The name for the organization “Healthy Moms, Healthy Babies America” will never make it as the name of a rock band: too much joy. Actually “Too Much Joy” could be a band name, so you never know. I like Olivia Walton’s short summary of the $100 million effort to improve maternal and baby health: “Healthy moms lead to healthy families.” I am confident that daily folic acid supplementation, a 400 mcg folic acid tablet, for women of child-bearing age will be part of these efforts to have healthy moms. While this one little over-the-counter pill may seem like an easy part of the maternal health challenge, we have not done a good job of implementing folic acid supplementation, even though it is a simple, safe and inexpensive tool for women and their babies.
Folic acid is essential for development of the embryonic brain and spinal cord. Very early in normal development, the neural tube closes. If it doesn’t close, the three most common and serious defects are anencephaly (which is always fatal), spina bifida and encephalocele.
Here are some of the challenges to preventing many of these defects.
The neural tube development process is complete before most women know they are pregnant. Once a woman knows she is pregnant and arrives for her first prenatal visit, almost always the closure of the neural tube has already occurred. From the CDC website: “Waiting until the first prenatal visit to start folic acid consumption will not prevent neural tube defects!” Folic acid must have been taken for a few weeks before fertilization to have the greatest possible positive effect. The March of Dimes recommends “at least one month.” While not all neural tube defects would be prevented, many would.
Approximately half of pregnancies are unplanned. From the CDC website: “CDC recommends all women capable of becoming pregnant get 400 mcg of folic acid daily.” Yep, that’s a lot of women; but birth control methods may not be perfect, and Life happens. Millions of women are unaware of this recommendation. And “capable of becoming pregnant” biologically applies to teenage girls, which creates its own set of challenges.
Folic acid can be obtained over-the-counter. It is cheap. $10-$20 will get you a year’s supply. Over-the-counter medicines and vitamins can seem not as important to women and providers.
Many women, including those with insurance, are not seeing primary care providers or gynecologists regularly. Many women do not have health insurance now, and the expectation is that the number will increase. They are less likely to get primary care.
The March of Dimes estimates that 2,300 pregnancies a year are affected by neural tube defects, which is why, despite the challenges, millions of women need to hear the information about the importance of folic acid and how simple and cheap it is. I know that diligent providers and informed patients will be successful, but how to reach the rest? Here are a few possibilities:
Prenatal visits during pregnancy are incredibly important. We need also to stress the importance of a pre-pregnancy medical visit when women are just beginning to formulate a plan for having a baby.
Health plans could be encouraged (or required) to implement a plan for free folic acid distribution. Maybe a gift certificate given at enrollment and annually.
Colleges and universities could do something similar for the many young women who may be unaware of the CDC recommendation. There are so many different ways to creatively distribute a year’s supply of folic acid to these young women.
Here’s my favorite. In the week leading up to Valentine’s Day, if a man or woman buys anything from willing large retailers or pharmacies, they get a free bottle of folic acid to give to their favorite Valentine. In the history of loss leaders, it will be a big win for America’s women and children.