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 vitamin B9 or folate) taken in the period before and immediately after conception can prevent up to 80% of NTD. Interventions to increase folate and folic acid intake by women of childbearing age were found to have time limited effect, be relatively expensive, and to have missed women, particularly those not amenable to health education and those whose pregnancies were unplanned. Voluntary folic acid fortification of foods failed to meet the effectiveness criterion and participation by the food industry had been low. The Folate Scientific Advisory Group convened by Food Standards Australia New Zealand (FSANZ) therefore recommended mandatory folic acid fortification standard, which was implemented in September 2009. This required the addition of 200–300 μg of folic acid per 100 g of non-organic wheat bread-making flour. The Australia and New Zealand Food Regulation Ministerial Council (now the Legislative and Governance Forum on Food Regulation) also committed to a comprehensive and independent review of mandatory fortification. This report of NTD rates from among pregnancies ended in 2007 to 2011 was a primary evidence base for that review.