Ethiopia faces a particularly high level of folate deficiency and folate insufficiency among women, which contributes to high rates of anaemia and can significantly increase the risk of neural tube defects (NTDs), neonatal mortality and under-5 mortality. The most recent hospital-based studies in Tigray and Addis Ababa show a very high incidence rate of NTDs in Ethiopia. The overall occurrence of NTDs was 13.1 per 1,000 births in Tigray. The rate is 10 times higher than the report from eight World Health Organization (WHO) member nations in Africa, and 26 times what it should be. This brief expounds upon the importance of large-scale mandatory food fortification to overcome these alarming rates of NTDs.