Reductions in child mortality by preventing spina bifida and anencephaly: Implications in achieving Target 3.2 of the Sustainable Development Goals in developing countries

Birth Defects Res. 2019 Aug 15;111(14):958-966. doi: 10.1002/bdr2.1362. Epub 2018 Aug 2.


Background: There is an opportunity to reduce child mortality by preventing folic acid-preventable spina bifida and anencephaly (FAP SBA) in developing countries. We estimated reductions in FAP SBA-associated child mortality in 69 countries with an immediate potential for mandatory fortification of wheat flour.

Methods: Using data from multiple sources, we estimated the percent reductions in neonatal, infant, and under-five mortality that would have occurred by preventing FAP SBA; and the contributions of these reductions toward each country's Sustainable Development Goals (SDG) for child mortality reduction. We used the combined prevalence of spina bifida and anencephaly in selected countries before fortification, and estimated preventable child mortality associated with FAP SBA, assuming 0.5 per 1,000 live births as minimum achievable prevalence from mandatory fortification.

Results: Annually, 56,785 live births with FAP SBA occurred in the 69 countries examined. Of these, about 49,680 (87%) would have resulted in deaths under age 5 years, and are preventable through mandatory folic acid fortification. On average, compared to current rates, prevention of FAP SBA would have reduced the neonatal, infant, and under-five mortality by 19% (95% uncertainty interval [UI]: 16-24%), 15% (UI: 13-17%), and 14%, (95% UI: 13-17%), respectively. Prevention of FAP SBA seemed to contribute toward achieving SDG on neonatal and under-five mortality in developing countries.

Conclusions: Prevention of FAP SBA will lead to notable and immediate reductions in child mortality. Many countries have an opportunity to effectively move toward child mortality-related SDG targets with existing milling infrastructure for food fortification.

Keywords: anencephaly; child mortality; folic acid; fortification; mortality; spina bifida; sustainable development goals.

MeSH terms

  • Anencephaly / epidemiology
  • Anencephaly / mortality*
  • Anencephaly / prevention & control
  • Child
  • Child Mortality
  • Developing Countries
  • Female
  • Flour
  • Folic Acid / metabolism
  • Folic Acid Deficiency / mortality
  • Folic Acid Deficiency / prevention & control
  • Food, Fortified / economics
  • Food, Fortified / standards
  • Genetic Diseases, X-Linked
  • Goals
  • Humans
  • Infant
  • Male
  • Neural Tube Defects
  • Pregnancy
  • Prevalence
  • Spinal Dysraphism / epidemiology*
  • Spinal Dysraphism / mortality*
  • Spinal Dysraphism / prevention & control
  • Sustainable Development
  • Triticum


  • Folic Acid

Supplementary concepts

  • Neural tube defects X-linked