Access matters

“For decades, healthcare providers have recommended that women of reproductive age take folic acid, a form of vitamin B that can help prevent severe birth defects affecting the brain and spinal cord. Yet despite widespread awareness campaigns, many women still do not receive the recommended amount. A new UC Irvine study sheds light on why. Drawing on health data from more than 85,000 women across the United States, researchers found that access to healthcare and health insurance strongly influences whether women take folic acid supplements. The findings suggest that systemic barriers, not simply personal choice or cultural background, may be limiting access to a proven preventive intervention. The study, published in the Journal of Sexual and Reproductive Healthcare , analyzed data from women ages 18 to 49 from the National Institutes of Health’s All of Us Research Program, one of the nation’s largest and most diverse health research initiatives. Researchers examined how factors such as race, ethnicity, income, and insurance coverage affect folic acid consumption. Why folic acid matters Folic acid helps prevent neural tube defects such as spina bifida and anencephaly. These conditions develop very early in pregnancy, often before a woman realizes she is pregnant, which is why health experts recommend daily folic acid supplementation for women who could become pregnant. Despite those recommendations, overall use remains lower than public health officials would like to see. The UC Irvine team found that women without health insurance were significantly less likely to report taking folic acid supplements. Researchers also observed that older pregnant women were more likely to use supplements, a trend that may reflect greater engagement with healthcare providers and prenatal care services. The findings point to a simple but important reality: access to healthcare can determine whether people receive preventive information and resources before pregnancy begins. “Preventing neural tube defects begins long before pregnancy, which is why access to healthcare and preventive education is so important for all women of reproductive age,” says corresponding author Yael Marks, health sciences assistant clinical professor in the UC Irvine School of Pharmacy & Pharmaceutical Sciences. “Our findings show that structural barriers like insurance coverage can strongly influence whether women receive this simple but lifesaving intervention.” Looking beyond demographics The researchers also explored racial and ethnic differences in supplement use. Among Hispanic participants, the study found no significant difference in folic acid use between women born in the United States and those born elsewhere. Instead, factors such as age, pregnancy status, educational attainment and health insurance coverage were more strongly associated with supplementation. The results challenge assumptions that birthplace alone determines preventive health behaviors. Instead, they highlight the influence of broader social and economic conditions. The project itself reflected a multidisciplinary approach, bringing together experts from the School of Pharmacy & Pharmaceutical Sciences, the Department of Chicano/Latino Studies and the Department of Psychology. Researchers say that collaboration helped provide a more complete understanding of the issue. “This collaboration allowed us to examine folic acid supplementation not only as a medical issue, but also through the lens of social inequities and healthcare access,” says co-author Isabel Almeida of the Department of Chicano/Latino Studies and Department of Psychology. “Bringing together researchers from different disciplines helps us better understand the barriers communities face and identify more effective public health solutions.” Informing future public health efforts Researchers believe the study’s findings can help guide efforts to reduce preventable birth defects through improved healthcare access, education and culturally responsive outreach programs. The timing is especially notable as policymakers across the country explore additional ways to increase folic acid intake. California became the first state in January 2026 to require folic acid fortification of corn masa flour products, including tortillas, a move designed to reduce neural tube defects among populations that regularly consume masa-based foods. The UC Irvine study also supports broader efforts to expand fortification initiatives in other states. Ultimately, the research underscores a larger lesson about preventive healthcare: effective interventions are only useful when people can access them. For the thousands of families affected by birth defects each year, improving access to insurance coverage, preventive education and nutritional resources could make a meaningful difference long before a pregnancy begins.

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