Why don't women take folic acid?

Folic acid important before conception
The survey also found that one-third of women polled who have seen television public service ads about folic acid believe the ads are for women who are trying to get pregnant, or for a different age group, but not for them.

"It appears that many women are still in denial about their need for folic acid," says Dr Jennifer L. Howse, March of Dimes president. "About 50 percent of pregnancies in the United States are unplanned, so it's important for every woman capable of having a baby to take a multivitamin with folic acid daily, even if she's not thinking of having a baby. While rates of spina bifida and other neural tube defects have been decreasing, the rate can drop lower still with daily folic acid intake."

The survey was conducted for the March of Dimes by The Gallup Organization under a grant from the US Centers for Disease Control and Prevention. Only 32 percent of women in the United States between the ages of 18 and 45 take a multivitamin containing folic acid on a daily basis, up only four percent since 1995. When the remaining women were asked why they don't take folic acid daily, the top answer (24 percent) was that they forget. Twenty-two percent said "no particular reason." Sixteen percent said they "don't need them," 9 percent said they eat a balanced diet, 4 percent said they don't like taking pills, and another 4 percent said vitamins cost too much.

When asked what would make them more likely to take a multivitamin containing folic acid on a daily basis, 33 percent of women said they would be more likely to do so on the advice of their doctor or health care provider.

Consumption is crucial
Daily consumption of the vitamin beginning before pregnancy is crucial because serious birth defects of the brain and spine known as neural tube defects (NTDs) occur in the early weeks following conception, often before a woman knows she is pregnant.

"Although folic acid now has a higher profile in this country, much more needs to be done to prevent disabling or fatal NTDs from occurring," says Dr Howse. "Health professionals such as physicians, nurses, midwives, and pharmacists need to remember to use every contact they have with women of childbearing age to advise them to take a multivitamin with folic acid daily."

A comparison of seven annual surveys conducted by The Gallup Organization for the March of Dimes also shows that there has been an increase in awareness of folic acid among women of childbearing age, from 52 percent in 1995 to 79 percent in 2003. Ten percent of women know that, to be effective, folic acid must be consumed before pregnancy, up from only 2 percent in 1995. Those who know that folic acid prevents birth defects has increased to 21 percent in 2003, up from only 4 percent in 1995.

NTDs are among the most serious birth defects in the United States. Each year, an estimated 2,500 babies are born with these defects, and many additional affected pregnancies result in miscarriage or stillbirth. To help prevent NTDs, all women capable of becoming pregnant should consume a multivitamin containing 400 micrograms (0.4 mg) of folic acid every day one to three months before pregnancy, as part of a healthy diet containing foods with folic acid, such as leafy green vegetables, beans, and fortified grains.

The March of Dimes 2003 survey results are based on telephone interviews with a national sample of 2,006 women age 18 to 45 conducted from April 25 to June 3, 2002. For results based on samples of this size, one can say with 95 percent confidence that the error attributable to sampling and other random effects could be plus or minus three percentage points.