supplementation and voluntary fortification, to 1.5 per 1000 since (including terminations of pregnancy for NTDs). However, evidence from the randomized controlled trials suggests that a 70% reduction is possible (Lumley et al, 2004).…”