Introduction The occurrence of neural tube defects (NTDs) is usually brought about by a constellation of factors. Although it took lengthy periods before a relationship between the folic acid and NTDs was made, evidence has shown that there is significant association in the causation (Kadir & Economides, 2002, p. 255). In fact, the risk of concurrence and recurrence of the general abnormalities are minimized by the application of peri-conceptional folic acid supplementation. Although variations exist on the recommended dosages in several countries, improvements in health have been observed. Relationship between peri‐conceptional folic acid intake and NTD Intensification and increased calls for fortification have gained momentum in the last ten years aimed at enhancing the uptake of folic acid among the marginalized populations in the United States and Australia. While fortification has gained acceptance, critics of the approach argue that it is associated with masking of macrocytic anemia which is believed to cause irreversible brain damage to women, thereby interfering with the functioning of antagonistic folate drugs. Furthermore, lack of solid empirical evidence denoting the efficacy and benefits of utilizing the intervention curtailed the development of a policy framework regarding the drugs. Empirical evidence from across the world has denoted high benefits and efficiency with regards to the utilization of folic acid hence acting as a justification for the enactment of mandatory folic acid supplementation. A study conducted in Canada produced positive outcomes whereby the incidence of open NTDs reduced by more than half in the Nova Scotia after three years of fortification (Gucciardi et al, 2002, p. 342; Persad et al, 2002, p. 242). In relation to empirical studies, several countries have developed policies in tandem with efficiency depicted in the current studies. Abraham and Webb (2000, p. 76), asserted that marginal improvements in terms of folic acid consumption must be reinforced with mandatory food fortification policies in line with other countries such as US and Canada. In addition, empirical studies in Chile, Canada and United States denoted an insignificant relationship between high folate levels with deficiencies in vitamin B12 (Oakley et al, 2004, p. 840). The Mandatory fortification program in Australia has received criticism with concerns over its tendency to introduce adverse risks to the general population. Introduction of a mandatory fortification of about 200 micrograms was preferred due to its success in the international arena. This was also in relation to the existing frameworks regarding the utilization of thiamine. In their argument, critics denote an increased level in cases of cancer growth at risk groups, interference with drug treatments and the unjustified exposure of more than 20 million Americans to excessive folic acid. Policy options and the scientific and ethical dilemmas Scientific evidence denoting an increased relationship between folate fortification and prevention of the occurrence of neural tube defects has been recorded in many studies. Mandatory fortification requires food manufacturers to provide additives such as minerals or vitamins to certain types of food. This is mainly undertaken in response to a widesprea