Healthcare and insurance access influence folic acid use among women
A University of California, Irvine study found that insurance coverage and healthcare access significantly impact folic acid supplement use among U.S. women aged 18-49, with uninsured women and certain racial/ethnic groups showing lower adherence to recommendations. The research, using NIH’s All of Us Research Program data, highlights structural barriers like insurance gaps and suggests policies like folic acid fortification in corn masa flour could improve public health outcomes.
Researchers at the University of California, Irvine analyzed data from over 85,000 women aged 18 to 49 in the U.S. using the National Institutes of Health’s All of Us Research Program. Their study, published in the *Journal of Sexual and Reproductive Healthcare*, found that access to healthcare and insurance coverage strongly influences whether women take folic acid supplements, which help prevent neural tube defects like spina bifida and anencephaly. Women without insurance were significantly less likely to report supplement use, while older pregnant women showed higher adherence, possibly due to better prenatal care access. The study also revealed racial and ethnic disparities: non-Hispanic Black women were more likely than non-Hispanic White women to report folic acid use, while among Hispanic participants, age, pregnancy status, education, and insurance coverage were key factors. Researchers noted that structural barriers, such as lack of insurance, may outweigh birthplace in determining supplement use. Yael Marks, the study’s corresponding author, emphasized that preventing neural tube defects requires early access to healthcare and education for women of reproductive age. The interdisciplinary team, including experts from the School of Pharmacy & Pharmaceutical Sciences and the Department of Chicano/Latino Studies, highlighted how social inequities and healthcare access shape preventive care. Co-author Isabel Almeida stated that collaboration across disciplines provided deeper insights into the barriers communities face. The findings support public health efforts to reduce preventable birth defects through improved access, education, and culturally responsive outreach. The study’s timing coincides with growing state-level efforts to fortify corn masa flour with folic acid. In January 2026, California became the first state to mandate folic acid fortification in masa-based products like tortillas, targeting populations that rely on these staples. Researchers said the findings could inform similar policies nationwide, addressing disparities in folic acid consumption and reducing neural tube defects.
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