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HOUSE OF REPRESENTATIVES:
RECEIVED
SEVENTEENTH CONGREBS —pare._ 29 AUG 2016

CONGRESS OF THE PHILIPRINES .... yal)
First Regular Session eee yea

HOUSE OF REPRESENTATIVES BY:

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House Bill No, 824 REGISTR
ICE

BILLS AND INDEX SE:
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Introduced by REPRESENTATIVE PIA S. CAYETANO

EXPLANATORY NOTE

Maternal health has been closely linked to newborn survival. The desire to
have children and raise them well empowers many women and families to plan for
their pregnancies. Many, however, do not have the knowledge and access to
reproductive health services.

Public health data show that congenital anomalies rank among the top 20
causes of death across the life span and are already the third leading cause of death
in the infancy period. Some of these defects, like that of the neural tube defects,
happen in the first month of pregnancy—often before a woman even knows that she
is pregnant. Neural tube defects are birth defects of the brain, spine and cord.

In the Philippines, 17% of all intended pregnancies end up in miscarriage.
Further, more than half of all pregnancies are unplanned

Empirical studies have shown that folic acid deficiency increases the risk of
pregnant women to have an early miscarriage or give birth to a child with congenital
anomalies or birth defects. A prevalence study of folic acid deficiency among
pregnant women showed that more than half (51.7%) had deficiency. Moreover, the
scale and impact of folic acid deficiency in the Philippines is still difficult to quantify
due to insufficient data. However, folic acid deficiency makes a substantial
contribution to the national and global burden of miscarriage, neural tube defects,
intrauterine growth retardation and pre-term births. Folic Acid is a micronutrient
belonging to the B complex group of vitamins. This micronutrient can be found in
fruits, vegetables, legumes, and dairy products; and its deficiency can be brought
about by low intake of the food group mentioned above, malabsorption and intestinal


parasite infections, and genetic disorders of folic acid metabolism. Unfortunately, the
mean one-day intake of Filipinos, women of reproductive age (including pregnant
and lactating mothers), is low in vegetables (10.7%), fruits (7.3%), legumes (0.55%),
and dairy products (3.8%), based on the 2008 National Nutrition Survey. Intervention
studies claim that folic acid intake can lower the risk of miscarriages and neural tube
defects by 20% and 70%, respectively.

These premises, therefore, warrants a comprehensive approach that
addresses the causes of folic acid deficiency and its association to miscarriages and
congenital anomalies. Fortification of food products with folic acid has been
considered to be the most effective method of ensuring adequate intake of folic acid
in women of reproductive age. Periconceptional folic acid supplementation also has
a strong protective effect against congenital anomalies. Actions, policies,
and programmes to promote and increase the supply, access, consumption, and
utilization of an adequate quantity, quality, and a variety of food for all population
groups shall be enacted and supported, which further includes food-based
strategies, nutrition counseling, public health and food safety measures.

For these reasons, the passage of this bill is urged.

PIAS. CAYETANO

2~ District of Taguig City


SEVENTEENTH CONGRESS
CONGRESS OF THE PHILIPPINES
First Regular Session
HOUSE OF REPRESENTATIVES

House Bill No 341

Introduced by REPRESENTATIVE PIA S. CAYETANO

AN ACT
ESTABLISHING AN INTEGRATED UTILIZATION AND PROMOTION OF FOLIC
ACID FOOD FORTIFICATION AND SUPLEMENTATION

Be it enacted by the Senate and the House of Representatives of the Philippines in
Congress assembled:

ARTICLE 1
GENERAL PROVISIONS

SECTION 1. Short Title. —This Act shall be known as the “Folic Acid Act of 20XX".
SEC. 2. Declaration of Policy. — It is the policy of the State to equally protect the life
of the mother and the lives of the unborn from conception, promote the right to health
of the people, and instil health consciousness among them. In pursuit of these
policies, the State recognizes the need to adopt and support a comprehensive
approach that addresses the causes of folic acid deficiency and its association to
miscarriage and congenital anomalies. Actions, policies and programmes to promote
and increase the supply, access, consumption and utilization of an adequate
quantity, quality, and a variety of food for all population groups shall be enacted to
strengthen other policies that were formulated and implemented which includes food-
based strategies, nutrition education, public health and food safety measures, and
supplementation. This Act shall also support the achievement of global goals for
adequate nutrition and attainment of healthy life for all and at all ages. The State also
recognizes that an effective public education program is vital in preventing the ill-
effects of folic acid deficiency among pregnant women, such as miscarriages and
congenital anomalies

