Making a technology of public health: folic acid and pre-conceptional nutrition in Britain in the 1980s and 1990s

 

Salim Al-Gailani
(Cambridge University)

Since the early-1990s, governments and health organizations around the
world have encouraged women to make sure they get enough of the
B-vitamin folic acid before and during pregnancy. The expert consensus
is that women with diets deficient in folic acid are at increased risk
of bearing a child with a relatively common defect of the brain and
spinal cord, such as spina bifida. The promotion of nutritional
guidelines around folic acid is intertwined with the emergence of
‘pre-conception care’, a novel set of clinical and preventative
practices concerned with women’s health before pregnancy. At least for
those (typically affluent and educated) women for whom conception is
planned, the daily ritual of swallowing a vitamin supplement has become
a routine part of the experience of pregnancy. Health policy makers
continue fiercely to debate the risks and benefits of the mandatory
national fortification of grain products with folic acid, but the
politics of these new guidelines on ‘pre-conceptional nutrition’ have
not yet received historical attention. This paper explores the
controversy around clinical research on folic acid supplementation in
Britain in the 1980s. By highlighting the contested meaning of
nutritional advice and expertise, it reveals the vital role of
non-experts—journalists, the food industry, health consumer groups and
anti-abortion activists—in constructing the identity of folic acid as a
technology of public health.

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