According to a report from the Alabama Department of Public Health, women without health insurance had 22.7 infant deaths per 1,000 births, more than twice the rate of deaths of infants from mothers with health coverage. Some health experts say a lack of medical care access is a contributing factor to the state's overall infant mortality rate, historically one of the highest in the United States. Meanwhile, Alabama's decision not to expand Medicaid as part of federal health care reform could hamper its efforts to save more babies' lives, some experts say.
"Maternal care, even pre-conception care between pregnancies ... the health of the mom is a big part of this," Dr. Martha Wingate, associate professor in the school of public health at UAB, said of the state's infant mortality rate. "It certainly is an access issue."
The ADPH report shows that in 2012, women without insurance had 22.7 infant deaths per 1,000 births. Women with private insurance, however, had 6.8 infant deaths per 1,000 births last year. For women on Medicaid, the federal insurance program for low-income Americans, the infant mortality rate was 9.7 per 1,000 births.
Overall, 519 Alabama babies died before their first birthday last year, a rate of 8.9 deaths per 1,000 births. Alabama's infant mortality rate has remained higher than 8 deaths per 1,000 births for the last decade. In contrast, the U.S. rate was 6 deaths per 1,000 births in 2011, the latest national data available.
Calhoun County had eight infant deaths in 2012, a rate of 6.2 per 1,000 births, state figures show.
Alabama's infant mortality rate was second in 2011 only to Mississippi's, which had more than 9 deaths per 1,000 births.
The report shows high rates of smoking and low birth weights in Alabama are major factors contributing to the state's high infant mortality rate. Babies that weigh less than 5 pounds, 8 ounces are more than 20 times more likely to die than infants of normal weight, the report states. According to the Centers for Disease Control and Prevention, Alabama is among the top three states with the highest rates of smoking. Also, infants of mothers who smoke have a 51 percent higher infant mortality rate than nonsmoking mothers, the ADPH report shows.
Shelley Birchfield, nurse manager for the maternity ward at Regional Medical Center in Anniston, said women with insurance have greater access to prenatal care, giving their babies a greater chance of survival.
"Not seeing a physician is a huge contributor to mothers having pre-term births," Birchfield said. "With prenatal care, you can detect if the mother has diabetes or hypertension or other issues that you can get under control, which will help lead to a healthier pregnancy."
Earlier this year, Alabama chose not to expand its Medicaid program as part of the 2010 Affordable Care Act, opting to reform it first. States that chose to expand Medicaid will receive full federal funding for their programs for the next three years.
M.J. Ellington, policy analyst for Alabama Arise, a nonprofit that advocates for low-income residents, said the fact that a large percentage of Alabama women with infant deaths are uninsured is a significant problem.
"If these people who do not have insurance were brought into the insurance system, through Medicaid or through private insurance, that 22.7 death rate could change so dramatically," Ellington said. "Health tracking, especially for young mothers, if they don't have that then they don't know if they have problems that could be corrected."
Donald Williamson, state health officer, agreed that greater access to health care through Medicaid could help lower the state's infant mortality rate.
"If the state ultimately tries to do something with Medicaid, it will likely do something positive with that population," Williamson said.
However, Williamson added that Medicaid expansion alone would not solve the state's infant death problem.
"We're talking about case-managing to ensure mothers get follow-up care," Williamson said. "Just giving them a Medicaid card alone won't solve the problem."
Wingate agreed that expanding Medicaid will only go so far toward lowering infant mortality rates. She said other issues like Alabama's high smoking rate would still be an issue regardless of health insurance coverage rates.
"Giving women access to services, depending on the population, might play a role, but I don't think it will be the magic bullet," Wingate said.
Williamson said the ADPH plans to expand its efforts to decrease smoking rates in the state to reduce the number of infant deaths. For instance, the state's anti-smoking program plans to offer women of childbearing age up to eight weeks of nicotine replacement therapy, such as nicotine patches, instead of the traditional two weeks.
Williamson said the health department will also ramp up efforts to discourage induced labor except in the case of a medical emergency.
"Studies have shown that women who carry the baby between 39 and 40 weeks have less of a chance of having a baby with low birth weight," Williamson said.
Birchfield said RMC recently instituted a policy against induced labor except for medical emergencies.
"We're trying to get that education out, to get them to wait," Birchfield said.
Birchfield said RMC offers various programs to increase the chances of infant survival, including prenatal classes and education about sleep safety for babies. The hospital also encourages breastfeeding, which some studies show provides healthier nutrients than formulas, Birchfield said. The hospital also encourages the mothers and anyone living with them not to smoke, she said.
"One fetal death is too many," Birchfield said.
Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star.