While infant mortality remains a persistent problem in Alabama and the United States, the national infant mortality rate of 5.6 per 1,000 live births for 2022 trended up for the first time in 20 years, while Alabama’s rate decreased to the lowest rate in state history, 6.7. Infant mortality rates are measured by the number of infants who die before reaching their first birthday. Infant mortality is widely considered to be the best overall gauge of the healthiness of a society.
For black Alabamians, however, infant mortality rates increased between 2021 and 2022 from 12.1 to 12.4. Infant mortality for whites improved from 5.8 to 4.3. In 2021 there were 58,040 births to Alabama residents, and 443 infant deaths. In 2022, there were 58,162 births and 391 infant deaths. Infant deaths to white mothers numbered 226 in 2021 and 174 in 2022. Infant deaths to black mothers were 206 in 2021 and 201 in 2022.
A tremendous amount of data is collected regarding infant births and deaths, and this information is used to assess and direct evidence-based strategies to improve health outcomes. A quarter of all births in Alabama were to mothers without adequate prenatal care, and the majority of births to mothers with no prenatal care, 54.3 percent, were to mothers aged 20-29. Almost half of all births in the state are covered through Alabama Medicaid, which includes women that received Medicaid benefits throughout their pregnancy and delivery, and the uninsured women that received emergency Medicaid when they were admitted for labor and delivery services. Fifty-nine percent of infant deaths in 2022 were from mothers enrolled in Medicaid. Alabama Medicaid began providing one year of postpartum services October 1, 2022, to continue to address chronic health conditions of women after delivery.
A positive trend which is statistically significant is the decrease in births with maternal smoking from 6.1 in 2021 to 4.8 in 2022. Mirroring national trends, births to teenagers, age 10 to 19, decreased to the lowest percent of live births ever for all races, just 6.0 in 2022. In 2013, the percent was 9.3. In 2022, there were 2,202 births to white teens and 1,168 births to black teens.
Many underlying factors contribute to infant mortality including poverty, educational levels, housing, nutrition, and access to adequate prenatal care. To improve the health of mothers and babies and to reduce risks, the department’s Bureau of Family Health Services has several ongoing initiatives.
Sleep-related infant deaths remain a major problem, and some of these deaths are preventable. The Perinatal Division provides cribs to families who cannot afford to provide a safe place for their infant to sleep, and this year the Alabama Department of Public Health (ADPH) provided more than 725 cribs at no charge to the families. Media promotions in 2023 highlighted the importance of clearing the crib to reduce the risk of suffocation and other sudden infant deaths.
Other successful state interventions include nurse home visitation for first time or high-risk mothers, screening for substance abuse and depression, treatment of sexually transmitted diseases in pregnancy, breastfeeding promotion, child passenger safety, and the Well Woman Program. The ALL Babies Program, which provides Children’s Health Insurance Program coverage to pregnant women who do not qualify for Medicaid, was extended to 36 counties in May. Other initiatives include extension of Medicaid coverage for up to 12 months after mothers give birth, perinatal regionalization, the Count the Kicks national program which encourages expectant mothers to monitor fetal kicks daily to recognize early signs of complications, and the Special Supplemental Nutrition Program for Women, Infants, and Children, WIC, which opens the door to other perinatal services that include breastfeeding promotion.
Out-based nurses with the Fetal and Infant Mortality Review Program abstract cases and engage professionals in conducting root cause analyses of fetal and infant deaths. Staff review all deaths for women in prenatal care, during delivery, or postpartum up to a year after delivery. Similar to infant deaths, the Maternal Mortality Review Committee, a multidisciplinary committee, meets to determine whether deaths were preventable and how to prevent the deaths from occurring in the future. The Epidemiology Branch analyzes the data collected. This report helps the state understand the challenges of maternal health in Alabama and the findings and recommendations of the Maternal Mortality Review Committee. Scheduled to begin in 2024, the Maternal Autopsy Program will provide an opportunity for family members of a deceased pregnant or postpartum woman to request an autopsy of their loved one free of charge. This will help family members receive answers about their loved one’s death and provide a clearer understanding of the cause of death.
ADPH can identify a combination of factors contributing to infant mortality, but there is no easy or quick solution. Dedicated Family Health Services staff members continue to work to address infant mortality by providing education, support, and other resources to improve the health of mothers and infants in Alabama.
Scott Harris, M.D, M.P.H.
State Health Officer