SEC. 3. Objectives. — The objectives of this Act are’

1) To ensure that every woman of reproductive age has access to food and food
products containing folate and folic acid and folic acid suppiements to reduce
the risk of miscarriage and having babies with neural tube defects and other
birth defects;

2) To ensure that there is adequate supply of folic acid-fortified food and food
products and folic acid tablets at an affordable price;


3) To ensure that there is sufficient and correct information on the role of folate
and folic acid for women of reproductive age and their children;

4) To ensure the creation of a sustained inter-agency collaboration for the
aggressive implementation and monitoring of this Act; and

5) To foster collaborative undertakings in continuous research on folic acid food
fortification and supplementation.
ARTICLE 2
DEFINITION OF TERMS

SEC. 4. Definition of Terms. - For the purpose of this Act, the following terms shall
be defined as follows:

1) Birth Defects means a physical or biochemical abnormality that is present at
birth that happens while a baby is developing in the mother's womb that may
be inherited or a result of environmental influence.

2)

Folic Acid is a micronutrient belonging to the B complex group of vitamins,
available in its endogenous (as folate) and synthetic forms.

3)

Fortification means the practice of deliberately increasing the content of an
essential micronutrient in food, so as to improve the nutritional quality of the
food supply and provide a public health benefit with minimal risk to health

4) Neural Tube Defects are birth defects of the brain, spine and cord. They
happen in the first month of pregnancy. The two most common neural tube
defects are spina bifida and anencephaly. In spina bifida, the fetal spinal
column does not close.

5)

Reproductive age means the age at first menstruation period of a woman up
to the age of cessation of menstruation.

6)

Supplementation is the term used to describe the provision of relatively large
doses of micronutrients, usually in the form of pills, capsules or syrups.

ARTICLE 3
INTEGRATED UTILIZATION AND PROMOTION OF FOLIC ACID FOOD
FORTIFICATION AND SUPPLEMENTATION

SEC. 5. Awareness and Promotion. - Medical and allied professionals in the
healthcare delivery system shall integrate in their practice, the reproductive health,
existing burden of miscarriage and birth defects, folic acid intake and deficiency, as
well as the nature and benefits of dietary diversifications, fortification, and
supplementation. The Department of Education (DepEd) and the Commission on
Higher Education (CHED) shall incorporate the above-mentioned information in their
curriculum. Furthermore, print, broadcast and social media promotion, with the use

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of mobile and computer applications shall promote information and other awareness
and promotional programs deemed appropriate to cover this Act shall be the
responsibility of the Department of Health (DOH), in coordination with the Philippine
Information Agency (PIA).

SEC. 6. Dietary Diversification. — The Food and Nutrition Research Institute (FNRI)
in collaboration with the National Nutrition Council (NNC) shall design functional food
and promote nutrition practices through nutrition education.

SEC. 7. Food Fortification. — Fortification of food and food products with folic acid
shall adopt and strengthen the Philippine Fortification Act of 2000, which stipulates
the fortification of food and food products with Vitamin A and Iron only. The type of
fortification and. the fortificant of choice shali be the responsibility of Food and Drug
Administration of the Philippines (FDA). Within three years after the enactment of
this bill, all food groups identified by NNC as commonly consumed and should be
consumed by women of reproductive age shall be fortified with folic acid, in addition
to the other micronutrients added to these food groups.

SEC. 8. Folic Acid Supplementation. — This program is intended for women in the
reproductive age. In addition to food fortification, women that could become pregnant
are required to take folic acid tablets daily. This program shall adopt and strengthen
the Administrative Order 2010-0010 or the revised policy on micronutrient
supplementation and shall ensure that: 1) there is adequate supply of folic acid
tablets, 2) the production, packaging, and distribution of folic acid tablets meet
quality standards, and 3) it is affordable and can be easily accessed by every
Filipina. DOH shall ensure that folic acid supplements are part of the routine services
in all barangay and municipal health centers. Supplements shall also be given in
evacuation centers during emergencies, disasters, and calamities. DOH shall ensure
that explanation on the prescriptions, administration, and delivery of supplements as
well as safety of ingestion are provided to all barangay health workers and the
women in the reproductive age.

SEC. 9. Research Development and Extension. - Research development and
extension undertakings on folic acid shall be incorporated in the National Unified
Health Research Agenda of the Philippine National Health Research System. The
National Institutes of Health (NIH) and all regional health research and development
consortia are required to take part in these undertakings.

