The Government recognises the concerns raised about how perinatal mortality reviews are carried out. The Perinatal Mortality Review Tool provides a framework which needs to also be supported by effective implementation to deliver the objectives of these reviews.

My Rt Hon. Friend, the Secretary of State for Health and Social Care, is chairing the Maternity and Neonatal Taskforce to develop a national action plan to reform maternity and neonatal services. As Baroness Amos’ report makes clear, there is a pressing need to improve the quality, transparency, oversight, and accountability of investigations and we are working with the taskforce to review this.

With regard to coronial investigation of stillbirth, I refer the Noble Lord to the answer provided on 15 July in response to Question HL1814, which, for ease of reference, has been reproduced below:

“All bereaved parents have the option to be involved in a high-quality review of the death of their baby, from 22 weeks' gestation up to 28 days post birth, through a perinatal mortality review. While this is carried out by the hospital or hospitals where the mother and baby were looked after, a national tool is in place, namely the national Perinatal Mortality Review Tool, to ensure such reviews are objective, robust, and standardised.

“There are a range of views on how stillbirths should be investigated, and it is important that the Government’s conclusions on coronial investigations of stillbirths reflect the recommendations Baroness Amos has made through the final report of her independent investigation into National Health Service maternity and neonatal care, and supports the most effective model for maternity investigations.

“As recommended in Baroness Amos’ report, we will publish the Government’s response to the 2019 consultation, jointly with the Ministry of Justice, in due course.”

The Government recognises the concerns raised about how perinatal mortality reviews are carried out. The Perinatal Mortality Review Tool provides a framework which needs to also be supported by effective implementation to deliver the objectives of these reviews.

My Rt Hon. Friend, the Secretary of State for Health and Social Care, is chairing the Maternity and Neonatal Taskforce to develop a national action plan to reform maternity and neonatal services. As Baroness Amos’ report makes clear, there is a pressing need to improve the quality, transparency, oversight, and accountability of investigations and we are working with the taskforce to review this.

With regard to coronial investigation of stillbirth, I refer the Noble Lord to the answer provided on 15 July in response to Question HL1814, which, for ease of reference, has been reproduced below:

“All bereaved parents have the option to be involved in a high-quality review of the death of their baby, from 22 weeks' gestation up to 28 days post birth, through a perinatal mortality review. While this is carried out by the hospital or hospitals where the mother and baby were looked after, a national tool is in place, namely the national Perinatal Mortality Review Tool, to ensure such reviews are objective, robust, and standardised.

“There are a range of views on how stillbirths should be investigated, and it is important that the Government’s conclusions on coronial investigations of stillbirths reflect the recommendations Baroness Amos has made through the final report of her independent investigation into National Health Service maternity and neonatal care, and supports the most effective model for maternity investigations.

“As recommended in Baroness Amos’ report, we will publish the Government’s response to the 2019 consultation, jointly with the Ministry of Justice, in due course.”

The Government recognises the concerns raised about how perinatal mortality reviews are carried out. The Perinatal Mortality Review Tool provides a framework which needs to also be supported by effective implementation to deliver the objectives of these reviews.

My Rt Hon. Friend, the Secretary of State for Health and Social Care, is chairing the Maternity and Neonatal Taskforce to develop a national action plan to reform maternity and neonatal services. As Baroness Amos’ report makes clear, there is a pressing need to improve the quality, transparency, oversight, and accountability of investigations and we are working with the taskforce to review this.

With regard to coronial investigation of stillbirth, I refer the Noble Lord to the answer provided on 15 July in response to Question HL1814, which, for ease of reference, has been reproduced below:

“All bereaved parents have the option to be involved in a high-quality review of the death of their baby, from 22 weeks' gestation up to 28 days post birth, through a perinatal mortality review. While this is carried out by the hospital or hospitals where the mother and baby were looked after, a national tool is in place, namely the national Perinatal Mortality Review Tool, to ensure such reviews are objective, robust, and standardised.

“There are a range of views on how stillbirths should be investigated, and it is important that the Government’s conclusions on coronial investigations of stillbirths reflect the recommendations Baroness Amos has made through the final report of her independent investigation into National Health Service maternity and neonatal care, and supports the most effective model for maternity investigations.

“As recommended in Baroness Amos’ report, we will publish the Government’s response to the 2019 consultation, jointly with the Ministry of Justice, in due course.”

The Government recognises the concerns raised about how perinatal mortality reviews are carried out. The Perinatal Mortality Review Tool provides a framework which needs to also be supported by effective implementation to deliver the objectives of these reviews.

My Rt Hon. Friend, the Secretary of State for Health and Social Care, is chairing the Maternity and Neonatal Taskforce to develop a national action plan to reform maternity and neonatal services. As Baroness Amos’ report makes clear, there is a pressing need to improve the quality, transparency, oversight, and accountability of investigations and we are working with the taskforce to review this.

With regard to coronial investigation of stillbirth, I refer the Noble Lord to the answer provided on 15 July in response to Question HL1814, which, for ease of reference, has been reproduced below:

“All bereaved parents have the option to be involved in a high-quality review of the death of their baby, from 22 weeks' gestation up to 28 days post birth, through a perinatal mortality review. While this is carried out by the hospital or hospitals where the mother and baby were looked after, a national tool is in place, namely the national Perinatal Mortality Review Tool, to ensure such reviews are objective, robust, and standardised.

