From Portugal to Russia, Europe is often viewed as a more developed part of the world where the clinical signs of vitamin and mineral deficiencies are not prevalent.  In reality, however, certain countries in this region are still characterized by deficiencies at a level of public health significance which deserve attention. 

Wheat is the most commonly consumed grain in this region. Using wheat flour as the main food vehicle for fortification is especially appropriate for Europe given high regional consumption of bread and pasta.  In addition, common fortification challenges in other regions, such as an abundance of small mills and an underdeveloped transportation infrastructure, are not evident here.

About 4500 pregnancies in the European Union are affected by a neural tube defect every year. A paper published in 2015 said, 'Europe has an epidemic of spina bifida and anencephaly (two types of neural tube defects) compared with countries with mandatory folic acid fortification policy.'

In the European Union, an estimated 72% of affected pregnancies are terminated. For more information on how fortifying flour could be used to prevent these birth defects see the following three documents:

At one time Ireland had extensive voluntary fortification of foods with folic acid, but the percentage of fortified foods has decreased, and the incidence of neural tube defects is increasing.

In Switzerland, about 250 food products are voluntarily fortified with folic acid said, Erich P. Meyer, one of the founders of a national campaign to increase awareness about the need for folic acid intake. The campaign is focused on a website and an annual magazine. In 1999, 38% of the Swiss population said they were aware of the importance of folic acid; that had increased to 75% by 2011.

“We are well aware of the fact that we will never be able to reach the same level of results with our campaign as any mandatory fortification would achieve,” Meyer said. “However we believe that what we do is the best we could do.”

In Europe, we frequently collaborate with two key partners - the International Federation for Spina Bifida and Hydrocephalus (IF) and UNICEF.  Both entities have significant experience and knowledge related to country-specific flour fortification efforts in the region.

Fortification Legislation Status by Country and Grain

Click on any of the column headings to sort the list by Country, Wheat Flour, Maize Flour, or Rice.

Country Wheat Flour Maize Flour Rice
AndorraNo Fortification----
AustriaNo Fortification----
BelarusNo Fortification----
BelgiumNo Fortification----
Bosnia and HerzegovinaNo Fortification----
BulgariaNo Fortification----
Channel IslandsNo Fortification----
CroatiaNo Fortification----
CyprusNo Fortification----
Czech RepublicNo Fortification----
DenmarkNo Fortification----
EstoniaNo Fortification----
Faroe IslandsNo Fortification----
FinlandNo Fortification----
FranceNo Fortification----
GermanyNo Fortification----
GreeceNo Fortification----
Holy See------
HungaryNo Fortification----
IcelandNo Fortification----
IrelandNo Fortification----
Isle of ManNo Fortification----
IsraelNo Fortification----
ItalyNo Fortification----
LatviaNo Fortification----
LiechtensteinNo Fortification----
LithuaniaNo Fortification----
LuxembourgNo Fortification----
Macedonia, former Yugoslav RepublicPlanning----
MaltaNo Fortification----
Moldova, Republic ofMandatory----
MonacoNo Fortification----
NetherlandsNo Fortification----
NorwayNo Fortification----
PolandNo Fortification----
PortugalNo Fortification----
RomaniaNo Fortification----
Russian FederationNo Fortification----
San MarinoNo Fortification----
SerbiaNo Fortification----
SlovakiaNo Fortification----
SloveniaNo Fortification----
SpainNo Fortification----
Svalbard and Jan Mayen IslandsNo Fortification----
SwedenNo Fortification----
SwitzerlandNo Fortification----
UkraineNo Fortification----
United KingdomMandatory----

Europe - Fortification Status

Our definition of the legislative status is:

  • Mandatory: Legislation has the effect of mandating fortification of one or more types of wheat or maize flour or rice with at least iron or folic acid.
  • Planning: There is written evidence that the government is acting to prepare, draft, and/or move legislation for mandatory fortification.
  • Voluntary: Most countries allow voluntary fortification. We use this category if at least 50 % of the industrially-milled wheat or maize flour or rice produced in the country is being fortified through voluntary efforts.
  • Territory: An area under the jurisdiction of another country, according to the 2015 World Almanac. We assume the territory follows the food regulations of the governing body and will not have its own fortification legislation. See a list of territories.
  • No fortification: None of the above.
  • Dashes in the table below indicate that no information is available. Please send information to

Most fortification legislation mandates address only the most commonly consumed grain in the country. Click on the country name in the table above to see the amount of each grain available in the food supply, according to the Food and Agriculture Organization of the United Nations.



Global Miller's Symposium

20 April 2017

Fortifying our Future: Regional summit for improving the health of women and children through flour fortification

03 April 2017

WHO Guideline Development Meeting: Optimal Blood Folate

23 September 2013

European Health Forum Gastein

03 October 2012

UNICEF-FFI Workshops for CEECIS Region

12 June 2012


Flour Fortification Resulted in 35,500 Healthier Babies Last Year
15 July 2016

Researcher reflects on fortification progress 25 years after landmark study
11 May 2016

2015 Year in Review
23 March 2016

Systematic Review Yields Recommendations for Flour Fortification Programs
04 October 2015

Study Links Flour Fortification to Reduced Anemia Prevalence
07 July 2015

Regional Resources

Ukraine struggles to fortify wheat flour to prevent birth defects of the brain and spine

Neural tube defects in the Republic of Ireland in 2009-11

English women do not take folic acid supplements consistently

Folic acid fortification of wheat flour: a cost-effective public health intervention to prevent birth defects in Europe

Roadblocks to progress: a look at why Ireland and New Zealand halted mandatory flour fortification with folic acid

Flour Fortification - a possible strategy for the prevention of neural tube defects in Germany?