Fortify Alabama: Corn Masa Fortification for Spina Bifida Prevention

Neural tube defects (NTDs), such as myelomeningocele, are serious birth defects preventable with adequate maternal folate intake. In the United States, Hispanic populations have disproportionately high NTD rates. Mandatory fortification of enriched cereal grains in the 1990s significantly reduced NTDs but excluded corn masa flour (CMF), a staple in many Hispanic diets. This shortcoming may contribute to persistent disparities in NTD rates. We pursued a state legislative mandate for folic acid fortification of CMF to reduce NTDs. We also developed a legislative model that can be replicated nationwide to encourage broader fortification of CMF. A task force engaged the Hispanic community through bilingual outreach to understand dietary habits and the role of CMF to optimize the impact and cultural utility of resulting legislation. Based on these conversations, legislation was drafted with consultation from fortification experts ensuring scientific and policy viability. A legislative sponsor was secured through targeted engagement and lobbying. In June 2025, HB384 was signed into law by the governor of Alabama, mandating folic acid fortification of CMF and tortilla products. Opposition cited concerns about genetic variation in folic acid metabolism, prenatal care access, and governmental overreach. Alabama's legislative success demonstrates a model for addressing sources of disparity in health care access and outcomes. Additional states replicating this approach may promote national CMF fortification policy or incentivize industry adoption of CMF fortification, potentially preventing up to 120 NTD cases per year in the Hispanic community, saving up to $100 million in annual health care spending.