Fifteen years after she lost her first child to a rare and devastating birth defect, Andrea Lopez takes comfort in knowing that other Latina mothers may finally be able to avoid the same pain.
In January, California became the first state to require food manufacturers to add folic acid, an important vitamin, to corn masa flour used to make tortillas and other traditional foods widely used in its community.
It’s a long-delayed measure aimed at reducing Hispanic children’s disproportionately high rates of serious conditions called neural tube defects, which Lopez’s son, Gabriel Code, suffered when he was 10 days old.
“It’s such a small effort for such a big impact,” said Lopez, 44, who lives in Bakersfield and is now a lawyer with two young daughters. “There’s very little I wouldn’t do to save anyone from this heartache.”
Similar legislation takes effect in Alabama in June, and legislation is pending or being considered in Florida, Georgia, Oklahoma and Oregon. Four other states — Texas, Delaware, New Jersey and Pennsylvania — have shown “active interest” in the issue, according to the Food Fortification Initiative, an advocacy group focused on addressing micronutrient deficiencies.
“All women and children in the United States should have access to folic acid and have healthy children.” said Scott Montgomery, the group’s president.
Maize Masa was excluded from the national mandate
For nearly 30 years, folic acid, an important B vitamin, has been required in rich wheat and white breads, cereals, and pastas in the United States.
Decades of research show that by 1998 the need for serious birth defects such as spina bifida and encephaly had dropped by 30%, preventing 1,300 cases a year. It is considered one of the great public health achievements of the 20th century.
But corn masa flour, used in the Latino diet, remains a staple of fortification—and rates of conditions like spina bifida and encephaly remain stubbornly high in that community.
In 2016, federal regulators allowed, but did not require, folic acid to be added to cornmeal products. By 2023, only 1 in 7 corn masa flour products and no corn tortillas contain folic acid, a review found.
Nationwide, Hispanic women have the highest rates of these defects during pregnancy. In California, the rate among Hispanic mothers is twice as high as among white or black women, state data show.
California’s new law — and the state’s greater purchasing power — could help expand its adoption nationwide, said state Assemblyman Joaquin Arambula, who sponsored the bill passed in 2024.
“You have to be the first to get the ball rolling,” he said. “So, I’m glad that other states have taken up that position.”
The California act and pressure from advocates have already prompted changes.
Groma Corporation, the parent company of Mission Foods and Azteca Milling, has been involved in the fortification issue for nearly two decades. Azteca, the largest brand of corn masa flour with folic acid, began selling some—but not all—Mesica varieties in 2016.
As of this year, 97% of the company’s retail sales in the United States included folic acid. The rest will be solidified before July, Groma said in a statement.
Mission Foods launched Fortification in 2024. It now adds folic acid to all of its branded and private-label corn tortillas in the United States
Such actions by large manufacturers have paved 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 group that has pushed for stronger.
Initially, the industry was concerned that folic acid could affect taste and the cost of changing labels, said Jim Kabani, president of the Tortilla Industry Association. But he now expects tortilla makers to start selling stronger products on a larger scale.
“I think overall the train is leaving the station and it’s going to be more and more interstate,” he said.
Public health experts like the growing movement.
“The science is clear: folic acid supplementation works,” said Vijaya Kuncharla, professor of epidemiology at Emory University and director of the Spina Bifida Prevention Center. “It’s safe. It’s stable. And it’s cheap.”
That view contrasts sharply with critics—including some at the highest levels of government—who see food security consolidation as a form of government overreach.
Late last year, Health Secretary Robert F. Kennedy Jr. criticized California’s new law in an X post: “This is madness. California is fighting a war against its own children — targeting the poor and communities of color,” he wrote.
A spokesman for Kennedy declined to comment on the comments.
Social media feeds are rife with people claiming that folic acid fortification is “toxic” or that people with a particular gene variant known as MTHFR cannot process the vitamin properly.
According to advocates and medical experts, none of these claims are accurate.
“What’s really crazy is that our nation’s top health officials are spreading false claims and scaring people into avoiding foods that prevent birth defects and save babies’ lives,” said CSPI Senior Policy Scientist Eva Grenthal.
Folic acid “has never been shown to harm people or populations in fortified doses,” said Dr. Jeffrey Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham. which works to prevent neural tube defects in the United States and around the world.
The US Centers for Disease Control and Prevention asserts that “people with the MTHFR gene variant can process all forms, including folic acid.”
Even Kennedy’s new Federal Diet guidelines advocated consolidation. The documents supporting the guidelines advise pregnant women to eat folate-rich foods, such as green vegetables, beans and lentils. But they also acknowledge that folic acid from fortified foods or supplements is “important” for preventing neural tube defects before and during early pregnancy.
“The folic acid fortification of millet flour may help prevent neural tube defects,” the CDC website adds.
Neural tube defects, which affect about 2,000 babies in the United States each year, occur in the first weeks after pregnancy, when the tube that forms the spinal cord and brain does not develop properly.
This is often before most women know they are pregnant. More than 40% of pregnancies in the United States are unintended. In these cases, many women will not be ready to get pregnant, notes Dr. Kimberly B. Dale, medical director of the rehabilitation clinic that helps children with spina bifida at Miller Children’s Hospital in Long Beach, California.
“Even the best efforts of women to go to the OB right away and start prenatal vitamins, it’s too late,” BeDell said.
Adding folic acid to cornmeal, the same way it’s added to other grains, is one way to ensure the nutrient reaches the broader population that needs it, she added.
At age 28, pregnant with her first child, Andrea Lopez didn’t know the importance of folic acid or that the vitamin might be missing from her diet.
Then, a mid-pregnancy ultrasound revealed that her baby had anencephaly, a fatal condition in which the head does not develop properly.
Lopez carried the pregnancy to term and Gabrielle lived 10 days. The pain of losing him will never go away, she said, adding that Gabriel will be a freshman in high school this year. He supports a California law requiring folic acid fortification of cornmeal and finds it “mind-boggling” that the act took so long to enact.
“Trust me, you don’t want to go through this,” she said. “He is the love of my life. I have two little girls who survive, but he is my first born. He is my only son.”
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