Fifteen years after experiencing the tragic loss of her first child due to a rare birth defect, Andrea Lopez finds solace in the possibility that other Latina mothers may avoid similar heartache. In January, California became the first state to mandate the addition of folic acid, a vital vitamin, to corn masa flour, commonly used in tortillas and other traditional foods in her community.

This long-overdue legislation aims to address the disproportionately high rates of neural tube defects among Hispanic infants, a condition that claimed Lopez's son, Gabriel Cude, when he was just 10 days old. "It's such a small effort for such a tremendous impact," said Lopez, now 44 and a lawyer living in Bakersfield with two young daughters. "There is very little that I wouldn't do to spare anybody this heartache."

Alabama will implement a similar law in June, and several states, including Florida, Georgia, Oklahoma, and Oregon, are considering similar legislation. Additionally, Texas, Delaware, New Jersey, and Pennsylvania have expressed interest in the issue, according to the Food Fortification Initiative, an advocacy group focused on combating 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 Left Out of National Mandate

For nearly three decades, the addition of folic acid has been mandatory in enriched wheat and white breads, cereals, and pasta in the U.S. Research shows that the 1998 requirement reduced rates of serious defects like spina bifida and anencephaly by approximately 30 percent, preventing around 1,300 cases annually. It is regarded as one of the major public health achievements of the 20th century.

However, corn masa flour, a staple in Latino diets, was excluded from the original fortification mandate, leading to persistently high rates of conditions like spina bifida in this community. In 2016, federal regulators allowed, but did not mandate, 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 contained folic acid.

High Birth Defect Rates Among Hispanic Mothers

Hispanic women nationwide experience the highest rates of neural tube defects during pregnancy. In California, the rate among Hispanic mothers is double that of white or Black women, according to state data. California’s new law, coupled with the state's significant purchasing power, could promote broader adoption across the nation, said Assemblymember Joaquin Arambula, who sponsored the 2024 legislation.

"You have to be the first oftentimes to get the ball rolling," he noted, expressing hope that other states will follow suit. California's initiative and advocacy efforts have already prompted changes in industry practices. Gruma Corp., the parent company of Mission Foods and Azteca Milling, has been engaged with the fortification issue for nearly twenty years, beginning to sell some varieties of its Maseca corn masa flour with folic acid in 2016.

As of this year, 97 percent of Gruma's retail sales in the U.S. include folic acid, with plans for the remainder to be fortified by July. Mission Foods also began fortifying its products in 2024, adding folic acid to all its branded and private label corn tortillas in the U.S.

These actions by larger producers have encouraged smaller manufacturers to follow suit, according to a recent report from the Center for Science in the Public Interest, a consumer advocacy organization that has been advocating for fortification.

Initially, industry concerns revolved around the potential impact of folic acid on flavor and the costs associated with changing labels, according to Jim Kabbani, head of the Tortilla Industry Association. However, he now anticipates that tortilla makers will begin offering fortified products more widely. "I think overall the train has left the station and it will be more and more states," he remarked.

Public health experts are optimistic about this growing momentum. "The science is clear: Folic acid fortification works," stated Vijaya Kancherla, an epidemiology professor at Emory University and director of the Center for Spina Bifida Prevention. "It's safe. It's proven. And it's cost-effective."

Criticism of Fortification Efforts

This perspective sharply contrasts with critics, including prominent government officials, who view food fortification as government overreach. Health Secretary Robert F. Kennedy Jr. criticized California's new law on social media, calling it "insanity" and claiming it targets poor communities and communities of color. A spokesman for Kennedy declined to elaborate on these comments.

Social media is filled with claims that folic acid fortification is "toxic" or that individuals with a specific gene variation, known as MTHFR, cannot process the vitamin effectively. However, advocates and medical experts refute these claims. "What's truly insane is that our nation's top health official is spreading false claims and frightening people into avoiding a nutrient that's proven to prevent birth defects and save babies' lives," said Eva Greenthal, a senior policy scientist at CSPI.

At fortification doses, 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 focused on preventing neural tube defects. The CDC emphasizes that individuals with the MTHFR gene variant can process all types of folate, including folic acid.

Interestingly, even Kennedy's federal dietary guidelines support fortification efforts, advising pregnant women to consume folate-rich foods while acknowledging that folic acid from fortified foods or supplements is "critical" before conception and during early pregnancy to prevent neural tube defects. The CDC further states, "Folic acid fortification of corn masa flour could help prevent" neural tube defects.

The Urgency of Fortification

Neural tube defects, affecting around 2,000 babies each year in the U.S., occur in the early weeks of pregnancy when the spine and brain's forming tube fails to develop correctly. This often happens before many women even realize they are pregnant, as over 40% of U.S. pregnancies are unintended. In such cases, many women may not have adequately prepared for pregnancy, noted Dr. Kimberly BeDell, medical director of a rehabilitation clinic for children with spina bifida in California.

"Even women's best efforts in going to an OB right away and starting prenatal vitamins, it's just too late," BeDell explained. Adding folic acid to corn masa, similar to its addition in other grains, ensures the nutrient reaches the broader population that needs it.

At 28, pregnant with her first child, Andrea Lopez was unaware of folic acid's importance and that her diet might lack this essential vitamin. During an ultrasound, she learned her baby had anencephaly, a fatal condition where the skull fails to develop properly. Lopez carried the pregnancy to term, and Gabriel lived for just 10 days. The pain of his loss remains with her, and she realizes that Gabriel would have been a high school freshman this year. She supports California's law mandating folic acid fortification of corn masa and is astonished at the delay in implementing such a necessary measure. "Trust me, you don't want to go through this," she stated. "He's the love of my life. I have two little girls that survived, but he's my first born. He is my only son."