The relationship between awareness and supplementation: which Canadian women know about folic acid and how does that translate into use?

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Although the benefit of folic acid (FA) to prevent neural tube defects (NTD) is well established, not all women take supplements in the periconceptional period. This study used data from the Public Health Agency of Canada's Maternity Experiences Survey to evaluate determinants of awareness of FA among recently pregnant women in Canada, and the extent to which that translated into actual supplement usage. Telephone interviews took place between October 23, 2006 and January 31, 2007 with women who were 5 to 14 months postpartum to survey their experiences during pregnancy, birth and the postpartum period. These analyses were conducted on women who responded to questions relating to FA supplementation. The 6,421 respondents were weighted to represent 76,508 women using weights which corresponded to the sampling strata, the mother's first language and Aboriginal status. Overall, 77.6% of surveyed women knew that taking FA periconceptionally could help protect against NTD. Women who were younger, single or separated reported less awareness and use of FA, while higher maternal age, level of education and income were positively associated with both knowledge and use. Despite longstanding national guidelines for supplementation, there were regional variations in knowledge and use of FA. The data indicate clear socio-demographic differences among Canadian women with respect to their knowledge and use of FA. Although most women understood the benefits of FA supplementation, a little over a third of them did not take FA supplements prior to becoming pregnant, and less than half supplemented according to national guidelines. Identification of those subpopulations whose use of supplements is suboptimal may allow for targeted educational or other interventions to further encourage FA use.