Why in News?
- Renewed public health concern following reporting on Spina Bifida, India’s most common birth defect, and the persistently low awareness about its prevention.
- Expert calls for:
- National awareness campaigns.
- Food fortification with folic acid.
- India continues to record one of the highest global prevalence rates, despite three decades of scientific evidence on prevention.
Relevance
GS II (Social Justice & Health)
- Preventive healthcare and maternal nutrition.
- Public health awareness failures.
- Role of State in reducing avoidable disabilities.
GS III (Human Resource Development)
- Nutrition, micronutrient deficiency, and long-term productivity.
- Cost-effectiveness of prevention vs treatment.
What is Spina Bifida?
- A neural tube defect (NTD) where the spinal cord fails to develop properly in early pregnancy.
- Occurs very early in gestation (within first 28 days).
- Leads to irreversible neurological damage.
Magnitude of the Problem in India
- >25,000 children born annually with Spina Bifida.
- Prevalence: ~4 per 1,000 births (much higher than global best practices).
- India among countries with highest disease burden globally.
- >75% of affected children lack access to comprehensive medical care.
Clinical & Social Impact
- Physical disability:
- Ranges from mild foot weakness to complete paralysis below the hips.
- Many children wheelchair-dependent from early childhood.
- Associated conditions:
- Hydrocephalus (excess fluid in brain).
- Urinary & bowel incontinence.
- Orthopaedic deformities (club foot).
- Cognitive function:
- No intellectual impairment — children can lead productive lives if treated.
- Socio-economic burden:
- Long-term medical costs.
- Caregiver burden.
- Loss of household income and dignity.
Why Folic Acid is Critical ?
- Folic acid (Vitamin B9) intake:
- Before conception and during early pregnancy.
- Can prevent >70% of Spina Bifida cases.
- Evidence established since 1991:
- Medical Research Council (MRC) Vitamin Study (published in The Lancet).
- Cost-effective:
- ₹1 spent on prevention saves >₹100 in treatment and rehabilitation.
India’s Policy & Awareness Gap
- No large-scale national awareness campaign.
- Limited counselling on pre-conception nutrition, especially for:
- Rural women.
- Unplanned pregnancies.
- Absence of:
- Mandatory food fortification with folic acid.
- Systematic education via primary healthcare systems.
- Represents public health negligence, given known preventability.
Global Best Practices
- 68 countries mandate folic acid fortification in staple foods.
- Outcomes:
- Reduced Spina Bifida prevalence to <1 per 1,000 births.
- Combined approach:
- Mass awareness campaigns.
- Mandatory fortification laws.
Emerging Research & Indian Context
- Exploration of universally consumed food vehicles:
- Salt.
- Tea.
- Preliminary Indian trial:
- Tea fortification with folate and vitamin B12.
- Published in BMJ Nutrition, Prevention & Health.
- Objective:
- Address both neural tube defects and anaemia-related neurological issues.
Expert & Institutional Advocacy
- Strong advocacy by public health experts including:
- Emory University-based Center for Spina Bifida Prevention.
- Calls for:
- Primary prevention over curative focus.
- Integration of folic acid awareness into maternal health programmes.
Way Forward
- Launch nationwide awareness campaign on:
- Pre-conception folic acid intake.
- Early antenatal nutrition.
- Introduce mandatory food fortification with folic acid and vitamin B12.
- Strengthen:
- Primary healthcare counselling.
- Referral and rehabilitation systems for affected children.
- Align with goals of:
- Reducing under-five mortality.
- Preventing avoidable disabilities and stillbirths.