“There are a range of views on how stillbirths should be investigated, and it is important that the Government’s conclusions on coronial investigations of stillbirths reflect the recommendations Baroness Amos has made through the final report of her independent investigation into National Health Service maternity and neonatal care, and supports the most effective model for maternity investigations.

“As recommended in Baroness Amos’ report, we will publish the Government’s response to the 2019 consultation, jointly with the Ministry of Justice, in due course.”

In the United Kingdom, folic acid fortification was first considered by the Committee on Medical Aspects of Food and Nutrition Policy (COMA) in 2000.

In its report on Folic Acid and the Prevention of Disease, COMA considered the 1997 paper by Hook and Czeizelb, Can terathanasia explain the protective effect of folic-acid supplementation on birth defects?.

COMA noted that “It has been suggested that some agents that reduce the incidence of birth defects might do so by increasing the rate of death or abortion of affected fetuses ("terathanasia") and that the effect of folic acid on [neural tube defects] NTDs could be mediated by this means. For this reason, there has been some concern over an increased rate of spontaneous abortions among women taking folic acid supplements.”

COMA further noted that it “is most likely due, however, to an increase in fertility and multiple pregnancies among women taking supplements and to an effect of folate in allowing the survival of non-viable conceptuses to a stage where their loss is recognised as abortions. The generally accepted view is that folic acid supplements prevent NTDs simply by allowing the normal development of the fetal neural tube.”

Folic acid fortification was recommended by COMA in 2000 and by its successor the Scientific Advisory Committee on Nutrition (SACN) in 2006, after an extensive review of the evidence on folate and health. The SACN has further considered the evidence in its 2009 report to the Chief Medical Officer on folic acid and colorectal cancer risk and its 2017 update on folic acid and did not identify any further concerns on the issue.

Folic acid fortification was recommended by the Committee on Medical Aspects of Food and Nutrition Policy (COMA) in 2000 and by its successor the Scientific Advisory Committee on Nutrition (SACN) in 2006, after an extensive review of the evidence on folate and health. The SACN has further considered the evidence in its 2009 report to the Chief Medical Officer on folic acid and colorectal cancer risk and its 2017 update on folic acid.

In SACN’s 2017 update on folic acid, the evidence on high folic acid intakes on cancer risk specifically in relation to prostate, breast, colorectal, and overall cancer risk was reviewed. The report concluded that the findings from the different types of studies were inconsistent but overall, the evidence was inconclusive in relation to prostate and colorectal cancer risk and did not suggest an adverse association with breast cancer or overall cancer risk.

The SACN’s risk assessments concluded that ‘conclusive evidence from randomised controlled trials (RCTs) has shown that folic acid supplementation during the early stages of pregnancy can reduce the risk of the fetus developing neural tube defects (NTDs)’.

Foetal death rates was not a health outcome specifically considered by the SACN.

The level of folic acid chosen for fortification was 250 micrograms per 100 grams flour, with a view to minimising the risk of the population exceeding the tolerable upper intake level, which was considered in the Governments impact assessment.

The Government is planning an evaluation on the impact of the policy.

All bereaved parents have the option to be involved in a high-quality review of the death of their baby, from 22 weeks' gestation up to 28 days post birth, through a perinatal mortality review. While this is carried out by the hospital or hospitals where the mother and baby were looked after, a national tool is in place, namely the national Perinatal Mortality Review Tool, to ensure such reviews are objective, robust, and standardised.

There are a range of views on how stillbirths should be investigated, and it is important that the Government’s conclusions on coronial investigations of stillbirths reflect the recommendations Baroness Amos has made through the final report of her independent investigation into National Health Service maternity and neonatal care, and supports the most effective model for maternity investigations.

As recommended in Baroness Amos’ report, we will publish the Government’s response to the 2019 consultation, jointly with the Ministry of Justice, in due course.

In October 2025, NHS England set out the expectation, through the Medium Term Planning Framework, for trusts to implement the National Bereavement Care Pathway for stillbirth and neonatal death. In practice, some of these standards will also be applicable in the context of miscarriage, ectopic pregnancy, and molar pregnancy, offering support for these women and families.

While miscarriage and other types of pregnancy loss were not explicitly covered in Baroness Amos’ final report into National Health Service maternity and neonatal care, she did make a recommendation around fundamentally reforming care, including through the development of a new modern service framework. The taskforce will consider all stages of maternity and neonatal care when developing its new national action plan, and we anticipate that the taskforce may wish to include pregnancy loss.

We are also working closely with NHS England to improve the availability of Early Pregnancy Assessment Units, and have extended the Baby Loss Certificate scheme, which provides recognition of pre-24-week loss.

In October 2025, NHS England set out the expectation, through the Medium Term Planning Framework, for trusts to implement the National Bereavement Care Pathway for stillbirth and neonatal death. In practice, some of these standards will also be applicable in the context of miscarriage, ectopic pregnancy, and molar pregnancy, offering support for these women and families.

While miscarriage and other types of pregnancy loss were not explicitly covered in Baroness Amos’ final report into National Health Service maternity and neonatal care, she did make a recommendation around fundamentally reforming care, including through the development of a new modern service framework. The taskforce will consider all stages of maternity and neonatal care when developing its new national action plan, and we anticipate that the taskforce may wish to include pregnancy loss.

We are also working closely with NHS England to improve the availability of Early Pregnancy Assessment Units, and have extended the Baby Loss Certificate scheme, which provides recognition of pre-24-week loss.