Infant and maternal health were two major factors in a recent analysis that ranked Alabama as the worst state to have a baby.
The analysis by the personal finance social network WalletHub was released in September. Vermont topped the overall rankings, while Alabama was number 51, ranked behind every other U.S. state and the District of Columbia.
“Families in the United States pay the highest birthing costs in the world,” wrote WalletHub’s Richie Bernardo, citing a 2012 report from the International Federation of Health Plans. “With our findings, we hope to enlighten expectant parents on the costs and conditions they can anticipate where they live.”
WalletHub experts evaluated states by examining several factors related to infant and maternal health, including hospital charges, infant care costs, infant mortality rates and access to healthcare for mothers and babies. Data for the analysis came from the U.S. Census Bureau, the U.S. Bureau of Labor Statistics, the U.S. Department of Health & Human Services, the Centers for Disease Control and Prevention and other governmental agencies and advocacy groups.
The WalletHub analysis highlights Alabama’s continuing woes when it comes to maternal and infant health. According to the 2014 KIDS COUNT Data report by the Annie E. Casey Foundation, ten percent of all babies born in Alabama in 2012 were low-birthweight. Alabama also has the second highest infant death rate in the nation.
Braden Richmond, an obstetrician-gynecologist (OB-GYN) in Anniston, said Alabama’s high number of rural poor makes maternal healthcare problematic for a large number of patients. According to the American College of Obstetricians and Gynecologists (ACOG), 52 percent of births in Alabama are financed by Medicaid, which requires maternity patients to enroll in the Alabama Medicaid Maternity Care Program.
“We see a lot of patients on Medicaid, which isn’t a problem, except that the patient has to have a Medicaid referral and follow the steps to get into the program. Other than that, care is not a problem. But then the question becomes where are you going to go?” Richmond said.
Alabama has one of the lowest numbers of OB-GYNs per capita in the country with 474 OB-GYN physicians serving a population of 2 million women, according to ACOG. Thirty-three of Alabama’s 67 counties do not have any OB-GYNs, and few hospitals offer labor and delivery services.
Joseph Biggio, professor of obstetrics and gynecology at the University of Alabama at Birmingham, said, “Over the last several years we have seen a number of labor and delivery units, especially in some of the smaller hospitals, close. While in some circumstances the providers moved to other facilities, in several cases the providers closed their offices and left the state. This only compounds the problem of attempting to get physicians to establish practices or join practices in the state.”
At the same time, the number of family physicians providing maternity care is declining, a trend that is concentrated in rural, underserved areas. These smaller communities, because of their demographics, typically cannot support specialty practices like obstetrics and gynecology.
As of 2012, only about 10 percent of family physicians in the state were offering obstetrics, said Daniel M. Avery Jr., professor and chairman of the department of obstetrics and gynecology in The University of Alabama’s College of Community Health Sciences,
“Half of the counties in the United States have no OB provider,” Avery said. “That leaves some 10 million women in the reproductive age with no local access to OB services. These women might not be able to afford to take off work or have transportation to travel to a town that does offer maternity care, so they don’t get adequate care.”
Not only are there economic factors at play, but not having a local obstetrics provider makes getting prenatal care, as well as delivery, challenging, increasing the risk of premature delivery and complications at pregnancy, Avery said.
Education is key
No single factor can be isolated to solve the problems the state faces, Biggio said. A lack of maternal care can lead to medical complications in pregnancy, which can then lead to premature births. Premature births often result in infant deaths. Educating women, even before pregnancy, is key.
“The importance of preconception care to optimize maternal health prior to pregnancy is a message that we will be hearing more about in the future,” Biggio said.
A well-educated, well-insured patient will have no problems with access to quality medical care, Richmond said. The continuing challenge is to help mothers improve their own health and, in turn, the health of their babies.
“The problem has nothing to do with their hearts,” Richmond said. “The battle is in education and motivating mothers to get the care they need.”
Share with others: