Neural tube defects (NTDs), including myelomeningocele, remain among the most devastating yet preventable congenital anomalies. Adequate maternal folate intake before and during early pregnancy can prevent up to 70% of these defects. Mandatory folic acid fortification of enriched cereal grains in the United States during the 1990s led to substantial national reductions in NTD rates, but this policy excluded corn masa flour (CMF), a dietary staple in many Hispanic American diets. As a result, Hispanic populations continue to experience 20%-40% higher rates of NTDs than other US population groups, representing a persistent and preventable health disparity.
Recognizing this gap, a multidisciplinary group led by pediatric neurosurgeons pursued a state-level legislative strategy to mandate folic acid fortification of CMF. Alabama and California, working in parallel, served as the pilot states for this effort. The initiative combined public health evidence, culturally informed community engagement and targeted legislative advocacy to address a structural inequity in preventive care.
Central to this effort was the creation of a task force that engaged Hispanic community leaders, families, advocacy organizations and food industry stakeholders through bilingual outreach. These conversations clarified the central role of CMF in daily nutrition, identified cultural considerations critical to policy acceptance and helped ensure that legislation would be both effective and culturally responsive. In parallel, fortification scientists and policy experts were consulted to ensure that proposed legislation aligned with existing federal standards, food manufacturing processes and established safety data.
With this foundation, legislation was drafted and a legislative sponsor secured through direct engagement and education. In June 2025, Alabama House Bill 384 (HB384), mandating folic acid fortification of corn masa flour and tortilla products sold in the state, was signed into law.
Alabama’s success established a replicable legislative and advocacy model that leverages physician leadership, community partnership and scientific rigor to address health disparities. Importantly, this work did not end with passage of a single bill. Pediatric neurosurgeons are now, through the new Corn Masa Taskforce, leading a coordinated, multistate expansion effort aimed at scaling this model nationally.
Active legislation or legislative development, led by our colleagues in pediatric neurosurgery is currently underway in multiple states. In Florida, efforts are being led by Dr. Hassan Akbari and Myron Rolle. In Georgia, Dr. Jacob Lepard is spearheading legislative engagement. I have been working in Oklahoma where a bill is currently in committee. In Texas, Dr. Trey McLugage and Dr. Laila Mohammad are advancing efforts tailored to their state’s legislative landscape. These initiatives are supported by a growing national task force that includes food fortification experts, industry partners, community organizations and advocacy groups, with pediatric neurosurgeons serving as conveners and physician-advocates.
Collectively, these state-based efforts aim to promote either nationwide CMF fortification policy or industry-wide voluntary adoption incentivized by state legislation. Modeling studies suggest that widespread CMF fortification could prevent up to 120 NTD cases annually in the Hispanic community alone, with associated reductions of up to $100 million in annual health care spending, not including broader societal and family impacts.
This work highlights the expanding role of pediatric neurosurgeons beyond the operating room: as advocates, policy leaders and public health partners. By addressing preventable causes of lifelong neurologic disability through evidence-based legislation, pediatric neurosurgeons are helping redefine the profession’s role in advancing health equity and primary prevention. The success of Alabama HB384 demonstrates that physician-led, community-centered legislative action can meaningfully reduce disparities and improve outcomes for vulnerable populations nationwide.
Michael Feldman, MD
Michael Feldman, MD is a pediatric and endovascular neurosurgeon at Oklahoma Children’s Hospital OU Health, specializing in pediatric cerebrovascular disease, spina bifida and hydrocephalus. He earned his BA magna cum laude in History and Brain and Cognitive Science and his MD with Distinction in Research from the University of Rochester. He completed neurosurgical residency and endovascular training at Vanderbilt University Medical Center, followed by pediatric neurosurgery fellowship at Children’s of Alabama/University of Alabama at Birmingham, along with the CSNS socioeconomic fellowship and Washington Committee fellowship during residency. His work focuses on pediatric neurovascular disease, CSF disorders and neural tube defect prevention, including legislative efforts to expand folic acid fortification and disparities in access to neurosurgical care.
