Alabama is in the bottom three for preterm births, but progress is slowing • Alabama Reflector

According to the March of Dimes, 143 of the average 1,112 babies born each week in Alabama are premature, which the CDC considers births that occur before 37 weeks of pregnancy. Of these, 22 babies per week are born “very early” or in the 35th week of pregnancy. The earlier a baby is born, the higher the risk of breathing problems, difficulty feeding, cerebral palsy, developmental delays, or vision and hearing problems.

Dr. Wes Stubblefield, the district medical officer for the Alabama Department of Public Health, said annual changes in infant mortality data are influenced by population size and data variability.

Alabama’s infant mortality rate is rising to its highest level in seven years

“The larger the data set, the more reliable the information is. The same applies to districts. “The graph for the entire U.S. is much smoother than that for Alabama when you compare year-over-year trends,” he said.

There are wide disparities in infant and maternal care in Alabama between whites and marginalized groups, and preterm birth rates are no different. According to Hill, black families in Alabama have a preterm birth rate of 15.9%, while Asian American and Pacific Islanders report the highest rate at 17.3%.

Although Asian Americans and Pacific Islanders make up just 0.1% of Alabama’s population, Hill said it is important to break down the data by specific racial and ethnic groups to better understand and address disparities. Pacific Islanders’ high preterm birth rates are statistically significant, she said, and highlight systemic inequities.

“We need to ask these communities directly what they need to thrive, rather than assuming one-size-fits-all solutions,” she said.

Dr. Christopher Zahn, director of clinical practice and health equity and quality at the American College of Obstetricians and Gynecologists (ACOG), said in a statement that the organization is committed to its efforts to address racial disparities in maternal and infant health, with particular emphasis Pays attention to reducing premature birth rates.

“One of ACOG’s longstanding policy priorities has been to extend postpartum Medicaid benefits from 60 days after delivery to one year. With Medicaid paying for approximately 64% of births for Black women, expanding this coverage is critical to reducing disparities, particularly racial health disparities,” Zahn said.

In March 2023, the Alabama Medicaid Agency received approval from the Centers for Medicare & Medicaid Services (CMS). Expand postpartum Medicaid coverage from 60 days to a full year. Medicaid pays for more than half of births in Alabama.

ACOG is also pushing for more investment in maternal and child health research, with a focus on improving diversity in clinical trials.

“ACOG advocates and supports the expeditious passage of the PREEMIE Reauthorization Actwhich would renew the federal government’s commitment to preterm birth research and programs, reauthorize activities to prevent preterm birth, and provide for a new study on the costs, effects of social factors and gaps in public health programs that lead to preterm birth,” Zahn said in the declaration.

A key factor associated with poor birth outcomes is inadequate prenatal care. Hill said Alabama’s rate of inadequate prenatal care, defined as the percentage of women who receive less than half of appropriate medical appointments during a pregnancy, is 18.1%. That’s higher than the national average of 15.7%. She said a lack of maternity care, particularly in rural areas, exacerbates this problem.

“Access to care is critical,” Hill said. “In counties with full access to obstetric care, we still see barriers such as transportation, family support and economic challenges that prevent women from receiving appropriate care.”

The March of Dimes examined for the first time how environmental factors such as extreme heat and air pollution contribute to adverse birth outcomes, highlighting the differences between different populations. For example, black and Hispanic populations are exposed to 56% and 63% higher levels of pollution, respectively, compared to white populations.

“We’re seeing a lack of air quality sensors, and we’re also dealing with the extreme heat to make sure our air pollution and things like that are being looked at for the benefit of pregnant women,” Hill said.

According to a May 2024 American Medical Association Journal studyExtreme heat events can impact perinatal health, with preterm and preterm birth rates increasing following heat waves, particularly among socioeconomically disadvantaged subgroups.

Both Hill and Stubblefield emphasized the need for targeted interventions to reduce inequalities.

“Significant disparities still exist, and reducing Alabama’s infant mortality rate remains a top priority for several different agencies in the state, including ADPH,” Stubblefield said.