As we reflect on the recent observance of Black Maternal Health Week, it is crucial to confront the staggering realities that Black women in Alabama face concerning maternal health care. A closer examination of data and statistics reveals the urgent need for targeted interventions and systemic reforms to address the unacceptable disparities in maternal health outcomes.

Disparities in maternal mortality

Multiple official definitions of maternal mortality exist. The World Health Organization defines maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” Similarly, the Centers for Disease Control and Prevention (CDC) defines pregnancy-related death as “a death while pregnant or within 1 year of the end of pregnancy from any cause related to or aggravated by the pregnancy.”

In the United States, the overall maternal mortality rate was 32.9 deaths per 100,000 live births in 2021. Black women are three times more likely to die from pregnancy-related complications than white women. The maternal mortality rate for Black women is a staggering 69.9 deaths per 100,000 live births. In comparison, the maternal mortality rate for white women is 26.6 deaths per 100,000 live births. Even more tragic, data shows that more than 80% of pregnancy-related deaths are preventable.

Alabama’s maternal mortality rates

In Alabama, the maternal mortality rate is 36.4 per 100,000 live births, the third worst rate in the country. Other reports rank Alabama’s maternal mortality rate even higher. For Black women in Alabama, the maternal mortality rate is significantly higher than the national average.

The maternal mortality rate for Black women in Alabama is about 100 deaths per 100,000 live births, according to a recent Milken Institute report. The maternal health crisis does not have a singular cause. Instead, multiple factors contribute to its complexity.

Barriers to prenatal care access

Access to prenatal care is a critical factor in positive maternal health outcomes. However, many Black women in Alabama face barriers to accessing timely and comprehensive prenatal care.

One major barrier is lack of health care providers and limited access to medical facilities. According to the Alabama Department of Public Health, 55 of Alabama’s 67 counties are considered rural, with 62% of the total population living in Primary Care Health Professional Shortage Areas (HPSAs). Additionally, many Alabama counties also are considered maternity care deserts, meaning pregnant individuals there lack access to essential obstetric services close to home.

Impact of implicit bias

Implicit bias and racism within the health care system contribute to disparities in maternal health outcomes. Implicit bias can be defined as “unconscious attitudes or stereotypes that affect our understanding, actions and decisions.”

Black women are more likely to experience mistreatment (such as shouting and scolding), dismissive attitudes, and medical neglect during pregnancy and childbirth, research has shown. The American College of Obstetricians and Gynecologists (ACOG) emphasizes the importance of addressing implicit bias in the health care system to improve maternal health outcomes.

Socioeconomic factors

Socioeconomic factors, namely poverty, also play a significant role in shaping maternal health disparities in Alabama. Alabama has several rural counties in the Black Belt that are “majority-minority,” where a majority of the population is Black. In 2019, four of Alabama’s counties with the highest poverty rates were majority-minority. Poverty and its residual effects (such as housing insecurity, food insecurity, lack of transportation and more) lead to poorer health outcomes.

Another serious consequence of poverty is lack of health coverage. In 2021, one in seven women in Alabama were uninsured. Uninsured women are more likely to have poor outcomes during pregnancy and delivery than women with insurance, research shows.

Conclusion

This data and many other studies highlight the urgent need for targeted interventions and systemic reforms to address maternal health disparities among Black women in Alabama. By addressing barriers to prenatal care access, combating bias in health care and addressing socioeconomic factors, we can work toward achieving equitable maternal health outcomes for all women in Alabama.