Impact of Insurance Coverage on Women's Health: Folic Acid Intake Findings

A research study from the University of California, Irvine, featured in the Journal of Sexual and Reproductive Healthcare, has highlighted a direct connection between healthcare access, insurance coverage, and the intake of folic acid supplements among women. This investigation, using data from the National Institutes of Health's All of Us Research Program, evaluates various factors such as race, ethnicity, income, and social determinants affecting folic acid consumption among over 85,000 women aged 18 to 49 across the U.S.

The research was a collaborative effort across multiple UC Irvine departments, including Pharmacy & Pharmaceutical Sciences, Chicano/Latino Studies, and Psychology. This underscores the importance of interdisciplinary collaboration in addressing public health issues. Folic acid, a B vitamin essential for preventing neural tube defects like spina bifida, has a low adherence rate among women of reproductive age despite national guidelines recommending its intake.

Uninsured women were significantly less likely to report supplement use compared to insured women. Older pregnant women displayed higher usage rates, likely due to better healthcare access. The study also revealed racial and ethnic disparities: non-Hispanic Black women were found to take more supplements than non-Hispanic White women. Among Hispanic women, factors such as age, pregnancy status, education, and insurance constituted stronger predictors of supplement use than nationality.

According to Yael Marks, Assistant Clinical Professor at the School of Pharmacy & Pharmaceutical Sciences, healthcare access barriers, including insurance availability, may play a crucial role in folic acid use. Co-author Isabel Almeida stressed that examining the issue through both healthcare and social equity lenses provides an in-depth understanding of the challenges faced by diverse communities.

These findings carry significant implications for public health initiatives aiming to reduce neural tube defects through improved healthcare access and education. Legislative moves by states, such as California's requirement for folic acid fortification in corn masa flour, align with these efforts and will take effect in January 2026.

As part of one of the largest health research initiatives, the All of Us Research Program seeks to collect diverse participant data to drive personalized medicine and public health research. UC Irvine serves as a host site, fostering collaborations across its School of Medicine and other campus entities.

Contributors to this research include Brian Vu and Tara Mostafazadeh from the Department of Clinical Pharmacy Practice at UC Irvine.