Editorial: Don't tinker with our daily bread

It is not too difficult to see why many public health authorities support the mandatory fortifying of bread with folic acid. No one questions folate's effectiveness in reducing the incidence of certain birth defects, notably spina bifida, if it is taken in sufficient quantity around the time a woman becomes pregnant.

Voluntary fortification has been permitted since 1996 and folic acid is added to some breads and breakfast cereals. The problem is that too few women have got the message. Folate consumption has risen only marginally and remains significantly below recommended levels.

By 2007, the drums beating for compulsion were enough to convince transtasman regulator Food Standards Australia New Zealand, and the addition of folic acid to all bread except organic varieties is due to start in September. This creates a problem for the Government. It never supported mandatory fortification but has inherited a standard agreed by the previous government. That government also had its reservations, and at one stage it appeared the differences between New Zealand and Australia would be resolved by separate standards. A compromise was finally reached, based partly on Australia's agreement that the folate should be added to bread, not flour.

Australian health authorities place much emphasis on the experiences of the United States and Canada, which made the fortification of types of flour compulsory in 1998. The number of babies born with spina bifida has dropped dramatically. New Zealand, for its part, seems swayed more by what has happened in Britain. There, plans to fortify all bread were put on hold after the Chief Medical Officer warned it could raise rates of bowel and breast cancer. Definitive research on a potential link is awaited. Another concern is that folic acid could mask other vitamin deficiencies in the elderly.

No such problems have been reported in the US or Canada, but the New Zealand Government remains cautious. That is the right approach. Problems may still appear in North America. Further, mandatory fortification does not, in any case, represent a complete solution. Women would need to eat 11 slices of bread a day to get their recommended dose of folate. That is impractical, so folate supplements would still be required. This, again, points to the need to educate women planning to become pregnant. Unfortunately, previous attempts to stress the importance of consuming an appropriate amount of folate have failed.

The Bakers Association says it has offered "a credible and effective alternative" to mandatory fortification. It would voluntarily fortify a significant range of breads aimed at the target audience, along with appropriate awareness-raising advertising. The problem with the first part of that equation is that, in essence, it would be little advance over the range of breads voluntarily fortified over the past 13 years. This has proved no solution.

The association is on firmer ground in suggesting an advertising campaign. The essential problem is that women have not been informed about folate in a way that has enabled them to grasp its importance and the ease of its consumption. It occurs naturally in green leafy vegetables, fruit, yoghurt and orange juice or can be consumed as a vitamin supplement. It should be part of women's everyday diet, especially given that half of pregnancies are unplanned. If such were the case, mandatory fortification of bread would, quite simply, be unnecessary.

The key priority must be to ram home the importance of a healthy diet high in folate. That is where the Government should be headed. Far better that than an exercise which, while reducing birth defects, would eliminate choice and could be dangerous for a range of people.