Study Links Insurance and Healthcare Access to Folic Acid Use, Birth Defect Prevention

A new study finds that access to healthcare and health insurance strongly influences whether women take folic acid supplements, a proven preventive measure against birth defects. Drawing on health data from more than 85,000 women across the United States, 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. The findings suggest that systemic barriers, not simply personal choice or cultural background, may be limiting access to a proven preventive intervention.

Women without health insurance were significantly less likely to report taking folic acid supplements, and older pregnant women were more likely to use supplements, a trend that may reflect greater engagement with healthcare providers and prenatal care services. 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.

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. The findings point to a simple but important reality: access to healthcare can determine whether people receive preventive information and resources before pregnancy begins.

The study's timing is 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.

In Texas, the University of Houston College of Pharmacy is developing a Texas-based community pharmacy research hub designed to help policymakers, providers and communities better understand the barriers, needs, and opportunities to improve pharmaceutical care for patients across the state. Led by the Prescription Drug Misuse Education and Research (PREMIER) Center, the PREMIER Center Community Pharmacy Research Network (PC-CPRN) is recruiting community pharmacies across Texas to serve as research partners. The network is currently anchored by the founding partner, Lufkin-based Brookshire Brothers Pharmacy, which operates 71 community pharmacy locations across Texas and Louisiana. "This network will help us understand both the barriers patients face at the pharmacy counter and the practical solutions already working in communities across Texas," the PREMIER Center director said. One early focus is understanding how community pharmacies can better implement evidence-based guidance for dispensing buprenorphine and supporting people with opioid use disorder.

Researcher perspectives also highlight the role of access in medication use. A University of Houston College of Pharmacy doctoral student examining diabetes management with real-world data, including the use of GLP-1 receptor agonists, said lower spending should not automatically be seen as a success. "Instead, we need to ensure that patients are receiving appropriate and timely care." By examining policies such as insulin cost caps, her work reframes the conversation from "Why are these drugs expensive?" to "Why are some patients unable to access them at all?" She noted that improving coverage for effective therapies may increase short-term spending but can prevent complications and reduce long-term costs. She also acknowledged that the data only captures patients who interact with the healthcare system: "There are many individuals who are not even in the data because they could never seek care at all likely due to barriers to access."