BIRMINGHAM, Ala. — Alabama has once again landed among the worst places in the nation to have a baby. That’s the damning takeaway from the 2025 March of Dimes Report Card, which handed the state an “F” for maternal and child health outcomes, citing persistently high rates of infant mortality, preterm births, and inadequate access to care.
The nonprofit’s annual report delivers a gut punch: Alabama ranks third in the nation for infant mortality, ninth for maternal mortality, and fourth for preterm birth rates. Birmingham, Montgomery, and Tuscaloosa all flunked as well, with local preterm birth rates in some cities topping 16 percent. Startlingly, nearly one in four women across the state miss out on essential prenatal care during the first trimester—often due to provider shortages, lack of transportation, or insurance hurdles.
While the health crisis weighs heavily on Alabama families, the underlying causes are political and structural. Year after year, Republican leaders have resisted broad Medicaid expansion, maintained restrictive abortion policies, and failed to invest in rural healthcare infrastructure. Alabama’s backward approach has left thousands in maternity care “deserts”—regions where no hospital offers obstetric services, making quality care a luxury reserved for the few.
Could it be any different? Many states, including California and Minnesota—both governed by progressive legislatures—achieve maternal mortality rates about a third of Alabama’s, thanks to broader Medicaid eligibility, robust postpartum support, and aggressive racial equity initiatives. Nationally, America is an outlier among wealthy nations: according to international comparisons, Alabama’s maternal and infant death rates are comparable to some developing countries like Nicaragua, Honduras, and Ghana.
Solutions are not rocket science. The March of Dimes, along with policy experts, recommends expanded Medicaid for all low-income families, paid parental leave policies, reimbursement for doula and midwife care, and universal postpartum mental health screening. A newly launched federal initiative awarded Alabama a grant to improve care delivery, increase support for mothers, and promote “birthing-friendly” hospitals, yet real progress will require sweeping reforms—especially in rural and majority-Black communities hit hardest by legislative neglect.
With elections looming and Alabama’s families paying the price, a growing coalition of health advocates is demanding that state lawmakers step up and end this public health crisis, one grounded not in a lack of medical knowledge but in failed, conservative political choices.