Fifteen years after experiencing the heartbreaking loss of her first baby due to a rare birth defect, Andrea Lopez finds solace in the knowledge that other Latina mothers might avoid similar grief. In January, California made history by becoming the first state to mandate that food manufacturers enrich corn masa flour with folic acid, a vital vitamin essential for preventing certain birth defects. This initiative seeks to combat the disproportionately high rates of neural tube defects in Hispanic infants, including the condition that claimed Lopez’s son, Gabriel Cude, just 10 days after his birth. “It’s such a small effort for such a tremendous impact,” emphasized Lopez, 44, a lawyer from Bakersfield with two young daughters. “There is very little that I wouldn’t do to spare anyone the heartache I experienced.”
Alabama is set to implement a similar law in June, with pending legislation in Florida, Georgia, Oklahoma, and Oregon. Additionally, states like Texas, Delaware, New Jersey, and Pennsylvania are expressing active interest in fortifying corn masa flour, according to the Food Fortification Initiative, a group dedicated to addressing micronutrient deficiencies. “All women and children in the United States should have access to folic acid and have healthy babies,” stated Scott Montgomery, the initiative’s director.
Corn masa was excluded from a national mandate
For nearly three decades, the addition of folic acid has been mandated in enriched wheat and white breads, cereals, and pastas in the U.S. Extensive research has demonstrated that the 1998 requirement led to a 30% reduction in serious defects like spina bifida and anencephaly, preventing approximately 1,300 cases annually. This mandate is often hailed as one of the significant public health achievements of the 20th century. However, corn masa flour, a staple in Latino diets, was excluded from this essential fortification requirement, resulting in persistently high rates of such conditions in that community.
Though federal regulators permitted the addition of folic acid to corn masa products in 2016, it was not made compulsory. By 2023, only around 1 in 7 corn masa flour products—and none of the corn tortillas—contained folic acid, according to a recent review.
Higher rates of birth defects among Hispanic moms
Nationally, Hispanic women report the highest rates of neural tube defects during pregnancy. In California, the incidence among Hispanic mothers is double that of white or Black women, as confirmed by state data. The recent legislation in California, bolstered by the state’s significant buying power, is expected to influence similar actions nationwide, as noted by state Assemblymember Joaquin Arambula, who sponsored the legislation passed in 2024. “Being the first often helps to get the ball rolling,” he remarked, expressing hope that other states will follow suit.
California’s proactive approach and advocacy pressure have already yielded positive changes. Gruma Corp., the parent of Mission Foods and Azteca Milling, has been actively engaged in fortification efforts for nearly two decades. Starting in 2016, Azteca began selling select varieties of its Maseca brand of corn masa flour enriched with folic acid. As of this year, 97% of the company’s retail sales in the U.S. incorporate folic acid, with the remainder expected to follow suit soon. Mission Foods has also initiated fortification in 2024, adding folic acid to all its branded and private label corn tortillas across the United States.
The actions taken by these industry leaders are paving the way for smaller manufacturers to adopt similar practices, according to a recent report by the Center for Science in the Public Interest, an advocacy group devoted to promoting fortification. Initially, the industry raised concerns that folic acid could alter flavor or increase labeling costs, said Jim Kabbani, head of the Tortilla Industry Association. However, he anticipates that tortilla producers will increasingly introduce fortified products to the market, stating confidently, “The train has left the station, and more states will follow.”
Public health experts are encouraged by this growing momentum. “The science is clear: Folic acid fortification works,” affirmed Vijaya Kancherla, a professor of epidemiology at Emory University and director of the Center for Spina Bifida Prevention. “It’s safe, proven, and cost-effective.”
RFK Jr. calls corn masa fortification ‘insanity’
This consensus sharply contrasts with critics, including some in high government positions, who view food fortification as an overreach. Recently, Health Secretary Robert F. Kennedy Jr. publicly derided California’s new law, declaring it “insanity” in a post on social media. “California is waging war against her children — targeting the poor and communities of color,” he asserted, although a spokesman declined to elaborate.
Social media has been rife with misinformation, with users alleging that folic acid is “toxic” and that individuals with a particular genetic variation, known as MTHFR, cannot effectively process the vitamin. Advocates and medical experts have refuted these claims. “What’s truly astonishing is that our top health official is propagating falsehoods and scaring people away from a nutrient proven to prevent birth defects and save lives,” remarked Eva Greenthal, senior policy scientist with CSPI.
According to Dr. Jeffery Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham, “At fortification doses, folic acid has never been shown to harm individuals or populations.” The Centers for Disease Control and Prevention also confirms that individuals with the MTHFR gene variant can process various forms of folate, including folic acid. Furthermore, federal dietary guidelines recognize the importance of folic acid from fortified foods or supplements in preventing neural tube defects, particularly in early pregnancy.
“Folic acid fortification of corn masa flour could help prevent” neural tube defects, the CDC website notes.
Without fortification, ‘It’s just too late’
Neural tube defects impact approximately 2,000 infants in the U.S. each year and typically arise within the initial weeks of conception, long before many women become aware of their pregnancies. Given that over 40% of U.S. pregnancies are unplanned, many women might not be prepared or taking necessary precautions. As Dr. Kimberly BeDell, medical director of a spina bifida rehabilitation clinic in Long Beach, California, explains, “Even with their best intentions, by the time women begin prenatal vitamins, it’s often too late.”
By fortifying corn masa in the same manner as other grains, the goal is to ensure that this essential nutrient reaches the broader population that requires it. When Andrea Lopez was 28 and expecting her first child, she was unaware of the critical role of folic acid and that it may not have been present in her diet.
An ultrasound revealed midway through her pregnancy that her baby was affected by anencephaly, a fatal condition characterized by improper skull development. She carried the pregnancy to term, and Gabriel lived only for 10 days. The enduring pain from this loss is something she carries every day; Gabriel would have been entering high school this year. Lopez firmly supports California’s law mandating folic acid fortification of corn masa, expressing disbelief at the length of time it took to implement such a necessary action. “Trust me, you don’t want to go through this,” she said. “He’s the love of my life. I have two little girls who survived, but he’s my firstborn. He is my only son.”
