Ireland is being forced to copy undemocratic UK decision
Dr Clare Craig
On 13 July 2026, the Irish Minister for Public Health, Jennifer Murnane O’Connor, launched a public consultation on the mandatory fortification of non-wholemeal flour with folic acid. It closes on 5 October. The stated aim is to reduce neural tube defects (NTDs), a group of conditions including spina bifida and anencephaly that arise in early pregnancy.
Ireland and the United Kingdom have some of the highest rates of these defects in western Europe since at least the 1970s. Low folate does raise the risk, and a share of affected pregnancies occur in women whose stores are low, but it cannot account for the rest. The relationship runs as a continuous gradient across the whole range of folate levels, so affected pregnancies still occur in women who are amply supplied, and most mothers whose baby has an NTD are not deficient. The World Health Organization’s own guidance concedes that low folate cannot explain every case. When rates fell across the British Isles the fall did not track the modest rise in dietary folate. The most direct test of that idea is what happens to these defects during a famine, and it does not support it; the evidence is set out in a companion article.
This July consultation comes only five months before the United Kingdom’s own mandate, under the Bread and Flour (Amendment) Regulations 2024, takes effect on 13 December 2026. Given that 70% of Irish flour is imported from the UK, is this a reaction to simplify processes in the UK or is it really aimed at Irish benefit?
WHO is pushing this?
The WHO’s World Health Assembly agreed a resolution in 2023 to accelerate the prevention of micronutrient deficiencies through food fortification. The World Health Organization and global nutrition bodies promote fortification as a means of meeting Sustainable Development Goal targets, in particular the nutrition target under Goal 2 and the health target under Goal 3. The impetus comes from a global timetable running to 2030.
The western European outlier
Across Europe folic acid fortification has remained voluntary. Manufacturers may fortify their products, but no government has required it, and most rely instead on advising women to take supplements before and during early pregnancy. The United Kingdom is the first country in western Europe to break from that position and mandate fortification. The only other European country to have legislated for it is Moldova. Every other nation on the continent, faced with the same evidence, has declined. Ireland now proposes to become the second country in western Europe to follow the British lead.
Why the choice is already half made
Ireland grows some of the highest-yielding wheat in the world, yet it has almost no milling capacity left. Since the closure of the Odlum’s mills the country imports nearly all of its flour. In 2023, 69 per cent of it came from the United Kingdom. British mills count the Republic as their largest export market, sending roughly 180,000 tonnes a year across the Irish Sea.
When UK fortification begins in December, folic acid will be present in the non-wholemeal flour British mills already supply to Ireland. The Food Safety Authority of Ireland has told Irish consumers to expect it, advising that breads, biscuits, cakes and pastries made with UK flour will carry folic acid on the Irish market shortly afterwards. A large part of the Irish bread and bakery supply will be fortified whether or not Ireland passes a law of its own.
The road not taken
Ireland has alternatives. It could source non-wholemeal flour from other European mills, or rebuild the domestic milling capacity it once had. Instead the direction of travel is towards writing the British requirement into Irish law and extending it to all non-wholemeal flour sold in the country. A decision taken by legislators in Westminster, without a parliamentary debate, is, through the supply chain, becoming the default for a population in another country.
Ireland had previously rejected this policy. A national committee recommended mandatory fortification in 2006, and the plan was put on hold in 2009 while the safety evidence was reviewed, after trial results raised questions about folic acid and the recurrence of colorectal adenomas. The consultation reopens the policy without the safety review that paused it having reached a conclusion.
The effect of the UK decisions to mass medicate its own population is that it is prescribing even for people outside of its jurisdiction.
Ireland can buy its flour from any country and grows plenty of wheat but is preparing to add a drug to their daily bread because of a decision taken in the UK. The fact that Ireland and the UK have had above average neural tube defect rates historically has never been explained in terms of diet or folate deficiency. The benefits have been overplayed and the risks ignored. Meanwhile, Ireland is being asked to adopt a British policy that was never debated in parliament and that really originated with the WHO.
