Folic acid advisories, a public health challenge

Résumé

Neural tube defects are neurological conditions affecting 1/1000 foetuses in France each year. If a foetus is affected there is a 90% chance of the pregnancy being terminated. Increasing folic acid intake over 400μg per day two months before and two months after conception reduces prevalence rates by 80%. Two types of government interventions exist to increase intake and reduce prevalence rates: (1) fortification of staple food, which increases population intake indiscriminately; (2) social marketing, increasing intake of conceiving women through information provision. France opted for the latter and has implemented it since 2005. The paper sets up a quasi-experimental setting to measure the impact of the social marketing campaign on consumption using a reduced form approach, as well as a structural model. It exploits the variation in the usefulness of folic acid information between households: households that are or want to conceiving a child use it, those that are not conceiving do not. The paper combines a highly detailed scanner data on grocery purchase with a dataset on macro- and micro- nutrient from before and after the information campaign. I find evidence of a positive impact on folic acid consumption and preferences. However, the effects are limited. A constant prevalence rate and a modest impact of the social marketing campaign suggest a fortification policy to be advisable.