Taking a 5 milligram folic acid supplement daily from before three months of conceiving a child can avoid birth defects.

The folic acid (vitamin B9) is available free of cost at all state-run health facilities, throughout the country.

However, due to lack of planning for babies and accidental pregnancies, most women do not take folic acid, which has been contributing to defective births and perinatal mortalities in Nepal, doctors say.

“Most of the birth defects can be avoided by the use of folic acid,” said Dr Jageshwar Gautam, a consultant gynaecologist. “The supplement is also free at state-run health facilities but very few women are taking it.”

Folic acid or vitamin B9 is water-soluble and naturally found in many foods. It is also added to foods and sold as a supplement in the form of folic acid, which is better absorbed than from food sources.

The Ministry of Health and Population said that folic acid has shown positive impact on the health of growing babies and the distribution of the said vitamin supplement avoids neural tube defects.

Neural tube defects are problems with the brain or spinal cord, including Spina bifida (a condition that affects the spine and is usually apparent at birth). Although the problem is not common it can cause a wide range of problems for babies including problems with movement, bladder and bowel, and learning difficulties among others.

“But due to lack of awareness about the importance of taking folic acid, many women are not taking the supplement even after pregnancy,” said Gautam. “Providing the supplement for free is not enough, authorities concerned should also pay attention to raising awareness about the importance of the said supplement.”

In Nepal, most pregnancies happen accidentally and most couples cannot figure out if the pregnancies are intended or unintended even after several months, thus depriving the pregnant women of the essential vitamin supplement.

According to a recent report by the United Nations Population Fund (UNFPA), nearly half of the pregnancies in Nepal are unintended.

The UNFPA’s “State of World Population 2022” report titled, “Seeing the Unseen”, says half of the 1.2 million pregnancies in 2017 in Nepal were unintended.

“Unintended pregnancy is a reality for millions each year, accounting for nearly half of all pregnancies,” reads the UNFPA’s report.

The UN agency’s report stated that the toll of these pregnancies is — and has long been — unseen.

Officials at the Ministry of Health and Population said that the programme has been launched for years to avoid perinatal mortalities (28 weeks fetus to up to one week baby) and birth defects.

“Folic acid has to be taken before three months of pregnancy but many women seek antenatal check up three months or more after conception,” said Nisha Joshi, a senior public health administrator at the Family Welfare Division. “We provide folic acid free of cost for six months (three months before and after pregnancy) and also give iron supplements after three months of pregnancy.”

The UN agency report highlighted how unintended pregnancies result in additional social and fiscal burdens, including through greater demand for health care, unsafe abortions, loss of income and productivity, and more fraught and unstable family relationships.

Joshi concedes that unintended pregnancies and lack of awareness in many people about the importance of taking folic acid have been contributing to birth defects.

“If a baby is born with birth defects, it will not only create huge stress in the family, especially to parents but such babies might need lifelong care, treatment and attention,” said Joshi.

But even though the health authorities have been providing free folic acid supplements from state run health facilities, they have not paid attention to launching awareness about the importance of said supplement.

Doctors say if the previous pregnancy had a neural tube defect, or biological parents have neural tube defects, or if the baby or its parents have a family history of neural tube defects, or have diabetes and take anti-epilepsy medicine, then chances of neural tube defects increase.

“Such people should talk to gynecologists before planning babies and take folic acid supplements before three months of pregnancy,” said Joshi.

Doctors say if a woman has the right level of folic acid in her body before getting pregnant, it reduces the risk of the baby developing neural tube defects by up to 70 percent.