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’s a long-delayed move aimed at reducing Hispanic infants’ disproportionately high rates of serious conditions called neural tube defects, which claimed Lopez’s son, Gabriel Cude, when he was 10 days old.

“It’s such a small effort for such a tremendous impact,” said Lopez, 44, who lives in Bakersfield and is now a lawyer with two young daughters. “There is very little that I wouldn’t do to spare anybody this heartache.”

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 — Texas, Delaware, New Jersey and Pennsylvania — have expressed “active interest” in the issue, according to the Food Fortification Initiative, an advocacy group that focuses on addressing micronutrient deficiencies.

“All women and children in the United States should have access to folic acid and have healthy babies,” 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 by about 30%, 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 — 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, a review found.

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 twice as high as for white or Black women, state data show.

California’s new law — and the state’s huge buying power — could help expand its adoption nationwide, said state Assemblymember Joaquin Arambula, who sponsored the legislation passed in 2024.

“You have to be the first oftentimes to get the ball rolling,” he said. “So, I’m glad other states have taken up that mantle.”

California’s 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 — but not all — varieties of Maseca, its largest brand of corn masa flour, with folic acid in 2016.

As of this year, 97% of the company’s 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 recent report 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.

“I think overall the train has left the station and it will be more and more states,” he said.

Public health experts cheer the growing momentum.

“The science is clear: Folic acid fortification works,” said Vijaya Kancherla, an Emory University epidemiology professor and director of the Center for Spina Bifida Prevention. “It’s safe. It’s proven. And it’s cost-effective.”

RFK Jr. calls corn masa fortification ‘insanity’

That view contrasts sharply with critics — including some at the highest level of government — 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 a post on X: “This is insanity. California is waging war against her children — targeting the poor and communities of color,” he wrote.

A spokesman for Kennedy declined to explain the comments.

Social media feeds are rife with people claiming that folic acid fortification is “toxic” or that people with a certain gene variation known as MTHFR can’t properly process the vitamin.

None of those claims is accurate, according to advocates and medical experts.

“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, CSPI’s senior policy scientist.

At fortification doses, folic acid “has never been shown to harm individuals or populations,” 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 “people with the MTHFR gene variant can process all types of folate, including folic acid.”

Even Kennedy’s 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 “critical” before conception and during early pregnancy to prevent neural tube defects.

“Folic acid fortification of corn masa flour could help prevent” neural tube defects, the CDC website adds.

Without fortification, ‘It’s 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’s often before many women realize they’re 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’s Hospital in Long Beach, California.

“Even women’s best efforts in going to an OB right away and starting prenatal vitamins, it’s just too late,” 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’t 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’s law requiring folic acid fortification of corn masa and finds it “mind-boggling” that the action took so long to enforce.

“Trust me, you don’t want to go through this,” she said. “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.”

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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U.S. Army 1st Lt. John Kauhaihao of Captain Cook was just 27 when he was killed in action on Sept. 5, 1969, in Tay Ninh Province during the Vietnam War.

He was posthumously awarded the Distinguished Service Cross — the Army’s second-highest military decoration for extraordinary heroism in combat, below only the Medal of Honor — in addition to the Purple Heart and other military honors.

Kauhaihao’s name now graces the U.S. Post Office in Captain Cook.

At the Keaukaha Military Reservation in Hilo on Friday, his 83-year-old widow, Shirley Kauhaihao, was among dozens honoring him and other Hawaii Island military members killed in action in the Southeast Asian nation.

The memorial service, hosted by the Big Island National Guard Retirees’ Association and the 1st Squadron 299th Cavalry Regiment, marked National Vietnam War Veterans Day, which is technically today. Today’s date is a fitting choice, as March 29, 1973, was the day the U.S. Military Assistance Command, Vietnam, was disbanded and the last U.S. combat soldier departed Vietnam. It was also around this date that Hanoi released the last of its acknowledged prisoners of war.

Shirley Kauhaihao, who had four children with the decorated hero, drove from Kona to attend the ceremony. She said the memorial at KMR bearing her husband’s name and nine others whose service, like her husband’s, began with the National Guard — assures “these men will never be forgotten, that they will live forever.”

In addition to the 10 whose names are engraved on the memorial, there were 42 other Big Island service members whose ultimate sacrifice was commemorated.

One, Sgt. 1st Class Rodney Yano of Kealakekua, was posthumously awarded the Medal of Honor for sacrificing his own life on Jan. 1, 1969, near Bien Hao, to clear a helicopter of prematurely detonating explosives that could have downed the aircraft and killed crew mates.

The 25-year-old air cavalryman was originally laid to rest at the National Memorial of the Pacific at Punchbowl in Honolulu. At his family’s request, however, his remains were re-interred on Nov. 11, 2025, Veterans Day, at the West Hawaii Veterans Cemetery in Kailua-Kona. Yano Hall, a county Parks and Recreation community center in Captain Cook, is named after him.

