MONTGOMERY, Ala. – Alabama is the “most dangerous” state in the country to be pregnant or give birth in, according to a new report from the ACLU of Alabama.
Alabama’s maternal mortality rate is 65 deaths per 100,000 births, which is nearly double the national rate, according to the report. That rate is even higher – 100 deaths per 100,000 births – for Black Alabamians.
The “Moms Matter” report makes policy recommendations based on that data and anecdotal findings from the organization’s six-city Moms Matter Listening Tour on maternal health. The ACLU of Alabama heard from 145 women across the state, including in-person stops in Selma, Montgomery, Tuscaloosa, Birmingham, Mobile and Anniston.
Findings
The most common challenge Alabama mothers reported was a lack of access to medical services, especially care in rural areas. The report also lists transportation issues and financial instability as barriers that can create unnecessary life-threatening situations.
“For many, simply reaching an appointment was a challenge,” the report said. “Limited or unreliable transportation meant missed prenatal and postpartum visits. Available transportation services often required advance scheduling, something impossible in urgent situations like labor or when experiencing complications.”
The report cites data that found 34% of Alabama’s 67 counties are maternal healthcare deserts. Pregnant Alabamians travel over 17 miles or 23 minutes to their nearest birthing hospital on average, according to the report.
Women across the state also shared that they were unsure of how to access maternal mental health resources, worsening conditions like postpartum depression.
“Participants reported minimal screening for postpartum depression and inconsistent follow-up,” the report reads. “Those who experienced miscarriage or pregnancy loss described receiving no structured grief support, leaving families to rely solely on informal social networks. Many felt abandoned by the system during their most vulnerable moments.”
A’Niya Robinson, director of policy and organizing at the ACLU of Alabama, said it was important to speak directly to the women impacted to get a full sense of the maternal health landscape and find a path forward.
Robinson said that in addition to mental health and transportation issues, many women at the stops spoke candidly about negative experiences with medical staff, often expressing that they felt a lack of autonomy.
“The last thing that came up was that folks didn’t have the best experiences with medical staff,” Robinson told Alabama Daily News. “They often felt like their pain was being dismissed, or they felt like they were essentially coerced into making decisions that they really didn’t want to make.”
The report says numerous women shared experiences of unnecessary cesarean sections and denial of their birthing preferences like epidurals and positions.
It also highlights the racial disparity that exists in Alabama for maternal mortality. Black Alabamians are three times more likely than other racial groups to die from pregnancy complications, according to the report.
Though the rate is higher for people of color, Robinson said that maternal mortality is an issue that touches everyone. She hopes lawmakers take action to help people across the state because even areas with greater access to quality resources don’t meet the existing demand, she said.
“I hope (lawmakers) realize that this is an issue that needs to be prioritized in Alabama even more than what it already is,” Robinson said. “We have data that literally covers each corner of the state, and the fact is that we actually have more places that we want to go, more maternity healthcare deserts in the state, more people we want to touch.”
Recommendations
The report offers several recommendations – some for lawmakers and others for healthcare facilities – about how the state can address the maternal health crisis.
Robinson said several of these policy recommendations come from the lived experiences women shared during the listening tour. These include expanded coverage for doulas and midwives, increased funding for postpartum depression screening and a recognition of a person’s right to contraception.
The ACLU of Alabama and its partners will be pushing for legislation to protect access to contraception and in vitro fertilization in 2027, Robinson said.
Several lawmakers, mostly Democrats, introduced legislation about maternal health during the 2026 legislative session, but most bills were never discussed in committee.
House Bill 128 from Rep. Marilyn Lands, D-Huntsville, allows the State Board of Midwifery to accept gifts and grants instead of solely relying on licensing fees and fines. Gov. Kay Ivey signed it into law in April, and it will go into effect on Oct. 1.
The report also offers suggestions about how hospitals and clinics could alter their practices to improve maternal health outcomes. Those recommendations center around improving communication with patients, completing screenings for mental health issues and making it easier for doulas to assist.
The report also notes that Alabama is one of only 10 states nationwide that has not opted to expand Medicaid, “further restricting access to essential maternal healthcare services.”
“Lawmakers have a clear directive here,” Robinson said. “The data is here, not just our numbers, but other partners have released lots of reports as well. For a state that often tries to market itself as being open for business, you also have to make sure that the conditions are sound for people to live and grow, and that’s just clearly not happening here.”
The Alabama Department of Public Health declined to comment on the report. The Alabama Department of Human Resources did not return ADN’s request for comment.