Serious congenital abnormalities are rare, but can have far-reaching consequences. NTD are congenital anomalies that occur in the first four weeks of pregnancy from abnormal development of the structure that forms the brain and spinal cord. NTD can be lethal and many who survive have lifelong serious impairment.
Evidence emerged in the early 1990s that vitamin supplements containing folic acid (a form of the B vitamin folate) taken in the period before and immediately after conception can prevent up to 80% of NTD. Evaluation of public health interventions to increase folate and folic acid intake by women of childbearing age found these strategies to be expensive, their effects time-limited, and to have missed many women, particularly those not amenable to health education and those whose pregnancies were unplanned. Evaluation of the program of voluntary folic acid fortification of foods found that the effectiveness criterion had not been met and that participation by the food industry had been low.
The Folate Scientific Advisory Group convened by Food Standards Australia New Zealand (FSANZ) to assess the potential benefits and risks of increasing folic acid intake within the whole population recommended mandatory folic acid fortification. Before the introduction of mandatory folic acid fortification, the Australia and New Zealand Food Regulation Ministerial Council (now the Legislative and Governance Forum on Food Regulation) committed to a comprehensive and independent review of mandatory fortification to begin two years after implementation.