An extensive review of the availability of anti-seizure drugs in 73 countries shows that while availability is increasing, safe prescribing is not keeping pace. Valproate, a drug linked to serious birth defects, is still widely used in many regions despite WHO warnings. The drug increases the risk of congenital developmental defects, particularly neural tube defects such as spina bifida, heart and other organ abnormalities, developmental disorders and autism. The risk of these defects is higher at doses above 1000 mg per day or at higher blood levels of valproate. In Europe, the prevalence of valproate-induced syndrome has decreased from 0.22 to 0.03 per 10 000 births between 2005 and 2014, but access to newer, safer drugs is limited in many countries. The researchers therefore call for global education of physicians and stricter precautions when prescribing valproate to women of reproductive age. This leaves millions of people at risk of harming their unborn babies.