Retired Col. Gerald Takase, BINGRA president and the event’s emcee, noted that the fallen service members were honored “in the shadow of our ongoing conflict” with Iran and urged the dozens in attendance to “remember all service members at this time.”

A proclamation from Gov. Josh Green, presented by Peter Sur, Green’s East Hawaii liaison, asked Hawaii residents “to contemplate the price of peace and and to express appreciation to those who have borne the unequal burden of war.”

Maj. Keoki Leong, executive officer of the Hawaii Army National Guard’s 1st Squad, 299th Cavalry, delivered the keynote address written by Brig. Gen. Tyson Tahara, the commander of the Hawaii Army National Guard. Tahara couldn’t leave Oahu because of duties related to the aftermath of the recent Kona low storms.

“Whether private or general, when called upon, like these brave soldiers we honor today, we answer,” Leong said.

From Tahara’s prepared speech, Leong noted the Hawaii Army National Guard’s 29th Infantry Brigade “lost 29 soldiers.”

“What are the odds that the number would match? That is 29 too much,” he said. Leong added the “bravery and honor of the lava brigade” earned the brigade 40 Purple Hearts, 187 Bronze Stars, 87 Air Medals, four Silver Stars, two Legions of Merit and a Distinguished Service Medal.

“To the ‘ohana of Vietnam veterans, you served as well,” Leong said for Tahara. “You endured long separations, uncertainties — and for some, profound loss.

“Your strength sustained those who wore the uniform, and your sacrifices are part of this legacy.”

He added that Vietnam veterans “answered their nation’s call during one of the most complex and challenging conflicts in our history.”

“Today, we recognize not only their service, but their sacrifice, their resilience and their enduring legacy …,” Leong said.

“These veterans are inspirations of bravery, the standard of heroes in the flesh — and they are the most valuable reminder of the cost of war.”

Each fallen service member’s name was read and a bell tolled for each name. In addition to Kauhaihao and Yano, they are:

Army

• Sgt. 1st Class Edward Loo Jr., Waimea;

• Sgt. Wilfredo B. Andrada, Hilo;

• Sgt. Alberto Milar Jr., Hilo;

• Cpl. Glenn Shibata, Kealakekua;

• Spec. 4 Larry Leopoldino, Hilo;

• Spec. 4 Frank Longakit, Hilo;

• Pfc. Dennis Penis, Honomu;

• Pfc. Dennis Silveri, Pahoa;

• Spec. 4 Gilbert Olivar, Kurtistown;

• Spec. 4 George Luis, Pahoa;

• Spec. 5 Delmore Nerveza, Hilo;

• Spec. 4 Wallace Matayoshi, Hilo;

• Spec. 4 John Cabrera, Kohala;

• 1st Sgt. Samuel Solomon Jr., Hawi;

• Spec. 4 Bobby Barcena, Hakalau;

• Sgt. James Kajiwara, Hilo;

• Staff Sgt. James Lindsey, Naalehu;

• Sgt. Eugene Castaneda, Honokaa;

• Spec. 5 Kaoru Honda, Hilo;

• 1st Lt. Lawrence Gallego, Papaaloa;

• Sgt. 1st Class George Salema, Kurtistown;

• Staff Sgt. Momi Kane, Kailua-Kona;

• Spec. 5 Aaron Hervas, Kailua-Kona;

• Spec. 5 Wolfgang Mohl, Papaikou;

• Spec. 4 Fred Hatada, Hilo;

• Sgt. 1st Class John Salazar, Kohala;

• Sgt. 1st Class Seichi Sakai, Kohala;

• Pfc. Fernando Valdez, Pepeekeo;

• Spec. 4 Michael Nakashima, Hilo;

• Pfc. Errol Perreira, Hilo;

• Spec. 4 Mose Kuahiwinui Jr., Kurtistown;

• Cpl. Robert Lazarus, Waimea;

• Sgt. Herman Ban, Hilo;

• Spec. 4 Calvin Serain, Ookala;

• Warrant Officer Wayne Hedeman, Kealakekua;

• Sgt. 1st Class Alfredo Sanut, Paauhau;

• Staff Sgt. Steve Johnson, Kailua-Kona;

• Sgt. Joseph Gaa Jr., Kealakekua;

• Sgt. Lester Alipio, Hakalau;

• Spec. 4 Terence Ogata, Hilo;

• Spec. 5 Arthur Kawachika, Hilo;

Marine Corps

• Cpl. Charles Iopa, Hilo;

• Lance Cpl. Harold Llanes, Kailua-Kona;

• Gunnery Sgt. Kenyu Shimabukuro, Hilo;

• Lance Cpl. Keith Puhi, Holualoa;

• Pfc. Charley Paro, Kohala;

• Lance Cpl. Hayward Peleiholani, Pahoa;

• Capt. John Peacock II, Kailua-Kona;

Navy

• Hospital Corpsman 2nd Class Steven Wolter, Hilo.

Email John Burnett at john.burnett@hawaiitribune-herald.com.