Maternity care is vanishing in rural Alabama resulting in maternity care deserts and increasing the state’s infant mortality rate, which is already above the national average, according to data presented at a College of Community Health Sciences academic lecture.
More than a third of Alabama counties lack adequate obstetrics services, requiring expectant mothers to travel long distances for prenatal care and to deliver their babies, or go without those services.
The lecture, “Vanishing care: Addressing rising infant mortality and maternity care deserts in West Alabama,” was provided by Dr. Ashley Steiner, a practicing family medicine obstetrician with University Medical Center, and Janise Norman, Region II perinatal coordinator for the Alabama Department of Public Health’s Bureau of Family Health Services.
Infant mortality is defined as the death of an infant prior to his or her first birthday. Alabama’s infant mortality rate in 2023, the latest year for which this data is available, was 7.8 deaths per 1,000 live births, a 1.1% increase from 2022. That compares to the national average of 5.6 deaths per 1,000 live births in 2023.
“A total of 449 infants died in Alabama before reaching their first birthday in 2023. That was 58 more infant deaths from the 391 deaths in 2022,” Norman said. “We’re going downhill. It’s disheartening to see these numbers.”
Preterm birth and low birthweight are major causes of infant mortality. In 2023, the preterm birth rate was 13.1% in Alabama compared to 10.49% nationally. Low birthrate was 10.43% in Alabama and 8.52% nationally in 2023.
Norman said a lack of availability and accessibility to maternity care services, particularly in rural Alabama counties, is edging up infant mortality rates, and she worries that additional rural hospital closures in the state could further increase those numbers. There have been at least seven rural hospital closures in Alabama since 2011, primarily due to insufficient insurance reimbursement.
A maternity care desert is defined as having no hospitals and birthing centers offering obstetrics care, no obstetrics providers, and any proportion of the female population between the ages of 18 and 64 without health insurance, said Steiner, also an assistant professor with CCHS, which operates UMC.
She said in West Alabama, nine of 12 counties are considered maternity care deserts – Choctaw, Greene, Hale, Lamar, Marengo, Marion, Perry, Pickens and Sumter.
“West Alabama is primarily a maternity care desert,” she said.
Steiner noted that in 1980, 45 of Alabama’s 55 rural counties provided maternity care. In 2024, that number had dropped to only 16 of 55 rural counties providing maternity care.
“This is dismal,” she said, adding that there is a link between maternity deserts and infant mortality. “Inadequate prenatal care is linked to poor outcomes.”
Work is underway to try and increase the availability of maternity care in West Alabama. Steiner said interviews are being conducted in Greene and Perry counties to better understand the barriers to accessing maternity care and what can be done to increase access to care. A CCHS faculty member was recently awarded a federal Health Resources and Services Administration grant to develop a maternity care telehealth program in Choctaw and Hale counties in collaboration with the Alabama Department of Public Health.
Steiner said other ways to increase maternity care include mobile clinics and free-standing birthing centers.