ARTICLE 4
IMPLEMENTATION

SEC. 10. Lead Agency. - The DOH shall be the Lead Agency in implementing this
Act. For the purposes of achieving the objectives of this Act, the DOH shall:

41) Establish a National Coalition on Folic Acid;
2) Develop the implementing rules and regulations for the immediate

implementation of the comprehensive program on folic acid within one
hundred eighty (180) days from the enactment of this Act;

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3) Identify a Regional Agency that will oversee the implementation of the Act in
every region in the country; and

4) Coordinate with government and non-government organizations for the
implementation of this Act.

SEC. 11. National Coalition on Folic Acid. — A National Coalition of Folic Acid
provision and utilization shall be established to oversee the overall implementation of
the actions, programs and projects and provide policy directions. The National
Coalition shall assist in the conceptualization, planning, and implementation of the
various programs/projects, primarily on health policy, research development and
extension, awareness and promotion, monitoring and review, regional operations,
and support.

The National Coalition shall be composed of government and private sectors,
academe, hospitals and other health centers, research institutes, and other non-
medical societies.

SEC. 12. Quality Assurance. - A quality assurance system will be established in
accordance to DOH guidelines for food fortification as well as guidelines set by the
World Health Organization (WHO) on food fortification and micronutrient
supplementation.

SEC. 13. Monitoring. - The DOH is given the overall responsibility for the
monitoring program and reporting progress. Other agencies may also contribute to
some elements of the monitoring program as deemed appropriate

SEC. 14. Review. — Periodic review will be done at least once every five years.
Outcome data from the National Nutrition Survey and other nutrition surveillance
systems shall be used in conducting such review.

SEC. 15. Database. — All regional agencies shall maintain a database of all patients
receiving folic acid interventions and those who refused to take folic acid
supplements. Data must be submitted to the DOH on an annual basis to establish a
national registry pursuant to this Act. Outcome data from this registry shall form the
basis for future programs and projects deemed necessary by the nation! to be
incorporated and implemented in this Act.

SEC. 16. Financing and Other Resources. — The Department of Trade and
Industry (DTI), Department of Science and Technology (DOST), Livelihood
Corporation (LIVECOR) and government banks are hereby required to assist and
support affected manufacturers in upgrading their technologies by facilitating soft
loans and financial assistance for the procurement of necessary technologies and
machines in compliance with the provisions of this Act. The Department of the
Interior and Local Government (DILG) shall mobilize and establish financing
programs to support folic acid interventions. Provision for folic acid supplements and
analytical and biochemical laboratory testing for folic acid levels shall be
incorporated in benefit package of the Philippine Health Insurance Corporation
(PhilHealth).


SEC. 17. Establishment and Accreditation of Folic Acid Laboratory Services.
DOH shall ensure that free-standing and hospital-based laboratories are offering
affordable and accurate analytical and biochemical folic acid tests. These
laboratories must be strategically located to be easily accessed by the public.

SEC. 18. Non Compliance with Folic Acid Fortification. — The following shall be
considered non-compliance with the fortification process:

1) If the food fortification levels do not comply with the DOH requirements and
WHO guidelines, except when the deviation from the fortification levels are
justified and are properly declared in the labeling; and

2) If the process of fortification does not conform with the DOH and other
government standards.

SEC. 19. Incentives and Disincentives. - All women who have taken folic acid
tablets before, during, and after conception up to delivery shall be given appropriate
incentives as identified by the National Coalition on Folic Acid

‘Any woman who refuse to take supplements on the grounds of religious and
cultural beliefs and other reason not specified, must acknowledge in writing her
understanding of the risks to her and to her unborn child. A copy of this refusal shall
be indicated in the surveillance registry

ARTICLE 5
FINAL PROVISIONS

SEC. 20. International Commitments. — Nothing in this Act is intended to violate
provisions of Treaties and International Agenda to which the Philippines is a party.

SEC. 21. Implementing Rules and Regulations. — Within one hundred eighty days
from effectivity of this Act, the Department of Health, shall issue the implementing
rules and regulations to this Act.

SEC. 22. Repealing Clause. — All general and special laws, decrees, executive
orders, proclamations and administrative regulations, or any parts thereof, which are
inconsistent with this Act are hereby repealed or modified accordingly.

SEC. 23. Separability. — \f, for any reason or reasons, any part of provisions of this
Act shall be declared or held to be unconstitutional or invalid, other provision or
provisions hereof which are not affected thereby shall continue to be in full force and
effect.

SEC. 24. Effectivity. — This Act shall take effect fifteen (15) days after its publication
in at least two (2) newspapers of general circulation

Approved,