Best method in India

Having shown without doubt that folic acid taken correctly can reduce the incidence of neural tube defects by at least 70%, the next thing that is needed to be considered is "Could the conception with NTDs in the general population of pregnant women be reduced by increasing the folic acid intake of all women of childbearing age?" One way to do this is to ask all women planning a pregnancy to take 400 micrograms of folic acid for 3 months before conceiving and for 3 months afterwards. This plan only works for a proportion of women. The reason why it does not work for the rest the following reasons:

• It is recognized that less than half of pregnancies are planned.
  
  
• Women need to be informed of the need to take folic acid and why it is important to do so. In India, the public awareness regarding the folic acid supplementation in prevention of NTDs is very poor. The best possible method for supplementation of folic acid in India described below:

Eating folic acid foods and avoiding over cooking are already part of advice for healthy eating for the general population. The consumption of vegetables and fruits need to be doubled in India women population. Women who are planing a pregnancy would benefit particularly from such a change of diet. Some women may be able to select a diet with 0.6 milligrams folate/ folic acid by increasing their consumption of folate rich foods. But it is very unlikely that in India this measure alone will ensure sufficient intake for the majority who need it. Some food products like wheat, salt or sugar can be fortified with folic acid. This will be an effective way of ensuring an increased intake for all women becoming pregnant. The fortification of these foods can be done with reasonable amount of the folic acid, which will not cause side effects.

We recommend that all women who are planning a pregnancy should be advised to take 400 micrograms of folic acid as a daily medicinal or food supplement from when they plan to have a baby until the twelfth week of pregnancy. This will be the most effective method of NTD prevention in India. That is every woman of childbearing age should be supplemented with 400 micrograms of folic acid daily.

Need for public awareness and inclusion of Govt. programmes
In India as we have discussed, the prevalence of NTDs is very high. The social and economical burden created by these disabled children is devastating. This urges the need for public awareness of this problem and prevention by folic acid supplementation. The public awareness can be increased by

• By giving information at science classes at children.
  
  
• Giving lectures at college where the women of the child - bearing age are attending the college.
  
  
• Public lectures regarding the role of folic acid in prevention of neural tube defects.
  
  
• Wide exposure of the general population of the facts through the media that is radio, television programmes.
  
  
• Press conferences, news releases, articles in magazines and newspapers.
  
  
• Involvement of medical / managed care providers.
  
  
• Distribution of brochures, educational material regarding folic acid prevention with each prescription dispensed at pharmacies.
  
  
• Making of posters, flyers, buttons, brochures, video, and newsletters stating the importance of folic acid.
  
  
• Help of non- government organization for public service.
  
  
• This type of campaign to increase the awareness of NTD prevention will really help in reducing the prevalence of NTD in India.

The Govt.'s role is pivotal in the prevention. The Govt. should introduce the central coordination facility through which the system should be developed to monitor the prevalence of neural tube defect and to start programme of folic acid supplementation in the periconceptional period. As in India the programme of multivitamins & Iron supplementation to pregnant women is already there, this program can be expanded and folic acid can be started before the woman becomes pregnant.