Mandatory fortification with folic acid for the prevention of neural tube defects: a case study of Australia and New Zealand

Purpose To present a case study of the considerations of mandatory fortification with folic acid in Australia and New Zealand. Methods Review of published reports and consumer advocacy views. Results Australia and New Zealand jointly approved mandatory fortification of flour with folic acid to prevent neural tube defects in 2007. Fortification was fully implemented in Australia in 2009 and has resulted in reduction in NTD. At the last minute, industry lobbying led to the New Zealand government not proceeding with fortification. With continued consumer advocacy, mounting scientific evidence, and a change of government, approval was given in 2021 for mandatory fortification of flour with folic acid. Conclusion In large part as a response to consumer pressure, New Zealand has now joined with Australia (and around 70 other countries) in fortifying flour with folic acid for the prevention of NTD.