Folic acid will be added to bread-making flour from August, to prevent devastating birth defects that can result in death or lifelong disability.

Fortifying bread and other food staples with folic acid is safe and has significantly reduced birth defects of the brain, spine, or spinal cord in other countries including the United States, Canada and Australia, says the Ministry of Health.

“Consuming folic acid just before conception and early on during the pregnancy is vital to protecting babies from the risk of major birth defects such as spina bifida, but as just over half of pregnancies in New Zealand are unplanned, many people will not be taking folic acid supplements during this critical time,” deputy director of public health Dr Harriette Carr said.

“Folate is naturally present in many foods. Folic acid fortification restores what is lost during processing such as flour milling. It is an internationally well-accepted and safe approach to supporting the development of babies during pregnancy.”

The Ministry of Health announced the measure in 2021.

It is a breakthrough for New Zealand’s medical and scientific communities and patient advocates, who were despondent after plans to add folic acid to bread in 2009 were upended by industry opposition claiming possible risks from “mass medication”.

New Zealand’s Ministry for Primary Industries in 2019 estimated that up to 171 pregnancies affected by a neural tube defect could have been prevented in the decade after 2009, had mandatory fortification of bread gone ahead. More than half of such pregnancies are terminated or result in stillbirths.

An investigation by the Herald exposed the heartbreaking stories of parents who have been pushing for years for New Zealand to match other countries by fortifying bread.

The benefit could be much greater than official estimates, because they don’t count miscarriages earlier in pregnancy. The College of Public Health Medicine believes as many as 200 such miscarriages could be prevented every year.

Getting enough folate, a natural B vitamin found in foods such as leafy green vegetables, before and in early pregnancy can considerably reduce the risk of neural tube defects, the most common of which is spina bifida.

An illustration of spina bifida. A 'snowflake condition', it affects each person differently.

It’s difficult to get enough from diet alone, and women are advised to take folic acid tablets. However, many don’t, and more than half of pregnancies aren’t planned - a proportion that rises for young mothers (83 per cent), Māori (75 per cent) and Pacific Kiwis (71 per cent). When those women realise they’re pregnant it’s often too late - the neural tube closes 15 to 28 days after conception.

A 2018 report by the New Zealand Prime Minister’s chief science adviser and the Royal Society concluded unequivocal benefits of mandatory fortification of packaged bread outweigh any potential adverse health effects, with “no evidence of harmful health effects of folic acid supplementation in adults, at least at low doses in the range suggested for fortification”.

New Zealand has a voluntary system that aims to fortify up to half of packaged bread, but that target has not been reached. From mid-august, all non-organic bread-making wheat flour produced or sold in New Zealand, will be fortified with folic acid.

An illustration of anencephaly, one of the birth defects that adequate folate consumption can reduce the risk of.