Maternal mortality is sky-high in Alabama — and it's mostly preventable.
A recent review of maternal mortality in Alabama found that many of the deaths were entirely preventable. One of the ways to fix this, the report noted, was ensuring access to a broad range of women's health services, including contraceptives and abortion care.
The Alabama Department of Public Health, along with the Alabama Maternal Mortality Review Committee, examined all maternal mortality deaths in the state for 2016. An overwhelming majority — nearly 70% — of the pregnancy-associated or pregnancy-related deaths could have been prevented.
Regrettably, it isn't surprising that Alabama has poor maternal health outcomes, including death. While the state has done a great deal to restrict abortion, it has done very little to foster women's health.
When it comes to supportive policies — policies that help ensure good health outcomes for women and families — Alabama has very few. That's in keeping with other states which restrict abortion rights: the more restrictions a state imposes, the less it has laws that support maternal and child health.
Alabama has refused to expand Medicaid, does not provide reasonable accommodations for pregnant workers, does not mandate paid sick leave, and does not have expanded family or medical leave.
Pregnant people who have mental health or substance abuse issues are especially at risk in Alabama. There aren't many in-patient beds for pregnant people with substance use issues and the state criminally charges women with felonies if they expose their fetus to drugs. This leads, the report noted, to people avoiding getting appropriate care because of fear of negative consequences.
Where Alabama takes very few steps to care for pregnant people, it takes nearly every possible step to limit access to abortion.
It imposes unnecessary standards on abortion facilities and limits who may provide abortions. There are mandatory counseling requirements, mandatory waiting periods, and mandatory ultrasounds. Parental consent is required, and telemedicine to administer medication abortion is prohibited. Abortion is prohibited in nearly all cases after 20 weeks.
Recently, Alabama hasn't been content with these myriad restrictions. In 2019, the state passed a law that would have banned nearly all abortions, though it was later blocked by the courts. Earlier this year, the state used the COVID-19 crisis to try to block access to abortion by declaring it a nonessential medical procedure.
Simply expanding Medicaid and allowing for longer postpartum coverage could make a huge difference in maternal mortality in Alabama. Right now, Alabama ends Medicaid pregnancy coverage only six weeks after childbirth. If women have pregnancy-related issues that arise after that time, they may have no meaningful medical care.
But that's not enough. The report also found that increased access to contraception in the postpartum period so that births might be appropriately and safely spaced out would help decrease maternal mortality. Ensuring rural hospitals stay open and making sure there are enough family practitioners, nurse practitioners, and nurse midwives would also help. And finally, the report declared that "safe abortion services and access to contraceptives are also imperative to women's health."
Contraception and abortion services are part of a continuum of maternal health care. Alabama has largely ignored that continuum, choosing instead to try to ban abortion and restrict the behavior of pregnant people. Alabama's maternal mortality review shows this approach simply doesn't work.
Published with permission of The American Independent Foundation.