California’s Tortilla Law Targets Birth Defects. Other States May Follow

AlmaRosa Alarcon expected a routine delivery. She was 27 years old, healthy, and determined to give birth without an epidural. But when the doctor held up her daughter, Caterina, moments after she was born, he revealed tiny twisted feet, a condition known as clubfoot. Paramedics airlifted the newborn to a larger hospital, while Alarcon stayed behind, stunned.

“I didn’t think it was real,” she said. “I was in shock. I only spent like 20 minutes with her. It was one of the roughest days of my life.”

Doctors diagnosed the baby with a birth defect known as “spina bifida” that can cause lifelong complications, including nerve damage, mobility challenges and hydrocephalus — a buildup of fluid in the brain.

“I was living in darkness,” Alarcon said. “It was so horrible.”

Caterina spent her first weeks in the hospital. Medical appointments defined the years that followed — sometimes three a week, more than an hour from home. Alarcon, a single mother, had to leave her factory job to care for her daughter full time.

Research has linked spina bifida and other neural tube defects — serious conditions affecting the brain and spine — to women with low levels of folic acid during their pregnancy, Alarcon learned later.

Earlier this year, California became the first state in the country to require folic acid in corn masa flour — the base for tortillas, tamales and other staples in many Latino households. Public health experts said the new law could help prevent serious birth defects, which occur at higher rates among Hispanic families. Other states are considering similar laws. But the move has also drawn pushback from Health Secretary Robert F. Kennedy Jr. and others, who argue that adding vitamins to food, what’s known as fortification, is government overreach.

“Globally, there’s a massive amount of evidence that mandatory fortification of commonly consumed foods reduces neural tube defects,” said Sharon Bustrak with Food Fortification Initiative, a global nonprofit that advocates for adding vitamins and minerals to staple foods. “That evidence is very, very clear. There’s been some modeling to suggest that if nationally we fortified corn masa products, we could probably reduce between 100 and 200 birth defects per year.”

That need is especially visible at Marian Regional Medical Center in Santa Maria, down California’s Central Coast, where many patients are farmworkers and immigrants from Mexico, or Indigenous communities from Oaxaca and Guerrero.

As many as 80%-90% are Spanish-speaking. And in that population, neural tube defects show up more often than in the general population. Some years, Dr. Daniele Feldman, a maternal-fetal medicine specialist, treats as many as eight cases a year at the hospital.

“It can be really devastating,” she said. “And it’s always a really difficult conversation, because patients will inevitably ask … what could I have done differently?”

Neural tube defects develop very early in pregnancy — often before someone even knows they’re pregnant. The neural tube, which becomes the brain and spinal cord, is supposed to close within the first few weeks. Without enough folic acid, a B vitamin, that process can fail.

“Folic acid is really important in DNA synthesis and cell division,” said Dr. Shilpa Mathew, an obstetrician-gynecologist in Sacramento. “It’s really important to have that vitamin right at the beginning of pregnancy, when there’s tissue formation.”

In 1998, the federal government required folic acid in enriched grains like bread, cereal and pasta. Public health experts say the policy was a success, reducing neural tube defects in the United States by more than 30%.

But the benefits were not evenly distributed.

The rule did not include corn masa flour. Over time, a persistent disparity remained: Hispanic families continued to experience higher rates of birth defects. In California, those rates are roughly double that of white or Black women, according to state data.

“There are lots of reasons someone might not be taking folic acid,” Feldman said. Some people don’t know they should. Others aren’t planning to get pregnant. Cost can be a barrier. And for some, diet alone doesn’t provide enough.

Under the new law, manufacturers must add a small, standardized amount of folic acid, about 0.7 milligrams per pound, to corn masa flour, and disclose it on nutrition labels.

“California is once again leading the nation in protecting mothers and infants from preterm birth defects,” said Assemblymember Joaquin Arambula, the bill’s sponsor, in a statement. “I’m grateful that this legislation will provide a culturally appropriate way to address disparities to help prevent birth defects across our state.”

Critics argue that large-scale fortification is unnecessary for most people and could limit their choices. Some also argue that adding folic acid to foods like tortillas and tamales changes traditional recipes.

Social media is also rife with people who claim certain gene variants can’t properly process the vitamin, although medical experts said the science doesn’t back that up. Kennedy criticized California’s new law in a post on the social media platform X, calling it “insanity.”

The final version includes exemptions for small-scale producers and snack foods like tortilla chips, amendments that came after industry pushback.

2,000 miles away, Alarcon is watching closely as Alabama prepares to follow California’s lead this summer. She and Caterina, now 12, live in the city of Albertville.

After years of surgeries and treatment, Caterina’s condition is stable, but she has to wear leg braces and sometimes relies on a wheelchair. She struggles with migraines and incontinence. But Caterina is also a strong student who loves reading and anime — and is already imagining her future.

“I’m actually becoming a public speaker,” she said, lighting up as she described a podcast project. She plans to become a media consultant focused on making sure people with disabilities are represented accurately.

“I deeply support these new laws,” she said. “I wouldn’t wish my body on my worst enemy.”