Members of the University of Alabama at Birmingham Department of Neurosurgery, the Global Alliance for Prevention of Spina Bifida (GAPSBiF) and the UAB mission:brain chapter recently came together with March of Dimes to advocate for a bill that could address a significant health disparity in Alabama’s Hispanic community.
On March 19, 2025, the group visited the Alabama State House of Representatives in support of legislation requiring folic acid fortification in corn masa flour. The proposed legislation, Alabama House Bill 384 (HB 384), seeks to extend existing requirements for folic acid fortification to include corn masa flour—a key ingredient in the Hispanic diet.
Since the late 1990s, the U.S. Food and Drug Administration (FDA) has mandated folic acid fortification for enriched cereal grains, contributing to an overall decline in spina bifida cases across the country. However, despite its widespread consumption in the Hispanic community, corn masa flour was excluded from these mandates. This has left a gap in preventive measures for Hispanic populations, who are disproportionately affected by spina bifida, a debilitating neural tube defect (NTD) that can lead to disabilities and, in severe cases, infant mortality.
Research indicates that spina bifida is largely preventable with adequate maternal folic acid intake before and during early pregnancy, and an estimated 50% to 70% of NTDs are folic acid sensitive.
Although the FDA allowed voluntary fortification of corn masa flour in 2016, only a small percentage of manufacturers have chosen to fortify their products. The cost of fortification is relatively low—estimated at just $1 per metric ton of corn masa flour—but its benefits for public health are significant.
Experts estimate that a fortification mandate could prevent 30 to 120 spina bifida cases each year in the Hispanic community in Alabama alone, saving millions in healthcare costs and, more importantly, improving the quality of life for families affected by the condition.
In addition to the medical benefits, the legislation could have a profound social impact. Families of children with spina bifida often face emotional, financial and social hardships, including a 30% higher risk of divorce and underemployment, according to experts in the Department of Neurosurgery. Reducing the incidence of spina bifida through folic acid fortification could help alleviate these burdens and improve the well-being of affected families.
As HB 384 moves from the House of Representatives to the Senate for a vote, advocates are hopeful that this legislation will gain the support it needs to make a lasting difference in the lives of Alabama’s Hispanic population.