Fifteen years after she lost her first baby to a rare and devastating birth defect, Andrea Lopez takes comfort in knowing that other Latina mothers might finally avoid the same pain.
In January, California became the first state to require food makers to add folic acid, a crucial vitamin, to corn masa flour used to make tortillas and other traditional foods widely used in her community.
It鈥檚 a long-delayed move aimed at reducing Hispanic infants’ disproportionately high rates of serious conditions called neural tube defects, which claimed Lopez鈥檚 son, Gabriel Cude, when he was 10 days old.
鈥淚t鈥檚 such a small effort for such a tremendous impact,鈥� said Lopez, 44, who lives in Bakersfield and is now a lawyer with two young daughters. 鈥淭here is very little that I wouldn鈥檛 do to spare anybody this heartache.鈥�
A similar law takes effect in Alabama in June, and legislation is pending or being considered in Florida, Georgia, Oklahoma and Oregon. Four more states 鈥� Texas, Delaware, New Jersey and Pennsylvania 鈥� have expressed 鈥渁ctive interest鈥� in the issue, according to the Food Fortification Initiative, an advocacy group that focuses on addressing micronutrient deficiencies.
鈥淎ll women and children in the United States should have access to folic acid and have healthy babies,鈥� said Scott Montgomery, the group’s director.
Corn masa was excluded from a national mandate
For nearly 30 years, folic acid, a key B vitamin, has been required to be added to enriched wheat and white breads, cereals and pastas in the U.S.
Decades of research show the 1998 requirement cut rates of serious defects such as spina bifida and anencephaly , preventing about 1,300 cases a year. It is regarded as one of the top public health triumphs of the 20th century.
But corn masa flour, a staple used in Latino diets, was left out of the original fortification requirement 鈥� and rates of conditions such as spina bifida and anencephaly in that community have remained stubbornly high.
In 2016, federal regulators allowed, but did not require, folic acid to be added to corn masa products. By 2023, only about 1 in 7 corn masa flour products and no corn tortillas contained folic acid, .
Higher rates of birth defects among Hispanic moms
Nationwide, Hispanic women have the highest rates of having those defects during pregnancy. In California, the rate among Hispanic mothers is as for white or Black women, state data show.
California鈥檚 new law 鈥� and the state鈥檚 huge buying power 鈥� could help expand its adoption nationwide, said state Assemblymember Joaquin Arambula, who sponsored the legislation passed in 2024.
鈥淵ou have to be the first oftentimes to get the ball rolling,鈥� he said. 鈥淪o, I鈥檓 glad other states have taken up that mantle.鈥�
California鈥檚 action and pressure from advocates have already spurred changes.
Gruma Corp., the parent company of Mission Foods and Azteca Milling, has been involved in the fortification issue for nearly two decades. Azteca began selling some 鈥� but not all 鈥� varieties of Maseca, its largest brand of corn masa flour, with folic acid in 2016.
As of this year, 97% of the company鈥檚 retail sales in the U.S. include folic acid. The rest are expected to be fortified before July, Gruma said in a statement.
Mission Foods began fortification in 2024. It now adds folic acid to all of its branded and private label corn tortillas in the U.S.
Such actions by large producers have helped pave the way for smaller manufacturers to follow suit, according to a by the Center for Science in the Public Interest, a consumer advocacy group that has pushed for fortification.
Initially, the industry was concerned folic acid could affect flavor and the cost of changing labels, said Jim Kabbani, head of the Tortilla Industry Association. But he now expects tortilla makers will start selling fortified products on a broader scale.
鈥淚 think overall the train has left the station and it will be more and more states,鈥� he said.
Public health experts cheer the growing momentum.
鈥淭he science is clear: Folic acid fortification works,鈥� said Vijaya Kancherla, an Emory University epidemiology professor and director of the Center for Spina Bifida Prevention. 鈥淚t鈥檚 safe. It鈥檚 proven. And it鈥檚 cost-effective.鈥�
RFK Jr. calls corn masa fortification 鈥榠nsanity鈥�
That view contrasts sharply with critics 鈥� including some at the highest level of government 鈥� who regard fortification of the food supply as a form of government overreach.
Late last year, Health Secretary Robert F. Kennedy Jr. criticized California’s new law in : 鈥淭his is insanity. California is waging war against her children 鈥� targeting the poor and communities of color,鈥� he wrote.
A spokesman for Kennedy declined to explain the comments.
Social media feeds are rife with people claiming that folic acid fortification is 鈥渢oxic鈥� or that people with a certain gene variation known as MTHFR can鈥檛 properly process the vitamin.
None of those claims is accurate, according to advocates and medical experts.
鈥淲hat鈥檚 truly insane is that our nation鈥檚 top health official is spreading false claims and frightening people into avoiding a nutrient that鈥檚 proven to prevent birth defects and save babies’ lives,鈥� said Eva Greenthal, CSPI鈥檚 senior policy scientist.
At fortification doses, folic acid 鈥渉as never been shown to harm individuals or populations,鈥� said Dr. Jeffery Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham who works to prevent neural tube defects in the U.S. and globally.
The U.S. Centers for Disease Control and Prevention emphasizes that 鈥減eople with the MTHFR gene variant can process all types of folate, including folic acid.鈥�
Even Kennedy鈥檚 new federal dietary guidelines support fortification. Documents backing the guidelines advise pregnant women to eat folate-rich foods, such as leafy green vegetables, beans and lentils. But they also acknowledge that folic acid from fortified foods or supplements is 鈥渃ritical鈥� before conception and during early pregnancy to prevent neural tube defects.
鈥淔olic acid fortification of corn masa flour could help prevent鈥� neural tube defects, the CDC website adds.
Without fortification, 鈥業t鈥檚 just too late’
Neural tube defects, which affect about 2,000 babies each year in the U.S., occur in the first weeks after conception, when the tube that forms the spine and brain fails to develop properly.
That鈥檚 often before many women realize they鈥檙e pregnant. More than 40% of U.S. pregnancies are unintended. In those cases, many women won’t have been preparing for pregnancy, noted Dr. Kimberly BeDell, medical director of a rehabilitation clinic that helps children with spina bifida at Miller Children鈥檚 Hospital in Long Beach, California.
鈥淓ven women鈥檚 best efforts in going to an OB right away and starting prenatal vitamins, it鈥檚 just too late,鈥� BeDell said.
Adding folic acid to corn masa, the way it is added to other grains, is a way to ensure the nutrient reaches the wider population that needs it, she added.
At age 28, pregnant with her first child, Andrea Lopez didn鈥檛 know about the importance of folic acid or that the vitamin might be missing from her diet.
Then, an ultrasound mid-way through pregnancy showed that her baby had anencephaly, a fatal condition in which the skull fails to develop properly.
Lopez carried the pregnancy to term and Gabriel lived for 10 days. The pain of his loss never goes away, she said, adding that Gabriel would have been a high school freshman this year. She supports California鈥檚 law requiring folic acid fortification of corn masa and finds it 鈥渕ind-boggling鈥� that the action took so long to enforce.
鈥淭rust me, you don鈥檛 want to go through this,鈥� she said. 鈥淗e鈥檚 the love of my life. I have two little girls that survived, but he鈥檚 my first born. He is my only son.鈥�
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