EC Gynaecology

Neural tube defects (NTDs) remain a significant cause of neonatal mortality, disability, and adverse maternal-child health outcomes, despite strong evidence that periconceptional folic acid supplementation and food fortification can prevent most cases. In Ethiopia, recent advances in preconception care, micronutrient supplementation, and mandatory food fortification have strengthened efforts to prevent NTDs; however, these interventions remain insufficiently integrated across the continuum of care. In contrast, Ethiopia’s Prevention of Mother-to-Child Transmission (PMTCT) program has achieved notable success through the implementation of the World Health Organization’s four-prong HIV prevention framework. This commentary proposes adapting that proven framework to NTD prevention by focusing on: (1) preventing unintended pregnancies among at-risk women, (2) preventing NTDs during pregnancy through folic acid supplementation, fortification, counseling, and screening, (3) preventing recurrence among high-risk women, and (4) providing treatment, rehabilitation, and psychosocial support for affected children and their families. By drawing on lessons from Ethiopia’s HIV response, we argue that adopting a four-prong approach could strengthen policy integration, improve maternal and child health outcomes, and accelerate progress toward reducing the burden of NTDs.

Keywords: Folic Acid; Maternal Health; Neural Tube Defects; PMTCT; Preconception Care

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