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

Objectives: To evaluate a South Australian campaign to promote and implemen t 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 th roughout 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 professio nals. Main outcome measures: Knowledge about folate, folate-rich foods and the pe riconceptional period; participation of health professionals in advising wo men 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 campa ign. Health professionals and women in the postnatal period had higher init ial levels of knowledge about folate, which also increased significantly Th e proportions of women taking periconceptional folic acid supplements, and of health professionals advising women planning a pregnancy about folate, a lso increased significantly, and folic acid tablet sales doubled. Total pre valence of neural tube defects declined between 1966 and 1999 from a baseli ne of 2.0 per 1000 births to 1.1 per 1000 births (Poisson regression, P=0.0 3; average decline of 1.0% per year). Conclusions: A short educational campaign with a limited budget ($40 000) c an promote folate successfully, but alternative strategies such as food for tification are likely to be needed to achieve adequate periconceptional fol ate intake for a very high proportion of women.