Fifteen years after the heartbreaking loss of her first child to a rare birth defect, Andrea Lopez finds solace in the knowledge that other Latina mothers may evade similar grief. In January, California became the pioneer state to mandate the addition of folic acid—a vital vitamin—to corn masa flour, essential for making tortillas and other traditional foods prevalent in her community.
This long-overdue action aims to tackle the disproportionately high rates of neural tube defects affecting Hispanic infants, a tragic condition that took her son Gabriel Cude’s life when he was just ten days old. “It’s such a small effort for such a tremendous impact,” shared Lopez, 44, a lawyer from Bakersfield with two young daughters. “I would do anything to spare anyone from this heartbreak.”
A similar regulation is set to take effect in Alabama in June, and there is ongoing discussion or proposed legislation in Florida, Georgia, Oklahoma, and Oregon. Furthermore, Texas, Delaware, New Jersey, and Pennsylvania have expressed “active interest” in the matter, reports the Food Fortification Initiative, an advocacy organization committed to tackling micronutrient deficiencies.
“Every woman and child in the United States deserves access to folic acid to ensure healthy babies,” emphasized Scott Montgomery, the group’s director.
Corn masa was excluded from a national mandate
For nearly thirty years, the addition of folic acid to enriched wheat and white breads, cereals, and pastas has been mandatory across the U.S. Comprehensive studies indicate that since this requirement was enacted in 1998, the rates of severe birth defects like spina bifida and anencephaly have dropped by approximately 30%, preventing around 1,300 cases annually. It is hailed as one of the significant public health successes of the 20th century.
However, corn masa flour, a dietary staple for Latinos, was excluded from this original fortification mandate, resulting in persistently high rates of conditions such as spina bifida and anencephaly within that community. In 2016, federal regulators permitted—but did not mandate—the fortification of corn masa products with folic acid. By 2023, only about 1 in 7 corn masa flour products, and no corn tortillas, contained this critical vitamin, according to a recent review.
Higher rates of birth defects among Hispanic moms
Hispanic women across the nation face the highest prevalence of pregnancy-related neural tube defects. In California, the incidence among Hispanic mothers is reported to be double that of white or Black women, as indicated by state data.
The state’s new law—and its significant purchasing power—could catalyze similar initiatives nationwide, according to California Assemblymember Joaquin Arambula, who sponsored the legislation that passed in 2024. “Being the first can often initiate change,” he noted. “I’m pleased to see other states taking up this cause.”
California’s move, supported by advocates, has already led to momentum for change. Gruma Corp., the parent company of Mission Foods and Azteca Milling, has engaged with the fortification issue for nearly two decades. Azteca began fortifying select varieties of its popular Maseca corn masa flour with folic acid in 2016.
Currently, 97% of the company’s retail sales in the U.S. include folic acid, with plans to fortify the remaining products by July, according to Gruma. Mission Foods also commenced fortification in 2024 and now adds folic acid to all its branded and private label corn tortillas in the country.
Actions taken by larger producers are encouraging smaller manufacturers to follow suit, according to a recent report by the Center for Science in the Public Interest, a consumer advocacy group advocating for fortification.
Initially, the industry harbored concerns regarding flavor alterations and the costs associated with rebranding, as noted by Jim Kabbani, head of the Tortilla Industry Association. However, he now predicts a broader market for fortified products among tortilla makers. “I think the momentum is building, and more states will adopt similar measures,” he stated.
Public health experts welcome this growing progress. “The evidence is compelling: Folic acid fortification works,” commented Vijaya Kancherla, a professor of epidemiology at Emory University and director of the Center for Spina Bifida Prevention. “It is both safe and cost-effective.”
RFK Jr. calls corn masa fortification ‘insanity’
This perspective sharply contrasts with critics—including prominent government officials—who view the fortification of food as an overreaching government intervention. Late last year, Health Secretary Robert F. Kennedy Jr. denounced California’s new law via a post on X, calling it “insanity” and asserting that California is “waging war against her children—targeting the poor and communities of color.” A spokesperson for Kennedy declined to clarify these remarks.
Social media is rife with claims labeling folic acid fortification as “toxic,” particularly among individuals with a specific gene variation known as MTHFR, which purportedly hampers their ability to process the vitamin. However, these claims have been debunked by advocates and medical professionals.
“What truly is insanity is that our nation’s top health official is disseminating false information, frightening individuals into shunning a nutrient that is well-documented to prevent birth defects and protect infants’ lives,” remarked Eva Greenthal, CSPI’s senior policy scientist.
At the levels associated with fortification, folic acid has never been demonstrated to pose any harm to individuals or populations, emphasized Dr. Jeffery Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham who is actively engaged in efforts to prevent neural tube defects both domestically and globally. The U.S. Centers for Disease Control and Prevention also stress that individuals with the MTHFR gene variant can effectively process all forms of folate, including folic acid.
Even Kennedy’s new federal dietary guidelines support fortification, advising pregnant women to consume folate-rich foods, such as leafy green vegetables, beans, and lentils. Furthermore, they recognize that folic acid from fortified foods or supplements is “critical” before conception and during early pregnancy to avert neural tube defects.
Without fortification, ‘It’s just too late’
Neural tube defects affect approximately 2,000 babies annually in the U.S., arising in the initial weeks of pregnancy when the tube that forms the spine and brain fails to develop correctly. This often occurs before many women even know they are pregnant, as over 40% of U.S. pregnancies are unintended. In such cases, many women may not be prepared for pregnancy, explained Dr. Kimberly BeDell, the medical director of a rehabilitation clinic for children with spina bifida at Miller Children’s Hospital in Long Beach, California.
“Even the best intentions of expecting mothers to see an OB promptly and begin taking prenatal vitamins may arrive too late,” BeDell lamented. She emphasized that adding folic acid to corn masa—similarly to other grains—is an effective way to ensure the nutrient reaches the broader population in need.
At 28, while pregnant with her first child, Andrea Lopez was unaware of the importance of folic acid or whether it was present in her diet. This lack of knowledge became painfully evident when an ultrasound midway through her pregnancy revealed that her baby had anencephaly, a fatal condition characterized by incomplete skull development.
Lopez chose to carry her pregnancy to term, and Gabriel lived for just ten days. The enduring pain of his loss remains with her. She acknowledges that Gabriel would have been a high school freshman this year and supports California’s legislation mandating folic acid fortification in corn masa, finding it “mind-boggling” that such measures took so long to implement.
“Trust me, you don’t want to go through this,” she said, her eyes reflecting deep sorrow. “He’s the love of my life. I have two little girls who survived, but he’s my firstborn. He is my only son.”
