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This article (i) describes the challenge in finding the cause; (ii) examines the reasons for the failure of many countries to introduce folic acid fortification of staple foods such as flour and rice; (iii) shows that countries that have introduced fortification failed to do so in a fully effective way; (iv) shows how current preventive polices are confusing, inconsistent and sub-optimal; (v) shows that the proposed UK folic acid fortification policy is expected to prevent about 1 out of 10 NTD cases only; and (vi) proposes a simple, fully effective fortification policy that would prevent about 8 out of 10 NTDs and avoid the need for women to start taking folic acid supplements before pregnancy, a policy that has been shown to fail because only a small percentage of women adopt this practice.<\/jats:p>","DOI":"10.1177\/09691413221102321","type":"journal-article","created":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T07:59:04Z","timestamp":1655971144000},"page":"138-146","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":52,"title":["Folic acid and neural tube defects: Discovery, debate and the need for policy change"],"prefix":"10.1177","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1676-5908","authenticated-orcid":false,"given":"Nicholas J","family":"Wald","sequence":"first","affiliation":[{"name":"Professor of Preventive Medicine, Institute of Health Informatics, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,6,23]]},"reference":[{"key":"bibr1-09691413221102321","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196711232772104"},{"key":"bibr2-09691413221102321","first-page":"67","volume":"26","author":"Renwick JH","year":"1972","journal-title":"Brit J Prev Soc Med"},{"key":"bibr3-09691413221102321","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(65)91895-7"},{"key":"bibr4-09691413221102321","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(83)92654-5"},{"key":"bibr5-09691413221102321","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.282.6275.1509"},{"key":"bibr6-09691413221102321","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1984.tb04796.x"},{"key":"bibr7-09691413221102321","doi-asserted-by":"publisher","DOI":"10.7707\/hmj.v5i3.211"},{"key":"bibr8-09691413221102321","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(91)90133-A"},{"key":"bibr9-09691413221102321","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199212243272602"},{"key":"bibr10-09691413221102321","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)07104-5"},{"key":"bibr11-09691413221102321","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7415.616"},{"key":"bibr12-09691413221102321","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0089354"},{"key":"bibr13-09691413221102321","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/133.10.3166"},{"key":"bibr14-09691413221102321","doi-asserted-by":"publisher","DOI":"10.1177\/15648265080292S128"},{"key":"bibr15-09691413221102321","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.1994"},{"key":"bibr16-09691413221102321","unstructured":"Committee on Medical Aspects of Food and Nutrition Policy. 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