MONTGOMERY, Ala. — Alabama’s infant mortality rate increased to 7.8 deaths per 1,000 live births in 2023, the highest since 2016, according to Alabama Department of Public Health (ADPH) data released Thursday.
The 2024 infant mortality report, presented to the State Committee of Public Health meeting in Montgomery, said infant mortality among white children had risen, driven primarily by low birth weight. The rate of Black infant mortality, while showing little change over the year, remains more than double the rate among whites.
“We know what all the reasons are that contribute to infant mortality, and we kind of went through those trying to show low birth weight and short gestation and then smoking and teen moms, but we don’t know for sure … we don’t have an explanation. It just tells us there’s a lot more work to do,” said Dr. Scott Harris, Alabama’s state health officer, after the meeting.
The report said Alabama’s infant mortality rate jumped from 6.7 per 1,000 live births in 2022 to 7.8 per 1,000 live births in 2023, a statistically significant increase and above the national provisional rate of 5.6 for the same period. Low birth weight and preterm births remain key risk factors. Health officials and advocates attribute these trends to health access disparities and a mix of state-level health policies and social factors that affect maternal and child health.
Among white infants, the mortality rate increased from 4.3 to 5.7 deaths per 1,000.
“Last year, we were really excited to say we had the lowest number we’ve ever had in the history of our state. So it’s not clear if there was a single event that produced this,” Harris said.
Black infants in Alabama continue to face a mortality rate over twice as high as white infants, a long-time problem in Alabama. The mortality rate for Black infants in 2023 was 13 deaths per 1,000.
Advocates are pressing for more support in high-need areas, especially rural and underserved communities where access to health care remains limited.
Honour Hill, director of maternal and infant health initiatives for March of Dimes in Alabama, said that addressing disparities requires understanding both health conditions and social drivers, including access to nutritious food and safe housing.
“There’s a host of factors at play, from maternal health conditions to social conditions where people live,” Hill said.
The 2024 March of Dimes Report Card for Alabama suggests that health inequities in Alabama are influenced by chronic maternal health conditions, such as hypertension, diabetes, and smoking, which have been linked to higher preterm birth rates.
According to the report, 5.3% of births in Alabama are to women with pre-existing hypertension. Their likelihood of having a preterm birth is significantly higher than for those without this condition. Chronic conditions also disproportionately impact low-income and minority communities, worsening the risk of adverse birth outcomes.
The report also says identifies gaps in health care policies, such as Alabama’s limited Medicaid expansion, leave many low-income women without coverage until pregnancy. While Alabama has extended Medicaid coverage to one year after birth, the March of Dimes argues that full Medicaid expansion could allow better access to preventive care during pregnancy, improving maternal health, reducing preterm births and ultimately lowering infant mortality rates.
“There’s only so much you can do to that nine months. If we have someone who’s getting pregnant, does not have access to the care they need, to the resources they need to stay healthy, the safe exercise areas, the food, if we’re not affecting them before they get or getting them into services,” Hill said. “Then the nine months we have with mom where she is pregnant and may be eligible for Medicaid is such a short time period in comparison.”
Alabama is one of ten states that has not fully expanded Medicaid.
Alabama’s strict abortion laws may also influence maternal and infant health, according to Brittni Frederiksen, associate director of women’s health policy at KFF, a national health policy research organization. Strict abortion laws can deter OB-GYNs from practicing in those states, reducing access to prenatal and emergency obstetric care.
While Alabama has an exception for fatal fetal anomalies, Frederiksen said that it is very difficult for women to secure approval for terminations from their providers under this exception, and doctors often hesitate due to the extensive documentation required to justify these cases. As a result, women may be carrying pregnancies with fatal anomalies to term, which can contribute to higher rates of infant mortality as these infants may not survive long after birth.
According to the October 2024 WeCount report, which tracks changes in abortion volumes following the Dobbs ruling, there have been zero abortions in Alabama since the state’s abortion ban took place, suggesting women are carrying babies with fatal anomalies to term, Frederiksen said.
“Post Dobbs, where, particularly in states where abortion is banned, people may not be getting access to terminations like they were before. Particularly with fatal fetal anomalies. And so they’re being forced to carry these pregnancies, and then these infants are dying after childbirth because of these fatal fetal anomalies,” Frederiksen said.
ADPH has launched several initiatives aimed at reducing infant mortality, such as the Fetal and Infant Mortality Review (FIMR) program, which investigates infant deaths and identifies preventable factors. Safe sleep initiatives are another focus, with ADPH distributing cribs and educating families on reducing the risk of sudden infant death syndrome (SIDS), which remains a leading cause of death for infants.
“These are preventable deaths,” said Hill, pointing out that targeted measures could make a difference for many families across the state.
This article originally appeared in the Alabama Reflector, an independent, nonprofit news outlet. It appears on FOX54.com under Creative Commons license CC BY-NC-ND 4.0.
