There is no victory in an increase in Black infant mortality

The Alabama Department of Public Health recently released the infant mortality rate for 2022, lauding the fact that the overall rate improved from 7.6 deaths per 1000 births to 6.9.  But the real story is that Black infants are now dying at an even higher rate than the year before, showing that better outcomes are solely relegated to white babies alone. A Black baby is now almost three times as likely to die as a white one, just as Black mothers in Alabama remain three times more likely to die in childbirth or soon after.

This doesn’t come as any shock to us at West Alabama Women’s Center, where the vast majority of our patients are poor, Black, and on Medicaid or uninsured. Nor does it surprise us to learn that more than a quarter of these birthing people have had inadequate prenatal care, or that nearly 1,200 of those who gave birth had no prenatal care at all. We expect these numbers because they support the experiences of the patients that we see every day at our clinic, which offers sliding-scale and free prenatal care to those who are uninsured or under-insured or are unable to access an OB-GYN.

In the first 10 months of 2023 we have provided more than 400 pregnancy tests and nearly 200 prenatal visits in our Tuscaloosa clinic. Patients come to us primarily for pregnancy confirmation letters that they need in order to apply for Medicaid, as their application won’t be accepted without doctor validation. As patients without insurance, the task of finding a doctor willing to see them and then provide that mandatory letter is nearly impossible. Once they do have the letter and apply, they then wait to see if they will be enrolled – often four to six weeks – and only after that can they begin to book prenatal care.

Then there are the patients who are already on Medicaid. Many of them get stuck in an endless loop of trying to book into the calendar of a doctor who takes the insurance, often being told that it will be months before the first available appointment. Those with private insurance tend to have more luck, both because of a larger pool of doctors and the draw of higher reimbursements. Healthcare – as we see all too clearly – is primarily a profit-driven industry.

We know that receiving prenatal care in the first trimester is one of the biggest indicators of good health outcomes for both mother and child. An early appointment means the ability to address any health issues like high blood pressure or diabetes, both of which can lead to miscarriage, preterm birth, and other poor health outcomes, including stillbirth. It allows screening for numerous tests – perhaps most importantly STI testing, where rising rates of syphilis are leading to an increase in infant deaths. It offers tangible advice and assistance in accessing other vital health resources like dental care and addiction or mental health care, just some of the needs that may be postponed by patients who lack a primary care provider. And it offers an established provider to see if any complications arise that may need evaluation, allowing patients to avoid overflowing and expensive emergency rooms.

It is because of all these benefits that we have committed ourselves to seeing patients five days a week, regardless of insurance coverage or ability to pay. We understand that these are lives at stake, and the earlier someone is seen the more likely it is that both the pregnant person and the baby will be healthy in the end.

It is not lost on us that this is a commitment that we – the clinic who was once responsible for nearly half of the abortions in the state – have devoted ourselves to, when others around us deny these patients care.

Hopefully as this crisis grows, more doctors will vow to be just as pro-life.