Fifteen years after the devastating loss of her first child due to a rare birth defect, Andrea Lopez finds solace in the hope that other Latina mothers may soon be spared from similar heartbreak.
This January, California made history by becoming the first state to mandate the addition of folic acid to corn masa flour, a vital ingredient used in tortillas and various traditional foods prevalent in her community.
This long-awaited decision aims to address the disturbingly high rates of neural tube defects in Hispanic infants—conditions that claimed the life of Lopez’s son, Gabriel Cude, just ten days after birth.
“It’s a small effort with a tremendous impact,” said Lopez, now a 44-year-old lawyer in Bakersfield, who is raising two young daughters. “I would do anything to spare anyone from this heartache.”
A similar law will take effect in Alabama in June, while legislation is in progress or under consideration in Florida, Georgia, Oklahoma, and Oregon. Additionally, Texas, Delaware, New Jersey, and Pennsylvania have shown “active interest” in this critical public health issue, according to the Food Fortification Initiative, an organization advocating for the elimination of micronutrient deficiencies.
“Every woman and child in the U.S. deserves access to folic acid to ensure healthy babies,” stated Scott Montgomery, the group’s director.
Corn masa was excluded from a national mandate
For nearly three decades, the U.S. has mandated the addition of folic acid, an essential B vitamin, to enriched wheat and white breads, cereals, and pasta.
Research shows that this requirement, introduced in 1998, has successfully reduced serious birth defects like spina bifida and anencephaly by approximately 30%, thus preventing around 1,300 cases annually. It stands as one of the major public health victories of the 20th century.
However, corn masa flour, a fundamental component of Latino diets, was notably absent from this original fortification mandate, resulting in persistently high rates of defects such as spina bifida and anencephaly within this community.
In 2016, federal regulators permitted, but did not enforce, the addition of folic acid to corn masa products. By 2023, only about 14% of corn masa flour products and none of the corn tortillas on the market contained folic acid, according to a review.
Higher rates of birth defects among Hispanic moms
Statistics reveal that Hispanic women experience the highest rates of these defects during pregnancy nationwide. In California, the rate among Hispanic mothers is twice that of white or Black women, according to state data.
California’s groundbreaking law, alongside its significant market influence, could catalyze widespread adoption across the nation, noted state Assemblymember Joaquin Arambula, who sponsored the legislation that was passed in 2024.
“Being the first often helps kickstart broader change,” he said. “I’m pleased to see that other states are following suit.”
California’s action, bolstered by advocacy efforts, has already prompted changes in the industry.
Gruma Corp., the parent company of Mission Foods and Azteca Milling, has been actively involved in the fortification debate for nearly two decades. Azteca began offering select varieties of Maseca, its largest corn masa flour brand, fortified with folic acid as early as 2016.
As of this year, 97% of Gruma’s retail sales in the U.S. include folic acid, with full fortification expected before July. Mission Foods also started inclusive fortification in 2024, now adding folic acid to all its corn tortillas in the U.S.
Such advancements by major manufacturers are expected to encourage smaller producers to adopt similar practices, according to a recent report from the Center for Science in the Public Interest, a consumer advocacy group pushing for fortification.
Initially, industry concerns revolved around potential impacts on flavor and the financial burden of changing labels, said Jim Kabbani, head of the Tortilla Industry Association. However, he now anticipates broader availability of fortified products across tortilla makers.
“The train has left the station, and we can expect more states to jump on board,” he remarked.
Public health experts are applauding this momentum.
“The evidence is clear: folic acid fortification is effective,” stated Vijaya Kancherla, an epidemiology professor 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 positive narrative, however, is challenged by critics, including some government officials who view food fortification as an overreach by the state.
Late last year, Health Secretary Robert F. Kennedy Jr. described California’s new law as “insanity” in a post on X: “California is waging a war against its children—particularly targeting the poor and communities of color,” he claimed.
A spokesperson for Kennedy did not provide additional comments regarding these remarks.
Social media platforms have seen a flurry of claims labeling folic acid fortification as “toxic,” especially for those with a genetic variant known as MTHFR, which supposedly hampers proper processing of the vitamin.
However, these assertions lack scientific backing, according to numerous advocates and medical experts.
“What’s truly alarming is that the nation’s top health official is spreading misinformation, deterring individuals from a nutrient that has been demonstrated to prevent birth defects and save lives,” argued Eva Greenthal, a senior policy scientist with CSPI.
At therapeutic doses, 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 preventing neural tube defects.
The U.S. Centers for Disease Control and Prevention (CDC) emphasizes that “individuals with the MTHFR gene variant can effectively process all forms of folate, including folic acid.”
Even Kennedy’s recently released federal dietary guidelines support fortification efforts. The supporting documents recommend that pregnant women consume folate-rich foods such as leafy greens, beans, and lentils while acknowledging the critical role of folic acid from fortified foods and supplements before conception and during early pregnancy.
The CDC also highlights that “fortification of corn masa flour could help prevent” neural tube defects.
Without fortification, ‘It’s just too late’
Neural tube defects, which impact around 2,000 infants annually in the U.S., develop within the first weeks after conception when the spinal cord and brain fail to form properly.
This often occurs before many women even recognize they are pregnant, with more than 40% of U.S. pregnancies being unplanned. In these situations, many women are unprepared for pregnancy, noted Dr. Kimberly BeDell, medical director of a rehabilitation clinic for children with spina bifida at Miller Children’s Hospital in Long Beach, California.
“Despite a woman’s best efforts to visit an OB-GYN right away and start prenatal vitamins, it may already be too late,” said BeDell.
Adding folic acid to corn masa, similar to how it is added to other grains, ensures that this essential nutrient reaches a broader population in need, she added.
When Andrea Lopez was pregnant at 28, she was unaware of folic acid’s significance or that her diet might lack this vital vitamin.
An ultrasound during her pregnancy later revealed that her baby had anencephaly, a fatal condition where the skull does not develop properly.
Lopez carried the pregnancy to term, and Gabriel lived for just ten days. The pain from that loss remains pervasive, she shared, noting that Gabriel would have been starting high school this year. She fully supports California’s law mandating folic acid fortification and finds it “incomprehensible” that such action took so long to implement.
“Trust me, you do not want to go through this,” she expressed. “He was the love of my life. I have two beautiful daughters now, but he will always be my firstborn, my only son.”
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