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The disappearance of maternity units and rural hospitals has hit Alabama especially hard, causing some pregnant women to drive more than 70 miles for medical care, according to a report from the March of Dimes.
Almost 28 percent of Alabama women live more than 30 minutes away from a hospital with a birthing unit, compared to 9.7 percent nationwide, according to the report on maternity care deserts. Women in some counties must travel more than 78 minutes to reach the nearest labor and delivery unit, the study found.
The shortages are starkest in rural Alabama. A map showing the distance from each county to the nearest birthing hospital shows that women in the Black Belt, an area named after its dark soil and for the descendants of enslaved people who still live there, have some of the farthest drives in the state.
Honour McDaniel, director of maternal and infant health initiative for the March of Dimes in Alabama, said the report shows that Alabama women are not getting the resources they need.
“Our women have to be healthy before, during and after pregnancy and we need to give them the resources in order for them to live lives that are free of these complications and have the right start for their child,” McDaniel said.
Longer distances to birthing hospitals are linked with poorer outcomes for women and babies, according to the report. It can also cause stress and financial strain for women who have to travel for hours to get prenatal care or deliver babies.
“This really affects women because they are going to have to take off work to travel to see their obstetrician or family medicine obstetrician,” McDaniel told Al.com. “That’s taking time off work, that’s finding childcare for their children in order to drive 23.5 minutes away on average. Plus, you have the time for the appointment itself.”
The March of Dimes has been tracking the closure of labor and delivery units across the country. They have counted 301 closures since they began tracking in 2018. In Alabama, the number of labor and delivery units decreased by 24 percent between 2019 and 2020, according to the report.
The lack of access to care is especially troubling because Alabama mothers and babies have some of the worst health outcomes in the country. The state’s infant mortality rate is higher than the national average, and Black infants die at twice the rate of white ones. Most counties in Alabama have high rates of pre-term birth the study found.
McDaniel said Hispanic women and African American women have high rates of inadequate prenatal care.
“People are taking off hours to go to their obstetrician appointment,” she said. “When you have kids and a job and you have to put dinner on the table, that can be a huge impact for your day. And many women, it can’t happen. You just don’t have the resources to do that every time.”
High numbers of Alabama mothers have underlying health conditions that can complicate pregnancy, according to the report. Recently, the state created task forces to address high rates of maternal mortality. McDaniel said the March of Dimes is participating in that work to help reduce the number of women who die in the first year after childbirth.
Alabama lawmakers recently expanded Medicaid coverage for pregnant women to 12 months after birth, but McDaniel said a full expansion to all low-income people could help women become healthier before pregnancy. She said the state could also do more to increase telehealth coverage for maternity care in rural areas.
“We know if we have healthy moms, we’re going to have healthy families,” McDaniel said.
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