Ireland's food authority is also seeking views on a pro-industry policy that would allow folic acid fortified foods to carry a special logo and health claim.
The small country has one of the highest rates of neural tube defects in Europe - approximately 1-1.5 per 1,000 births - and although it has advised women planning to have babies to take folic acid supplements since 1993, these campaigns have had little success.
A committee made up of Irish scientists, members of public health organizations and food industry representatives, yesterday opened a consultation process on three different initiatives that would be more effective than current policy in reducing cases of spina bifida in Irish babies.
These include mandatory fortification of bread-making flour with folic acid, mandatory fortification of all flour with the vitamin, and 'structured voluntary fortification' of foods, where manufacturers would be allowed to make a health claim on foods to which they have added a specific level of folic acid.
The special committee says it has reviewed policies on folic acid in other countries. Their proposals show that they are looking west to the benefits seen in the US and Canada rather than across the channel to the UK, which recently claimed there was not enough safety data to support a higher intake of the vitamin across the population.
The USA and Canada introduced mandatory fortification of all flour with folic acid in 1996, resulting in a significant reduction of birth defects, ranging from 28 per cent to 78 per cent in Newfoundland.
However although a scientific advisory committee (COMA) to the UK government had recommended the addition of folic acid to flour to cut the incidence of spina bifida, heart attacks and strokes in that country, the its Food Standards Agency warned in 2002 that such a policy could mask deficiency of vitamin B12 in the elderly.
"We're going for a slightly lower level than advised by COMA and have done modelling exercises, based on data on food consumption in Ireland, to make sure that no-one will reach the tolerable upper intake level of this vitamin," said Alan Reilly, deputy chief executive of the Food Safety Authority of Ireland (FSAI).
The option for mandatory fortification suggests that bakers add 120mcg of folic acid per 100g of bread consumed.
"There are sufficient grounds for fortification with respect to public health. You just have to look at the results in the US and Canada," Reilly told NutraIngredients.com.
He added: "We've moved on a bit since 2002 and the UK's decision. A series of articles in the BMJ and Lancet recently show the need to look at fortification."
Reilly added that he did not want to pre-empt the results of the consultation process. It is likely to raise issues of consumer choice as well as safety concerns.
There is room for support from the food industry however.
Alexander Waugh, director general of the National Association of British and Irish Millers (NABIM) said yesterday that while he had not had a chance to speak to Irish millers yet, their position was likely to be similar to that taken by UK millers in 2002, namely that fortification was a public health issue.
"Millers have always felt that this is a public health decision. If the government decides that it is necessary then we will do it. If however they are concerned about side effects then millers will also be concerned and will not do it voluntarily," he said.
He added however that the voluntary approach, which would allow manufacturers to make a health claim, would offer better chances of recovering the rather high costs of folic acid.
The UK already requires millers to fortify flour with calcium, iron, thiamin and niacin so folic acid could be added in the same process.
Only about 5 per cent of bread in the UK and Ireland is currently fortified with folic acid. The most common food sources of the vitamin in Ireland are breakfast cereals, potatoes and other vegetables.
Maureen Lynott, chairwoman of the National Committee on Folic Acid Food Fortification, said that research shows that only one in five pregnant women take a folic acid supplement and over a third of women consume no folic acid at all - either though food or supplements.
"Almost 50 per cent of pregnancies in Ireland are unplanned, so a large segment of females may not have taken folic acid for the recommended period prior to conception to assist prevent NTDs."
She added: "There are only a limited number of foods fortified with folic acid, so it is very difficult to get enough folic acid from food alone. The optimal approach would be for women to take a folic acid supplement daily and to eat fortified foods as a part of their daily diet."
The consultation, which can be accessed on a new website, closes on 24 June 2005.
Following analysis of all submissions, expected by early autumn, the National Committee on Folic Acid Food Fortification will make a policy recommendation to the Minister for Health and Children.