Fortification of selected foodstuffs with folic acid in the UK: consumer research carried out to inform policy recommendations

ABSTRACTBackground The UK Food Standards Agency Board identified four options to increase folate intake in women of reproductive age in order to reduce the risk of neural tube defect (NTD) affected pregnancies; these ranged from continuing with current policy, to mandatory fortification of bread or flour with folic acid. In order to appraise these options, the agency carried out a consultation, and also commissioned four pieces of research. This paper provides detailed information about two of the research studies, which used qualitative research approaches to gather consumer evidence. Methods Study 1: This was carried out with people from a wide range of demographic backgrounds. A ‘reconvened group’ methodology was used, with five groups convened twice, in five geographical locations. In addition paired, in depth face-to-face interviews were conducted with female black and ethnic minority consumers. Study 2: This was carried out with young mothers living in deprived communities. The approach used for this study was in depth face-to-face interviews (n = 24). In addition, discussions were held in seven friendship groups. Results Study 1: only a minority of participants knew about a link between spina bifida and folic acid, and these tended to be women with young families. After the provision of some information about the causes and impacts of NTDs, the majority were in favour of action to tackle the issue. Support for mandatory fortification increased considerably during the study, and at the final discussion, this option was most preferred. Study 2: In this group, there was a fatalistic approach to pregnancy and to health. The women were less likely to change established habits if this required effort, money or doing something unfamiliar. They tended to actively avoid thinking about risks, by rationalizing them. Mandatory fortification was preferred by the majority of respondents. Conclusions In this research, mandatory fortification was the preferred option. There were outstanding concerns about risk, and the maintenance of consumer choice, which would need to be addressed in policy recommendations.