6 Selective Abortion and Folic Acid Fortification as Contrasting Strategies for Prevention of Congenital Neural Tube Defect John A. A. Nichols The Postgraduate Medical School, The University of Surrey UK 1. Introduction Prenatal diagnosis of severe disability and the option of termination of pregnancy (TOP) have been widely available to parents in most countries in the Western world for three decades. This has come to be known as selective abortion. The ethics of this procedure is a large subject that I will not attempt to address in this paper. Some countries have laws that forbid selective abortion unless the mother’s life is at risk. Where neural tube defects (NTDs) are concerned, medical opinion might favour TOP in a mother carrying an anencephalic fetus. The anencephalic infant will not normally survive for more an hour after birth but the mother may have a difficult and even life threatening labour because the lack of a fetal head prevents normal labour from progressing. The pregnancy tends to go overdue and vaginal delivery is complicated by shoulder dystocia and can be very difficult and hazardous for the mother. However 60% of women in the world would not be able to access an early TOP for this type of pregnancy due to poverty, religious reasons or anti-abortion legislation. In the republic of Ireland, which has anti-abortion legislation, this situation has encouraged legislators to consider minimising the need for selective abortion by introducing mandatory fortification of flour with folic acid (FA). 1.1 Objections to folic acid fortification of bread, flour and grain Scientists, oncologists and politicians have urged caution in implementing folic acid fortification of bread, flour and grain. Oncologists were amongst the first to point out that many cancer chemotherapy drugs work by inhibiting folate metabolism and subsequent research showed that giving folic acid can accelerate tumour growth in animal models (Hubner et al., 2007). The arguments for and against fortification depend on the interpretation of data from countries where fortification has already been implemented. In Chile, which has similar anti-abortion legislation to The Republic of Ireland, a ten year policy of fortification has reduced the incidence of NTD births by 40% - from 17/10,000 births to 10.1/10,000 births (Hertrampf et al., 2004). However the UK and Irish governments have held back on fortification and the following issues have caused pause for thought: