Vijaya Kancherla, PhD, Lorenzo D. Botto, MD, Laura A. Rowe, MPH, MS, Nathan A. Shlobin, BA, Adrian Caceres, MD, Anastasia Arynchyna-Smith, MPH, Kathrin Zimmerman, BA, Jeffrey Blount, MD, Zewdie Kibruyisfaw, MD, Kemel A. Ghotme, MD, PhD(C), Santosh Karmarkar MS, M.Ch., Graham Fieggen, MD, Sylvia Roozen, PhD, Godfrey P. Oakley Jr., MD, Gail Rosseau, MD, and Robert J. Berry, MD.
Lancet Global Health, S2214-109X(22)00213-3.

Published: May 23, 2022


July 2021 marked the 30th anniversary of the publication of the landmark trial showing that folic acid prevents most cases of spina bifida and anencephaly. Mandatory fortification with folic acid is safe, cost-effective, and sustainable intervention to prevent cases, yet it is implemented by few countries effectively; only one-quarter of preventable cases are prevented worldwide. We summarize evidence and make an urgent call to action for a World Health Assembly resolution on universal mandatory folic acid fortification to accelerate the slow pace of prevention globally, and to assist countries in reaching their 2030 SDG goals on child mortality and health equity. The cost of inaction is profound, disproportionately impacting vulnerable populations.