In the first fifteen days of the current legislative session, we have seen Governor Kay Ivey and the state Legislature work together to reform the Alabama Department of Veterans Affairs and address the violent crime epidemics in our largest cities by banning Glock switches. The Governor will also soon sign legislation to give teachers and state workers paid paternal leave.
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However, there is another critical issue that our elected officials have yet to take meaningful action on: maternity care deserts-counties with no obstetric care providers, or hospitals that offer maternity services.
Maternity care deserts have become alarmingly common in rural Alabama, leaving expectant mothers with few options and forcing many to travel excessive distances for care. Nearly half of our state’s 55 rural counties are full maternity care deserts. Most of the remaining rural counties have limited access to maternity services. Combined, this means nearly 70% of Alabama’s counties lack adequate maternal healthcare — an almost unfathomable reality in our modern era and something our state’s leaders should find unacceptable.
The impacts of the lack of care are devastating.
Nearly a third of Alabama women live more than half an hour from the nearest birthing hospital, compared to just 9.7% of women nationwide. These heightened travel times also mean heightened risk.
This absence of care has and will continue to result in dire consequences. Alabama’s maternal and infant mortality and morbidity rates rank the highest in the United States. Here, approximately 65 mothers will die per 100,000 babies born this year. Proportionally, this seems like a relatively small number, but these are lives at risk, not mere data points.
The numbers represent real Alabamians — mothers lost, children growing up without them, and families left reeling by a system that is failing them.
Without action to address this crisis, Alabama will continue to be one of the worst places in America to give birth.
The rise of maternity care deserts in Alabama is the direct result of years of financial strain on rural hospitals. Before the COVID-19 pandemic, 84% of Alabama’s rural hospitals were already operating in the red. To stay afloat, many began cutting less profitable services, with obstetric care being one of the first on the chopping block.
The cuts, while financially necessary for struggling hospitals, have been devastating for rural mothers, creating a cyclical decline in care. When hospitals eliminate labor and delivery units, expectant mothers must travel elsewhere for care, meaning fewer patients use local hospitals, leading to further financial losses.
In an attempt to remain viable, many of our rural hospitals have been reclassified as rural emergency hospitals (REH). This reclassification eliminates inpatient beds altogether. So, while this move may provide short-term financial relief, it is one of the most significant contributors to our decline in maternal care.
Additionally, many of these rural hospitals serve a high number of Medicaid patients, and declining reimbursements have made it nearly impossible to keep labor and delivery units open. In Conecuh County, where there are no delivery hospitals or prenatal care providers, the average distance to give birth was between 22 and 29 miles. However, some women have had to travel over 70 miles to give birth. Without changes in policy and funding, this crisis will only worsen.
Fortunately, our Legislature has the power and the time to take action.
That said, I am proposing a dual-faceted legislative approach to this issue that would make a significant impact by expanding obstetric services in rural emergency hospitals and strengthening the pipeline of physicians trained to provide obstetric care in rural communities.
First, legislation must allow rural emergency hospitals to maintain inpatient beds and provide obstetric services.
Currently, hospitals that transition to REH status lose their ability to offer inpatient care, exacerbating the crisis for expectant mothers. By permitting these hospitals to provide obstetric services — under proper licensing and staffing requirements — we can restore access to life-saving maternal care. Additionally, the Alabama Department of Health (ADH) should move forward with creating grant programs to assist rural hospitals in funding obstetric care, covering costs for staffing, training, and vital infrastructure.
Second, we must invest in training and incentivization for rural physicians.
Expanding the curriculum for state-funded Rural Medical Scholars programs to include obstetrics training will ensure rural family medicine physicians are equipped to provide critical maternity care in these regions. To attract and retain these providers, Alabama should offer financial incentives, including loan repayment for those who commit to serving in high-need areas and signing bonuses for those who join rural emergency hospitals or clinics.
By partnering with medical schools, such as the University of Alabama at Birmingham, the state can further develop accredited training programs tailored to meet the needs of our rural communities.
If we are truly a pro-life and pro-family values state, then our policies must reflect that across the board. Without access to care, rural mothers and babies will continue to die, and Alabama will maintain a reputation for poor maternal healthcare.
This legislation is not a wholesale fix to this crisis. Still, it is a critical step toward saving lives and strengthening Alabama’s rural healthcare system.
Avery Alexander is a Senior at the University of Alabama double majoring in Communication Studies and Political Science. She currently serves as the Chairwoman of the College Republican Federation of Alabama and sits on the Alabama Republican Party’s Steering Committee. You can contact her at [email protected].
