Karen Bell — An often overlooked maternal health issue: micronutrients!

Women in Africa face yet another health risk that is largely invisible until pregnancy or infection place extraordinary demands on their bodies.

Micronutrient deficiencies affecting much of the population—specifically lack of iron, iodine, folate, zinc, and vitamin A—can contribute to death and disability from anemia, diarrhea, miscarriages, and birth defects if left uncorrected.  For example, folic acid, the synthetic form of folate, a soluble B vitamin found in spinach, legumes, citrus fruit, and whole grains, will prevent severe birth defects if a woman takes it regularly prior to becoming pregnant.

Much of the population consumes diets that don’t contribute enough of these key vitamins and minerals. In many countries, maternal and child health programs have been distributing iron and folic acid supplements to pregnant women for years, yet these often, especially in sub-Saharan Africa, do not reach the most vulnerable women in time to make a difference. Folic acid consumption will prevent most cases of spina bifida and anencephaly if taken daily prior to conception, will promote healthy fetal growth, and will help protect a woman from developing severe anemia during pregnancy and postpartum. Folic acid has many benefits for people of all ages, including cardiovascular disease and possibly cancer prevention. A UNICEF report estimates that up to 27,000 infant and 1,600 maternal deaths annually could be avoided in Tanzania if young women who might become pregnant consumed adequate amounts of micronutrients.

Tanzania is now considering whether and how to implement a strategy that will deliver folic acid to the entire population through fortification of staple foods, wheat and corn. A National Food Fortification Alliance is working with international donors to help millers make this program a reality. The annual cost of this intervention, including both iron and folic acid enrichment, would be less than $1 per person per year. It is important for health care leaders to speak out and encourage government leaders to adopt the regulations and incentives needed to fortify flour with folic acid and iron.  Other countries that have required flour fortification, like the United States and Chile, have documented decreases in neural tube defects ranging from 20 to 40% annually.

Karen N. Bell, MPH, is a Senior Faculty Associate at the Rollins School of Public Health at Emory University.