MONTGOMERY, Ala. — Alabama’s infant mortality rate has risen sharply in 2024, highlighting a troubling trend tied to the state’s longstanding refusal to expand Medicaid. Health experts say the increase underscores the human cost of political decisions that have left tens of thousands without access to critical healthcare services.
The Alabama Department of Public Health recently reported that the state’s infant mortality rate — a key measure of public health — surged to 9.2 deaths per 1,000 live births, significantly higher than the national average of 5.4. The jump, from 7.6 in 2023, puts Alabama on par with some of the world’s least developed nations.
Alabama is a wealthy country within a wealthy nation, yet we’re seeing infant mortality rates comparable to places like Sri Lanka or Libya. This is a direct consequence of our political leadership ignoring the health needs of our most vulnerable residents.
The issue is compounded by the state’s refusal to expand Medicaid under the Affordable Care Act, a policy decision that has left approximately 300,000 Alabamians in a health coverage gap. Medicaid expansion would have provided health insurance to low-income residents, including thousands of women of childbearing age.
In states that have expanded Medicaid, studies show infant mortality rates have declined, particularly among African American infants, who face disproportionately high risks. But in Alabama, where Medicaid eligibility for non-pregnant adults remains among the strictest in the nation, many women forgo prenatal care due to cost, resulting in preventable complications like preterm births and low birth weights.
Rural hospital closures have further deepened the crisis. Since 2010, 18 hospitals in Alabama have shuttered, many in rural areas where Medicaid expansion could have stabilized finances by reducing uncompensated care. Now, women in those regions must travel hours for prenatal visits or deliver their babies in under-resourced facilities — if they receive care at all.
The decision not to expand Medicaid has created healthcare deserts across Alabama. The ripple effects of that decision are deadly for mothers and infants alike.
Alabama’s infant mortality rate is nearly double that of neighboring Georgia, which expanded Medicaid in 2023, and vastly outpaces countries like Germany and Japan, where rates hover around 2 per 1,000 live births. Even Cuba, a country with a fraction of the United States’ GDP, boasts a lower rate at 4.
For African American babies in Alabama, the outlook is even grimmer: the mortality rate exceeds 15 per 1,000 live births, a disparity linked to systemic racism, poverty, and lack of access to care.
Critics say the state’s refusal to expand Medicaid is rooted in cynical political calculations, with Republican leaders framing the move as a rejection of “federal overreach.” Yet the cost to Alabama is not just human — it’s financial. The federal government would cover 90% of expansion costs, and studies suggest the economic benefits of a healthier population far outweigh the expense.
The refusal to expand Medicaid is a political decision cloaked in fiscal rhetoric, but the reality is it’s costing lives. This is about ideology, not economics, and Alabamians are paying the price.
As the crisis deepens, calls for Medicaid expansion are growing louder. Advocacy groups have launched campaigns urging lawmakers to reconsider their stance, pointing to states like Kentucky and Louisiana, where expansion has improved health outcomes.
For now, Alabama’s most vulnerable families continue to bear the brunt of a decision that many see as avoidable.