Insurance coverage, healthcare access influence whether women get required amounts
- Women lacking adequate health insurance were significantly less likely to take recommended amounts of folic acid to help prevent serious birth defects, UC Irvine researchers found.
- The nationwide study analyzed health data from more than 85,000 women and found that healthcare access and other structural barriers may play a larger role in folic acid use than birthplace alone.
- Researchers say the findings can aid public health efforts focused on improving preventive care access, culturally responsive outreach and folic acid fortification initiatives.
Access to healthcare and insurance coverage strongly influence whether women take recommended amounts of folic acid to help prevent serious birth defects, according to University of California, Irvine researchers using the National Institutes of Health’s All of Us Research Program data.
The study, published in the Journal of Sexual and Reproductive Healthcare, analyzed health data from more than 85,000 women ages 18 to 49 across the U.S. Researchers examined how race, ethnicity, insurance coverage, income and other social factors affect folic acid consumption.
The project brought together researchers across multiple UC Irvine disciplines, including the School of Pharmacy & Pharmaceutical Sciences, the Department of Chicano/Latino Studies and the Department of Psychology, highlighting the value of cross-divisional collaboration in addressing public health disparities.
Folic acid, a form of vitamin B, helps prevent neural tube defects such as spina bifida and anencephaly, which develop early in pregnancy, often before a woman knows she is pregnant. National guidelines recommend daily folic acid for women who could become pregnant, but researchers found overall use remains low.
Women without health insurance were significantly less likely to report taking folic acid supplements, according to the study. Older pregnant women, in particular, were more likely to use supplements, which researchers said may reflect greater access to healthcare providers and prenatal care.
The study also examined racial and ethnic differences in supplement use. Non-Hispanic Black women were more likely than non-Hispanic White women to report taking folic acid supplements. Among Hispanic participants, researchers found no significant difference between U.S.-born and foreign-born women. Instead, age, being pregnant, educational attainment and health insurance coverage were associated with supplementation within this group.
The findings suggest that structural barriers, particularly healthcare access, may play a larger role in folic acid use than birthplace alone.
“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,” said corresponding author Yael Marks, health sciences assistant clinical professor in the 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.”
Co-author Isabel Almeida with the Department of Chicano/Latino Studies and Department of Psychology said the research’s interdisciplinary emphasis provided a broader understanding of how social and cultural factors influence preventive healthcare access.
“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,” Almeida said. “Bringing together researchers from different disciplines helps us better understand the barriers communities face and identify more effective public health solutions.”
Researchers said the findings can help inform public health efforts to reduce preventable birth defects through improved healthcare access, education and culturally responsive outreach.
The findings come as a growing number of states consider policies to increase folic acid fortification in corn masa flour. In January 2026, California became the first state to require folic acid fortification of corn masa flour products, including tortillas, to help reduce neural tube defects among populations that consume masa-based foods as dietary staples.
The study also supports efforts elsewhere to expand folic acid fortification in corn masa flour and tortillas, foods commonly consumed in many Hispanic households.
