MONTGOMERY, Ala. — Alabama’s infant mortality rate has climbed to the highest level since 2016, according to new data shared by the Alabama State Committee of Public Health Thursday.
Officials attribute the climb to poverty and a lack of access to health care.
“The news was not as good as we would have liked this year,” said State Health Officer Dr. Scott Harris during the meeting. “This is the highest number we’ve had since 2016, this is a statistically significant difference from last year, which is very concerning.”
The new data shows that for 2023, Alabama’s infant mortality rate was 7.8 infant deaths per 1,000 births, a statistically significant jump from the rate of 6.7 reported for 2022, an all-time low for the state. Compared to the national infant mortality rate for 2023 of 5.6, Alabama’s rate is among the highest in the country, where it has remained historically.
Broken down by ethnicity, the infant mortality rate for white infants was 5.7 per 1,000, a significant increase from the 4.3 recorded the previous year that accounted for a majority of the overall increase, Harris said. While the infant mortality rate for Black infants did not increase as drastically, the Black infant mortality rate was more than twice as high as white infants at 13 per 1,000.
“Even though the rates among Black infants are still way too high, there wasn’t much year-to-year variation in that group,” Harris said, noting the Black infant mortality rate increase from 12.4 per 1,000 to 13 between 2022 and 2023. “The group that explains the difference is low birth-weight, premature white babies, that’s where we saw the increase that led to the change.”
Measured in sheer numbers, there were 449 infant deaths in 2023; 229 white, and 204 Black. The infant mortality rate measures the number of deaths among infants, excluding miscarriages, who die within one year of birth, and then compared to the number of births that year, which in 2023 was around 57,800.
While approximately 45% of all infant births in the state are paid for through Medicaid, the state’s low-income health care program and an indicator for poverty, 52% of the infant deaths in 2023 were those whose births were paid for through Medicaid, a statistically significant correlation tying poverty to increased instances of infant mortality.
Harris noted that, outside of ongoing factors such as a general lack of access to health care and poverty, there weren’t any new factors immediately apparent that could explain the sharp increase in infant deaths. This led committee members to pose questions in an effort to get closer to an explanation.
“We know access is a huge problem here, we know that half of the counties don’t have (obstetric) services,” said committee member Dr. David Thrasher, a respiratory doctor from Montgomery. “Do we know if (obstetric doctors) are leaving the state?”
Committee member Dr. Eli Brown, an obstetrics doctor from Birmingham, said that from what he’s observed, recruiting medical staff has proven difficult “due to our abortion laws.”
The state’s abortion laws ban nearly all abortions outside of when the mother’s life is at risk.
“What happens when we have very stringent abortion policies that are very, very conservative, it’s very difficult to attract national physicians who are looking for places when they’re coming out of their fellowships,” Brown told ADN after the meeting.
“When they’re looking for faculty positions, a lot of those people do not want to come to a state with such conservative views because when it comes to pregnancy termination in cases of congenital abnormalities, many times we still have difficulties doing those procedures, and those faculty members feel like that they will be hamstrung by some of our laws.”
Dr. Max Rogers, committee member and obstetric doctor from Mobile, provided his own assessment after the meeting as to what could be done to help improve the state’s worsening infant mortality rate, telling ADN that expanding transportation options for Alabamians living in more rural areas could make a significant difference.
“I know when we have home health, it increases quality of life; (the University of Alabama) did a great study 20 years ago with outreach for cervical cancer screening, and they would train (medical assistants) how to do a pap smear and send them out into the Black Belt, and it made a huge impact in cervical cancer rates,” Rogers told ADN.
“We’re going to have to do something that probably involves going to them. They don’t have to be a physician, they might not even need to be a nurse, it might just need to be transportation. Something out of the box.”