Despite high overall folic acid supplementation rates reaching over 92% in both urban and rural China by 2019, adequate periconceptional adherence remained suboptimal at approximately 65%, with lower maternal socioeconomic status as the primary driver of inequality.
Overall periconceptional folic acid supplementation (FAS) use increased substantially from 2012 to 2019, reaching over 92% in both urban and rural areas of China.
Adequate periconceptional folic acid adherence remained suboptimal despite high overall supplementation rates.
Lower maternal socioeconomic status (SES) was strongly associated with reduced periconceptional folic acid supplementation use.
Maternal education was identified as the primary driver of socioeconomic inequality in periconceptional folic acid supplementation use.
Low paternal education persisted as an independent barrier to adequate folic acid adherence even after accounting for maternal factors.
Socioeconomic inequalities in folic acid supplementation were quantified using the Erreygers Concentration Index with maternal education as the primary SES measure.
This research suggests that while China has made impressive progress in getting pregnant women and those planning pregnancy to take folic acid supplements — with over 92% of both urban and rural women doing so by 2019 — far fewer women are taking folic acid in the way that is most effective. Only about 65% of women in both urban and rural areas were classified as having 'adequate' adherence, meaning they took folic acid at the right time and for the recommended duration around conception. This gap between simply taking any supplement and taking it correctly is an important public health concern, since folic acid is most beneficial when taken before and in the early weeks of pregnancy to help prevent serious birth defects. The study found that women with lower levels of education and lower socioeconomic status were significantly less likely to use folic acid supplements adequately. Maternal education was the single biggest factor explaining why some groups had lower rates of proper supplementation than others. Interestingly, the father's level of education also mattered independently — even after accounting for the mother's characteristics, having a less-educated father was associated with lower rates of adequate folic acid use. This suggests that household-level social and educational resources, not just the mother's own background, shape whether folic acid is used correctly. This research suggests that public health programs in China should move beyond simply increasing awareness that folic acid exists, and instead focus on helping women — particularly those with lower education levels or from lower socioeconomic backgrounds — understand how and when to take it correctly. Targeting educational outreach and support to these high-risk groups, and potentially engaging male partners as well, could help close the gap between overall supplement use and truly effective periconceptional folic acid adherence.
Upload your bloodwork. We'll cross-reference your results against this study and 4,700 others.
Upload Your LabsDong J, Gao X, Shi S, Yang Y, Xu J, Zhang Y, et al.. (2026). Trends, disparities, and socioeconomic inequalities in periconceptional folic acid supplementation in China: a nationwide survey analysis.. BMC pregnancy and childbirth. https://doi.org/10.1186/s12884-026-09015-2