Fifteen years after the heartbreaking loss of her first baby due to a rare birth defect, Andrea Lopez finds solace in the hope that other Latina mothers may be spared the same tragedy.
This January, California made history as the first state to mandate the addition of folic acid—a vital vitamin—to corn masa flour, a key ingredient in tortillas and other traditional foods that are staples in her community.
This long-overdue initiative aims to combat the disproportionately high rates of neural tube defects among Hispanic infants, conditions that claimed the life of Lopez’s son, Gabriel Cude, after just 10 days.
“It’s a small step that will have a huge impact,” said Lopez, now 44, who resides in Bakersfield and works as a lawyer. She is also a mother to two young daughters. “I would do anything to prevent anyone else from experiencing this kind of heartache.”
A similar law is set to be enacted in Alabama in June, with legislation either pending or under consideration in states like Florida, Georgia, Oklahoma, and Oregon. Four additional states—Texas, Delaware, New Jersey, and Pennsylvania—have also shown a keen interest in addressing this issue, according to the Food Fortification Initiative, a group advocating for the elimination of micronutrient deficiencies.
“All women and children in the United States deserve access to folic acid to ensure healthy babies,” stated Scott Montgomery, the director of the initiative.
Corn masa was excluded from a national mandate
For nearly three decades, the addition of folic acid to enriched wheat and white breads, cereals, and pastas has been a requirement in the U.S.
Research spanning years indicates that the 1998 mandate reduced serious defects such as spina bifida and anencephaly by approximately 30%, preventing around 1,300 cases annually. This achievement is lauded as one of the major public health victories of the 20th century.
However, corn masa flour, a dietary staple among Latinos, was excluded from the original fortification requirements, resulting in persistently high rates of conditions like spina bifida and anencephaly within this community.
In 2016, federal regulators permitted the addition of folic acid to corn masa products but did not require it. By 2023, around one in seven corn masa flour items and none of the corn tortillas contained folic acid, as noted in a review.
Higher rates of birth defects among Hispanic moms
Across the country, Hispanic women face the highest rates of pregnancy-related defects. In California, the incidence among Hispanic mothers is twice as high as that of white or Black women, as indicated by state data.
The new law in California, combined with the state’s immense purchasing power, could encourage wider adoption across the nation, noted state Assemblymember Joaquin Arambula, a key supporter of the legislation passed in 2024.
“Often, you need to lead the way to ignite progress,” he explained. “I’m pleased to see other states following suit.”
California’s initiative, alongside advocacy efforts, has already yielded significant changes.
Gruma Corp., the parent company behind Mission Foods and Azteca Milling, has been engaged in the fortification issue for nearly 20 years. Azteca began offering some varieties of its leading corn masa flour brand, Maseca, with added folic acid in 2016.
This year, 97% of Gruma’s retail sales in the U.S. will feature folic acid, and the remaining products are expected to be fortified by July, as the company announced.
Mission Foods will begin fortification in 2024, adding folic acid to all its branded and private-label corn tortillas in the U.S.
Such initiatives from major producers are prompting smaller manufacturers to follow suit, according to a recent report from the Center for Science in the Public Interest, a consumer advocacy group pushing for fortification.
Initially, industry leaders expressed concerns that folic acid might impact flavor and that changing labels could increase costs, as explained by Jim Kabbani, head of the Tortilla Industry Association. However, he now believes tortilla makers will increasingly offer fortified products.
“The momentum has begun, and I anticipate more states will follow suit,” he stated.
Public health specialists are encouraged by this growing trend.
“The evidence is clear: Folic acid fortification is effective,” said Vijaya Kancherla, a professor of epidemiology at Emory University and director of the Center for Spina Bifida Prevention. “It is safe, proven, and cost-effective.”
RFK Jr. calls corn masa fortification ‘insanity’
This perspective sharply contrasts with critics—some in high governmental positions—who argue that food system fortification represents government overreach.
Late last year, Health Secretary Robert F. Kennedy Jr. condemned California’s new law in a post on X, declaring, “This is insanity. California is waging war against her children—targeting the poor and communities of color.”
A spokesperson for Kennedy declined to elaborate on these comments.
Social media platforms are filled with claims that folic acid fortification is “toxic” or that individuals with a specific gene variation known as MTHFR cannot effectively process the vitamin.
Advocates and medical experts refute these assertions.
“It is appalling that our nation’s leading health official is spreading misinformation and scaring people away from a nutrient proven to prevent birth defects and save lives,” stated Eva Greenthal, a senior policy scientist at CSPI.
At fortification levels, folic acid “has never been shown to harm individuals or populations,” asserted Dr. Jeffery Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham who focuses on neural tube defect prevention both in the U.S. and abroad.
The U.S. Centers for Disease Control and Prevention clarify that “people with the MTHFR gene variation can process all types of folate, including folic acid.”
Even Kennedy’s new federal dietary guidelines advocate fortification. The documents recommend that pregnant women consume foods rich in folate, such as leafy greens, beans, and lentils, while also recognizing that folic acid from fortified foods and supplements is “critical” in preventing neural tube defects both before conception and in early pregnancy.
“Folic acid fortification of corn masa flour could help avert” neural tube defects, the CDC website affirms.
Without fortification, ‘It’s just too late’
Neural tube defects affect about 2,000 infants annually in the U.S. and occur in the crucial weeks following conception when the tube that develops into the spine and brain does not form correctly.
This often happens before many women even realize they are pregnant, especially since more than 40% of U.S. pregnancies are unintended. In such situations, many women may not be prepared for pregnancy, as highlighted by Dr. Kimberly BeDell, medical director of a rehabilitation clinic for children with spina bifida at Miller Children’s Hospital in Long Beach, California.
“Even if women act quickly to see an OB and start prenatal vitamins, it may already be too late,” BeDell stated.
Fortifying corn masa flour in the same manner as other grains helps ensure that the vital nutrient reaches the broader population that needs it, she added.
At 28 years old and pregnant with her first child, Andrea Lopez was unaware of the significance of folic acid or that it might be lacking in her diet.
Then, during a mid-pregnancy ultrasound, she learned that her baby had anencephaly, a fatal condition in which the skull fails to develop.
Lopez carried her pregnancy to term, and Gabriel lived for ten days. The heartache of his loss remains with her, she reflected, noting that Gabriel would have been a high school freshman this year. She strongly supports California’s law mandating folic acid fortification and is astounded it took so long to be implemented.
“Trust me, you don’t want to go through this,” she urged. “He was the love of my life. I have two little girls who survived, but he was my firstborn, my only son.”
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