Neural tube defects (NTDs) are serious birth defects with more than 300 000 deliveries annually worldwide, causing increased mortality, morbidity, disabilities, and economic burden. About 50% to 72% of NTDs are preventable by adequate folic acid supply in the critical period of organogenesis.1,2 This potential is vastly underused despite extensive public health efforts. The policy of folic acid supplementation is failing and has led to health inequalities.3 We analyze the current state of preconceptional folic acid use and propose the Folic Acid Rescue Strategy to increase the potential of folic acid supplementation in NTD prevention.