Fact Sheet

It’s time for Alabama to prove we care about mothers and children

Healthy parents and healthy children mean a healthier future for Alabama. Comprehensive maternal and infant health care investments are crucial to ensure the health and safety of both infants and Alabamians of child-bearing age, especially postpartum mothers, pregnant women and future mothers.

Alabama Arise envisions a world in which each successive generation is ensured a secure and healthy future. By adopting policy solutions to increase the number of health care providers and extend health coverage to more people, Alabama lawmakers can help turn that vision of a brighter future into a reality.

A deadly problem

Alabama has the highest maternal mortality rate in the nation. Similarly, Alabama’s infant death rates are higher than those in most other states. Alabama has the nation’s third highest infant death rate, behind only Mississippi and Arkansas.

Another sobering fact accompanies these stark realities: Black infants and Black Alabamians who give birth experience higher mortality rates than their white and Hispanic counterparts. In fact, the infant mortality rate for Black babies is 1.5 times higher than the state average and nearly twice as high as the infant mortality rate for white babies. Similarly, Black mothers in Alabama are twice as likely to die during childbirth as their white counterparts.

Contributing factors

No one specific factor is solely responsible for the poor maternal and infant outcomes in Alabama. Rather, numerous challenges have combined to cause and worsen the situation. Listed below are a few of the key ones.

Maternity care deserts: Perhaps the most alarming factor is the prevalence of maternity care deserts in Alabama. A maternity care desert is defined as a county or area where there is a lack of access to maternity care resources. These areas often have no obstetric providers and no birth centers or hospitals offering obstetric care.

More than one-third of Alabama counties are maternity care deserts, with some people having to drive up to 100 miles to reach the nearest labor and delivery department. The lack of essential delivery and prenatal care in the Black Belt and other areas worsens the state’s maternal and infant health disparities, especially for women with low incomes.

Lack of Medicaid expansion: Alabama has a high rate of women of childbearing age who are uninsured. Nearly 300,000 Alabamians find themselves in the state’s health coverage gap. They make too much money to qualify for Medicaid, yet too little to afford private health insurance. In Alabama, 1 in 6 women aged 18 to 44 – or roughly 16% – are uninsured.

Alabama has the nation’s sixth highest rate of uninsured women of childbearing age. Research shows that Medicaid expansion is associated with lower rates of infant and maternal mortality as well as with improvements in preconception health care access and health care use before pregnancy. But Alabama remains one of only 10 states that have not expanded Medicaid to cover adults with low incomes.

Limitations resulting from state policies: Across the nation, the leading cause of infant mortality is birth defects. One in five infant deaths results from severe birth defects. But Alabama fails to screen many newborns for several rare but treatable diseases. One likely reason for that shortcoming is a lack of dedicated state funding for such screenings.

Chemical endangerment laws also lead many doctors to forgo screenings that could help catch addiction-related issues for expecting parents. Instead of incentivizing appropriate screening, treatment and harm reduction, these laws criminalize addiction and cause more harm, according to the Alabama Maternal Mortality Review Committee.

Administrative choices for Medicaid: Numerous other policy changes could promote better health for parents and infants across Alabama. Among the March of Dimes’ recommendations are “improved integration of the midwifery model of care, reimbursement for doula care, and increasing the availability of telehealth services.” Medicaid also could allow reimbursement for donor breast milk.

Impacts of the abortion ban: Alabama’s abortion ban is considered one of the nation’s most restrictive. Infants born in states with the most restrictive abortion laws are “significantly more likely to die before their first birthday than [a]re those born in states with no restrictions,” a 2020 study in the International Journal of Environmental Research and Public Health found. In addition, the exceptions to Alabama’s ban are inadequate to protect the health of the parent.

Where do we go from here?

Alabama Arise is committed to learning more about and advocating for policy solutions to improve maternal and infant health outcomes in the state. This will include advocacy for Medicaid expansion to close Alabama’s health coverage gap. We also will monitor and aim to support administrative efforts to promote better maternal and infant health.