Introduction Neural tube defects (NTD) are the commonest birth defects accounting for one in every 1000 birth defects in the USA. A neural tube defect is defined as an opening that develops early in life in the brain of the fetus (Golalipour, Mobasheri, Vakili & Keshtkar, 2007, para. 1). The condition develops between the 25 th and 28 th day after conception. There are two types of neural tube defects with the most common being the open NTDs which occur when a defect in the backbone and the skull exposes the spinal cord, particularly during birth. Spina finida, anencephaly and encephalocele are the most common types of open NTDs in the United States of America. A constellation of factors is responsible for causing neural tube defects: environmental, genetic and dietary factors. About 60% of NTDs can be prevented through supplementation of women’s diet with 0.4 mg of folic acid and water-soluble B vitamins (Duke Centre for Human Genetics). According to Suarez et al (2000, p.1017), high prevalence rates of neural tube defects have been witnessed in the Mexican populations and subsequently in the areas along the Mexico USA border. The prevalence rates of NTDs in pregnancies during the period between 1993 and 1995 were found to be 6.4, 7.1, and 1.1 for anencephaly, spina bifida and encephalocele respectively (Hendricks, Simpson &Larsen, 1999, p.1120). The Chinese province of Shanxi has recorded the highest incidence of neural tube defects and NTD birth prevalence rate in the world. This has been blamed mainly on folic acid deficiency (Liz et al, 2006, p.238). The prevalence of NTDs in the United States is around 1 in 1000 live births with 3.7 in 10000 for anencephaly, 1.4 in 10000 for encephalocele and 5.5 for 10000 for spina bifida (Smith and Dlugos). The states bordering Mexico have reported higher prevalence and incidences of NTDs compared to other states. This is because most of the inhabitants are of Mexican origin. According to Harris and Shaw (1995, p.163), Mexican Americans have between 50 – 200 % higher than the whites, non-Hispanic, and African Americans. Cameron County in Texas recorded 29 cases per 10000,the highest prevalence for NTD in the USA, in 1995 with the authorities confirming that the endemicity of this condition was due to the high proportion (95%) of the population being of Mexican descent (Suarez et al, 2000, p.1019). Suarez and Hendricks (2002) found that prevalence in Mexican Americans was double compared to the US-born in California, Texas Mexico border and Cameron County particularly in 1990-1995. This study was done in Texas where epidemiological data was collected from the Texas department of health to analyze it and utilize it as a basis for policy recommendations. Methods Data for this study was collected from the Texas Birth Defects Epidemiology and Surveillance Branch of the Department of Health for the period 1999-2005. This branch is mandated to record and publish all data relating to neural tube defects research and surveillance and prevention in all the counties in Texas. The data was broken down in relation to maternal age, maternal race /ethnic group, infant/fetus sex, public health region and country of mother’s residence at delivery. The data were categorized into