Fifteen years after experiencing the heart-wrenching loss of her first child due to a rare and severe birth defect, Andrea Lopez finds solace in the hope that other Latina mothers may soon avoid similar anguish. The state of California has taken a significant step; beginning in January, it became the first state to mandate that food manufacturers add folic acid—a vital vitamin—to corn masa flour. This flour is the backbone of tortillas and many traditional foods prevalent in her community.
This long-awaited regulation aims to tackle the disproportionately high rates of neural tube defects among Hispanic infants, a situation that tragically claimed the life of Lopez’s son, Gabriel Cude, when he was just 10 days old.
“It’s a minor step that could lead to a monumental impact,” expressed Lopez, 44, a lawyer from Bakersfield, who now has two young daughters. “I would do anything to help others avoid this heartache.”
In addition to California, Alabama is set to implement a similar law in June, while other states, including Florida, Georgia, Oklahoma, and Oregon, are currently considering similar legislation. Furthermore, four additional states—Texas, Delaware, New Jersey, and Pennsylvania—have demonstrated “active interest” in this pressing issue, according to the Food Fortification Initiative, an advocacy organization dedicated to combating micronutrient deficiencies.
“Every woman and child in the United States deserves access to folic acid for healthy pregnancies,” stated Scott Montgomery, director of the initiative.
Corn masa flour was overlooked in national regulations
For nearly three decades, the addition of folic acid, a crucial B vitamin, has been mandated in enriched wheat and white breads, cereals, and pastas in the United States.
Extensive research indicates that the 1998 regulation reduced the incidence of severe birth defects like spina bifida and anencephaly by about 30%, preventing approximately 1,300 cases annually. This achievement is often celebrated as one of the foremost public health successes of the 20th century.
However, corn masa flour—a fundamental component of Latino diets—was excluded from the original fortification requirements, resulting in persistently high rates of birth defects such as spina bifida and anencephaly within that community.
In 2016, federal regulators authorized the addition of folic acid to corn masa products, although it was not obligatory. By 2023, a study revealed that only about one in seven corn masa flour products, and no corn tortillas, contained the essential nutrient.
Hispanic mothers face elevated birth defect risks
Hispanic women across the nation report the highest rates of birth defects during pregnancy. In California, the incidence among Hispanic mothers is double that of white or Black women, according to state statistics.
The recent legislation from California, along with its significant purchasing power, could inspire broader adoption of similar measures across the country, remarked state Assemblymember Joaquin Arambula, who championed the law enacted in 2024.
“Being the first often sets the wheels in motion,” he noted. “I’m pleased to see that other states are following our example.”
California’s initiative, bolstered by advocate pressure, has prompted changes within the industry.
Gruma Corp., the parent company of Mission Foods and Azteca Milling, has been engaged with the fortification issue for nearly two decades. Azteca began offering select varieties of Maseca, its leading brand of corn masa flour, fortified with folic acid in 2016.
As of this year, 97% of Gruma’s retail sales in the US feature folic acid, with plans for the remaining products to be fortified by July, according to an official statement. Mission Foods has adopted similar measures, ensuring that all its branded and private label corn tortillas in the US are now fortified.
These actions by major producers are paving the way for smaller manufacturers to follow suit, according to a recent report by the Center for Science in the Public Interest, a consumer advocacy organization advocating for fortification.
Initially, industry concerns centered around potential impacts on flavor and the costs associated with rebranding. Jim Kabbani, head of the Tortilla Industry Association, noted that producers are now more optimistic about wider distribution of fortified products.
“I believe the momentum is undeniable, and we will see more states getting on board,” he stated.
Public health experts are enthusiastic about the growing momentum in fortification initiatives.
“The evidence is clear: folic acid fortification is effective,” noted Vijaya Kancherla, an epidemiology professor at Emory University and director of the Center for Spina Bifida Prevention. “It’s safe, well-established, and cost-efficient.”
Critics question the fortification initiative
This perspective sharply contrasts with critics—including some government officials—who view the fortification of the food supply as government overreach.
Late last year, Health Secretary Robert F. Kennedy Jr. expressed his criticism of California’s law in a post on social media, calling it “insanity” and accusing the state of waging a “war against her children, targeting the poor and communities of color.” A spokesperson for Kennedy did not clarify those remarks.
Social media is rife with misinformation, where individuals claim that folic acid fortification is “toxic” or that certain genetic variations limit the body’s ability to process the vitamin. However, these assertions are inaccurate, say advocates and medical professionals.
“It’s truly concerning that our nation’s top health official is disseminating false information and causing undue fear about 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,” affirmed Dr. Jeffery Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham who specializes in neural tube defect prevention.
The CDC reinforces that “individuals with the MTHFR gene variant can effectively process all types of folate, including folic acid.” Even the new federal dietary guidelines support fortification, advising pregnant women to consume an abundance of folate-rich foods and acknowledging that folic acid is “critical” during the preconception and early pregnancy phases to help prevent neural tube defects.
According to the CDC, “The fortification of corn masa flour with folic acid could help avert” neural tube defects.
Fortification is vital for prevention
Neural tube defects affect around 2,000 infants annually in the US and occur during the initial weeks of conception, when the structures that will eventually form the spine and brain fail to develop properly.
This often takes place before many women are even aware they are pregnant, as over 40% of pregnancies in the US are unplanned. In such cases, many women do not have the opportunity to prepare 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.
“Even with their best efforts to visit an OB and start prenatal vitamins, for many, that timing is simply too late,” Dr. BeDell explained.
Incorporating folic acid into corn masa flour the same way it’s added to other grains can ensure that this vital nutrient reaches a broader population in need.
Andrea Lopez, who was 28 and pregnant with her first child at the time, was unaware of the importance of folic acid or its absence from her diet. An ultrasound during her pregnancy revealed that her baby had anencephaly, a fatal condition where the skull doesn’t develop correctly.
Lopez continued with the pregnancy, and Gabriel lived for only 10 days. The anguish of his loss remains with her; she reflects that he would be in high school this year. Supporting California’s law for folic acid fortification, she finds it “mind-boggling” that such action took so long to be put into effect.
“Trust me, you don’t want to endure this,” Lopez shared. “He is the love of my life. I have two little girls who survived, but he will always be my firstborn, my only son.”
[[nid:731916]]
