Letter to Food Manufacturers and Retailers from HHS Secretary Xavier Becerra on Folic Acid Awareness Week

Dear Food Manufacturers and Retailers:

As we recognize Folic Acid Awareness Week, I call on all companies who manufacture or sell corn masa flour products to consider the important health benefits of folic acid for women of reproductive age and make a commitment this year to increase the availability of fortified products. Folic acid, a synthetic form of folate, is an important B vitamin essential to fetal development especially in the early weeks of pregnancy.¹ Pregnant women with folate insufficiency have a higher risk of giving birth to infants affected with neural tube defects, specifically spina bifida and anencephaly. Studies show that some U.S. women do not consume enough folic acid to help prevent neural tube defects,² and that Hispanic women are more likely (7.5 per 10,000 live births) to have a child born with a neural tube defect compared to non- Hispanic white and non-Hispanic Black women.³ Increasing folic acid in dietary staples, like tortillas or other corn masa products, can help reduce the prevalence of neural tube defects.

In 1996, the Food and Drug Administration (FDA) implemented standards for the fortification of cereal grain products that are labeled as enriched such as enriched bread, rice, and pasta, with folic acid.⁴ Since the implementation of this policy, there has been a 36 percent decrease in pregnancies affected by neural tube defects.⁵ Despite this success, Hispanic women are less likely to consume folic acid from fortified foods or take a multivitamin containing folic acid.⁶ Recognizing that many U.S. women of childbearing age regularly consume products made from corn masa flour as a staple in their diet, including, in particular, women of Latin American descent, in 2016 FDA implemented standards for the fortification of corn masa flour with folic acid. However, there is currently limited availability of fortified corn masa flour products.⁷,⁸ An analysis by the Centers for Disease Control and Prevention (CDC) found that, since FDA implemented standards for folic acid fortification of corn masa flour products, there has not been a significant improvement in blood folate levels among Hispanic women of reproductive age.⁹

The U. S. Department of Health and Human Services (HHS) continues to work to increase awareness around this topic and to support the availability of fortified products. CDC recently launched new resources ¹⁰ to highlight and provide information on this important public health issue. Additionally, in March 2024, I convened representatives of large food manufacturers and retailers to discuss strategies to increase the commercial availability of corn masa flour products that are fortified with folic acid.¹¹ HHS stands ready to answer questions and partner with stakeholders to address this public health challenge. For example, FDA has established a resource site on fortifying corn masa flour products with folic acid.¹² This resource site is available in both English and Spanish and compiles relevant resources on folic acid fortification of corn masa flour for both industry and consumers, including an inquiry portal, regulatory information, and weblinks to helpful resources, such as dietary advice for pregnant people. Companies are encouraged to contact FDA through the inquiry portal: [email protected] for assistance.

HHS is happy to support further cross-industry conversations and provide additional materials to support public education campaigns. I commend the companies who have stepped up to increase the availability of fortified foods on shelves, but there is still more work to be done. I call on the food industry to join us in highlighting the importance of folic acid for all women of reproductive age and commit to increasing the availability of fortified products. Thank you for your attention to this critical public health issue impacting women nationwide.

Sincerely,

Xavier Becerra

¹https://www.cdc.gov/folic-acid/about/index.html

²https://pubmed.ncbi.nlm.nih.gov/35995050/

³https://onlinelibrary.wiley.com/doi/full/10.1002/bdr2.2301

⁴https://www.govinfo.gov/content/pkg/FR-1996-03-05/pdf/96-5014.pdf

⁵https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5931a2.htm

⁶https://www.cdc.gov/folic-acid/health-equity/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/folicacid/data.html

⁷https://static1.squarespace.com/static/5e1df234eef02705f5446453/t/65fdf150b840e1375cbe6a0b/1711141201503/Corn+Masa+in+the+United+States+-+Supply+Chain%2C+Market%2C+and+Fortification.pdf

⁸https://www.cspinet.org/sites/default/files/2023-02/CSPI_FailureToFortify_Eng_2023_final.pdf

⁹https://pubmed.ncbi.nlm.nih.gov/38457279/

¹⁰https://www.cdc.gov/folic-acid/index.html

¹¹https://www.hhs.gov/about/news/2024/04/03/readout-hhs-secretary-xavier-becerras-roundtable-fortifying-corn-masa-products.html

¹² https://www.fda.gov/food/food-additives-petitions/fortifying-corn-masa-flour-products-folic-acid

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