Folic acid will be required to be added to most bread in New Zealand after government approvals, the government says, to save lives and reduce health problems.
Minister for Food Safety Ayesha Verrall said in a statement this morning adding the acid to to all non-organic bread-making wheat flour would protect tamariki, preventing neural tube defects (NTDs) that could result in death or life-long disability.
The requirement would take effect after two years, she said.
"This B vitamin is safe and essential for health; particularly for development of babies early in pregnancy. Folate is naturally present in food; folic acid fortification restores what is lost during processing such as flour milling."
"A little over half of pregnancies in New Zealand are unplanned, so it's not practical for all women to take a folic acid supplement one month before they conceive - to reduce the risk of these conditions."
She said it would bring New Zealand into line with countries such as Australia, Canada and the United States.
Mandatory fortification had decreased NTD incidence in Australia - particularly among teenagers and indigenous women - she said, and could reduce New Zealand's health, education and productivity costs by between $25 million and $47.4m over 30 years.
It could mean between 162 and 240 fewer children with NTDs in New Zealand in that time, she said.
Some bread in Aotearoa is already fortified under a voluntary standard but a report for the government by the Office of the Prime Minister's Chief Science Advisor and the Royal Society Te Apārangi in June 2018 found less than half of packaged bread had folate added.
Verrall's office confirmed the move would not require a law change, only a notice under the Food Act 2012 adopting the relevant part of the Australia New Zealand Food Standards Code, and providing a two-year transition period.
The National government in 2009 opted out of moves by Food Standards Australia New Zealand to make folic acid inclusion mandatory, saying there was evidence it could increase risk of colon cancer.
In 2012 after an eight-week consultation process, it chose to keep the inclusion of the acid voluntary.
However, the 2018 report has found there was compelling evidence that taking folic acid supplements at recommended doses in pregnancy had no adverse effects, and that mandatory fortification was associated with lower rates of NTDs.
"No evidence was found to link folic acid supplements to increased risks of neurological/cognitive decline, diabetes, or cardiovascular disease; nor was there evidence that unmetabolised folic acid that remains within the body's circulation is harmful.
"The Panel reviewed data related to potential effects on cancer risk. Most data suggest no effect, but some limited evidence from genetic studies
of people with different folate metabolism suggests that higher folate levels may be associated with reduced risks overall cancer rates and lower risks of breast cancer in particular, but may also be associated with higher risks of prostate and colorectal cancer.
"The Panel discussed this issue in great depth over an extended period of time, and took this into account in preparing its unanimous advice."
It concluded that the benefits of fortification "outweigh any potential adverse effects", particularly considering the need to help disadvantaged people including Māori.
Dr Verrall said there had been frustration in the sector for a long time that the change had not come through.
"It's a shame that we've had several - over 100 - children born with these serious disabilities because of the scare campaign that was run when the policy was first floated," she told reporters this morning.
"On a personal note I've known this is something we should ahve been doing in New Zealand since I graduated from medical school and throughout my time as a doctor looked after people with this condition and knew it was entirely preventable if we took this action.
"People with spina bifida can have recurrent urinary tract infections because the nerves around their bladder are affected by the condition. Also sometimes they require a lot of surgeries to fix the condition in their spine and as a result of that can get serious infections."
Minister Damien O'Connor had started the consultation in 2019 and had been open about being frustrated at lack of political consensus on the issue, Verrall said.
Public consultation showed 85 percent of submitters were in favour of mandatory fortification.
Organic and non-wheat flour will remain exempt from fortification, and Verrall said people were still able to opt out by eating those.