Where you live shouldn’t impact whether you get health care. But many women face preventable barriers to obtaining maternal health care in Alabama. Closing Alabama’s health coverage gap through Medicaid expansion is an essential part of the solution.

Alabama has experienced a steady rate of labor and delivery department closures in recent years, creating several maternity care deserts in Alabama.

• A maternity care desert is defined as a county or area with 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.
• Since October 2023, at least four hospitals have closed their labor and delivery departments.

The closure of accessible labor and delivery departments is dangerous for mothers and babies.

• When rural hospitals close their obstetric units, pregnant women in those areas face increased challenges in accessing critical prenatal and delivery care, forcing them to travel long distances for maternity services.
• Longer travel distances to care can cause financial strain on families and increased prenatal stress and anxiety. The distance a woman must travel to access care becomes a critical factor during pregnancy, at the time of birth and in the case of emergencies.
• The farther a woman travels to receive maternity care, the greater the risk of maternal morbidity and adverse infant outcomes, such as stillbirth and NICU admission.

Expanding Medicaid would help strengthen access to maternity care providers by improving rural hospitals’ overall finances, which could reduce the number of labor and delivery department closures in the state.

• Medicaid expansion would increase the number of insured patients, reducing the amount of uncompensated care that hospitals provide. This increased financial stability could help keep labor and delivery units operational.
• Research shows that a rural hospital being located in a Medicaid expansion state decreases the likelihood it will close by an average of 62%.
• Rural hospitals in states that have expanded Medicaid coverage have more sustainable median operating margins compared with rural hospitals in non-expansion states.

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.

• Black infants and Black mothers experience higher mortality rates than their white and Hispanic counterparts in Alabama. 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.

Medicaid expansion can help address the high maternal mortality rate and health disparities in Alabama by ensuring continuous coverage before, during and after pregnancy.

• Medicaid expansion would provide more women with access to regular prenatal checkups, leading to early detection and management of potential health issues for both the mother and the baby.
• Research shows that adoption of Medicaid expansion is associated with lower rates of maternal mortality, and reduction in infant mortality as well.
• Medicaid expansion also has been found to increase preconception health counseling, folic acid intake and postpartum contraception.