Alabama Gets an “F” on March of Dimes Report Card

The latest March of Dimes report card paints a stark picture of maternal health in Alabama, declaring the State is in crisis—and Black women are paying the highest price.

According to the report, Alabama earned an “F” on the 2025 March of Dimes Report Card, ranking 49th out of 52 jurisdictions for preterm births. More than 7,300 babies in the State came early in 2024, contributing to a 12.7% preterm birth rate—a figure that experts say reflects systemic gaps in care.

The data underscores deep racial disparities. Black mothers, according to the report, face both higher health risks and poorer outcomes. Their babies are 1.6 times more likely to die before their first birthday than those born to White mothers.

Dr. Michael Warren, Chief Medical Officer for March of Dimes, told WSFA that the root of these disparities reaches far back. “We know those disparities … are really rooted in historical racism and discrimination,” he said.

One major policy issue he highlighted is Medicaid. Only two of six key initiatives recommended by the March of Dimes to improve maternal and infant health have been adopted in Alabama: the extension of postpartum Medicaid coverage to one year, and the operation of a State Maternal Mortality Review Committee.

The other four initiatives suggested by the March of Dimes but not adopted by Alabama are doula reimbursement, paid family leave, universal postpartum depression screening, and expanded medicaid eligibility for adult coverage.

Expanding Medicaid has been a contentious issue in Alabama for years. State Rep. Phillip Ensler (D-Montgomery) argued that expansion would help bridge the coverage gap for adults who make too much to qualify for Medicaid but not enough to buy private insurance. He emphasized that the federal government would cover most of the cost—and that expansion could also help keep rural hospitals open.

But not everyone agrees. Gov. Ivey’s office pushed back, noting that her concern remains how to fund Medicaid expansion over the long term.

Medical reporter and candidate for Congress in AL3 Terri LaPoint told ALPolitics.com that, “Dr. Warren has oversimplified the issue, blaming racial disparity and lack of Medicaid. Yet their own data shows that private insurance, not Medicaid, results in better outcomes. We must look deeper into the question of WHY there is a racial division in outcomes. We know that things like c-section rates and past abortions contribute to pre-term birth and mortality rates. We also know that the Covid vaccine and flu shot contribute to much higher rates of miscarriage, morbidity, and mortality, but neither this (WSFA) news report or the March of Dimes is addressing this.”

“One recommendation by the March of Dimes in the source document that would make a huge difference in outcomes is the use of labor doulas. Doula [and midwife] reimbursement is a low-cost, high-result measure that would make a significant difference in mortality and morbidity rates for birthing women,” LaPoint concluded.

The report card also flags Alabama’s infant death rate as a major concern: in 2023, there were 7.6 infant deaths per 1,000 live births, placing Alabama near the bottom nationally. Among the leading causes are premature birth, birth defects, and sudden unexpected infant death (SUID).

Preventive and prenatal care is also lacking. For example, only 21% of Black mothers receive adequate prenatal care, by one of the metrics used in the report.

Public health advocates say the solution requires more than just policy tweaks—it demands structural change. “Where you live and your race shouldn’t determine whether your baby survives,” said one community leader quoted in the report.

Not included in the report card, but certainly applicable to Alabama’s maternal and infant healthcare crisis, were attempts in the last legislative session to expand the scope of midwifery in the State. HB 257, introduced by State Rep. Ben Harrison (R-Elkmont) and its companion SB 87, by State Sen. Arthur Orr (R-Decatur), were designed to broaden midwife services in Alabama in ways that could have helped cut the State’s high infant-mortality rate. These bills would have had a disproportionately higher benefit in rural areas where access to prenatal and newborn care is limited. Both bills sought to expand the scope of practice for licensed midwives, allow care in freestanding birth centers, and permit midwives to administer or assist with basic newborn screenings—steps supporters argued would catch health problems earlier and give more mothers real options outside crowded hospitals. 

HB 257 never moved past introduction in the House, and SB 87 was amended so heavily that midwives withdrew their support, saying the changes stripped away the very tools needed to improve infant outcomes. In the end, neither bill survived the session in a form that would expand care and potentially save lives and improve outcomes.

As Alabama grapples with hospital closures, especially in rural areas, and long-standing health inequities, the March of Dimes report is calling for broad, sustained action—including Medicaid expansion, better prenatal support, and addressing racial disparities in health care. Without that, advocates warn, change will be slow—and lives could continue to be lost.

Alabama’s report card is available at THIS LINK.