Folate before pregnancy: the impact on women and health professionals of a population-based health promotion campaign in South Australia

Objectives: To evaluate a South Australian campaign to promote and implement knowledge that taking adequate folate/folic acid in the periconceptional period can reduce the risk of having a baby with a neural tube defect. Design and setting: The campaign, conducted in October 1994 - August 1995, targeted women of reproductive age and health professionals. Evaluation was by computer-assisted telephone interviews undertaken by random dialling throughout the State before and after the campaign, and by self-administered questionnaires to health professionals and women in the postnatal period. Participants: Women of reproductive age and four groups of health professionals. Main outcome measures: Knowledge about folate, folate-rich foods and the periconceptional period; participation of health professionals in advising women about folate, use of periconceptional folic acid supplements; sales of folio acid tablets; and prevalence of neural tube defects. Results: Significant increases in knowledge about folate followed the campaign. Health professionals and women in the postnatal period had higher initial levels of knowledge about folate, which also increased significantly The proportions of women taking periconceptional folic acid supplements, and of health professionals advising women planning a pregnancy about folate, also increased significantly, and folic acid tablet sales doubled. Total prevalence of neural tube defects declined between 1966 and 1999 from a baseline of 2.0 per 1000 births to 1.1 per 1000 births (Poisson regression, P=0.03; average decline of 1.0% per year). Conclusions: A short educational campaign with a limited budget ($40 000) can promote folate successfully, but alternative strategies such as food fortification are likely to be needed to achieve adequate periconceptional folate intake for a very high proportion of women.