The Alabama Birth Equity Initiative, a new coalition of state reproductive healthcare and mutual aid initiatives, is seeking to provide services that tackle Alabama’s reproductive healthcare crisis.
The initiative is a collaboration between the reproductive health and abortion-access group, the Yellowhammer Fund; the Birmingham-based food, housing and childcare support organization, Margins: Women Helping Black Women; the reproductive health advocacy organization, Chocolate Milk Mommies; and birth centers, Oasis Women’s Health and the Alabama Birth Center.
The coalition was launched in partnership with the National Institute for Reproductive Health’s Birth Justice Policy Lab, a year-long grant program that funds community-led reproductive health projects in Black and Indigenous communities.
The initiative is seeking to “create a measurable increase” in the number of licensed Black midwives in the state by funding midwifery apprenticeships, mentorships, scholarships, stipends and preceptor placements.
The initiative will also focus on policy advocacy and is planning mobile health units to provide reproductive health care services in rural communities, as well as expanding Margins’ mutual aid network through 24-hour food pantries, housing, utilities and childcare support.
“Too often, conversations about maternal health in Alabama stop at the hospital doors. But the truth is, safe birth starts long before labor—it starts with stable housing, reliable transportation, respectful care, and communities that have what they need to thrive,” Margins Executive Director Celida Soto said in a written statement.
“The Alabama Birth Equity Initiative is about making sure those things aren’t luxuries. It’s about building the kind of everyday conditions where Black women and birthing people can live full lives, not just survive pregnancy,” she added.
The initiative aims to work against barriers to maternal healthcare access, including rural hospital and obstetric service closures and a lack of access and trust in low-income, rural and minority communities.
Nonprofit March of Dimes’s annual report on maternal health outcomes, released last month, ranked Alabama among the worst U.S. states in terms of infant and maternal mortality, preterm births and access to adequate prenatal care.
Additionally, a 2023 study from the organization classified 34 percent of Alabama counties as maternity healthcare deserts, or areas without birthing facilities or maternity healthcare providers.
Roughly 30 percent of women lack a birthing hospital within 30 minutes of their home. Additionally, Black, Indigenous and people of color in the state in areas of socioeconomic vulnerability showed a 24 percent increased likelihood of inadequate prenatal care compared to those living in areas of low socioeconomic vulnerability.
“Alabama’s maternal health crisis isn’t just about a lack of doctors or closed hospitals—it’s about the way policy, poverty, and racism have worked together to make safe birth a privilege instead of a right. In one of the most hostile reproductive landscapes in the country, we can’t afford piecemeal solutions,” Yellowhammer Fund Executive Director Jenice Fountain said. “The Alabama Birth Equity Initiative is about changing the conditions that put our lives at risk—by building care systems led by Black women, rooted in community, and strong enough to last for generations.”
Fountain told APR that the Alabama Birth Equity Initiative will allow pre-existing advocacy organizations to work collaboratively to improve reproductive health outcomes.
“We were all separately working on different pieces of this issue. After the Dobbs decision, I became Executive Director at the Yellowhammer Fund, which, at the time, was essentially just an abortion fund, but people weren’t really like, paying attention to the maternal crises that were happening subsequently,” she said.
Fountain said the initiative aims to improve healthcare access for communities that not only struggle with limited access to care but also a lack of community trust in established medical providers.
“We’re in a place where people have navigated so much medical bias and harm, that there is a reluctance that’s not only based in finance, not only based in accessibility. It’s based on people not trusting that they can get care without stigma,” she said.
She explained that by expanding upon the Yellowhammer Fund’s mobile health services and food, housing and childcare support provided by Margins, the initiative seeks to provide numerous “wraparound” services that are better able to bridge financial and social barriers to care.
According to Fountain, the mobile health unit component of the initiative was conceived as a way the Yellowhammer Fund could build on its previous mobile reproductive care product distribution initiative. The organization purchased a bus in 2023, and toured the state distributing items such as emergency contraceptives, condoms, pregnancy tests, period products and diapers.
She said the program’s reception from local communities and healthcare workers who offered to help provide mobile services such as pap smears and HPV screenings inspired the initiative’s plan to establish a more comprehensive mobile health unit.
“Now we’re like, yes, we need to take that service to the community, where we built relationships, where people are trusting of us, and then give them the resources without the shame, without the stigma, without the cost, without the barrier of transportation,” she said.
Fountain also expressed hope that by offering midwifery preceptor training, the initiative will give opportunities to expand access to midwifery care in communities of color.
“We noticed with midwifery care, there were a lot of people that had aspirations to become a midwife but were telling us they were being treated horribly by the few places that they could get their preceptor hours in their training,” Fountain said. “Part of the issue, again, is that there’s not places to get your preceptors. We’ve even had midwives say, ‘Oh, these people literally just don’t accept Black student midwives.’”
The initiative’s midwifery training pilot program will fund the preceptor training of eight student Certified Practicing Midwives and two Certified Nurse Midwives at Alabama Birth Center in Huntsville and Oasis Women’s Health in Birmingham. Five applicants have already been selected for the program, with an online portal planned for accepting applications for the additional spots.
“We’re hoping to organize folks in communities that don’t have access to that type of programming but have interest,” Fountain said.
“If we teach 10 people inside of a community that’s underserved, midwifery, they’re going to use that. They’re going to apply it and benefit the community,” she added. “A lot of what we’re trying to do is just really help people become advocates for their own selves, for their own communities, for their own families. Because working only inside of the system as it’s set up is not working.”
Dr. Yashica Robinson, founder of Alabama Birth Center, has paid out of pocket for the training and travel expenses of student midwives completing preceptor training at the center since it opened a year and a half ago.
Robinson told APR she’s confident the initiative will help improve access to maternal care by funding training for midwives looking to practice in the state.
“We know that midwives and birth centers can help to close healthcare gaps by providing high-quality, affordable, culturally respectful care in communities where traditional health systems, you know, fall short,” she said.
“Providing great apprenticeship programs, making sure that midwives have access to preceptors so that they can complete their certification and go to fill gaps in these communities, we’re confident that we will see improvement in these healthcare outcomes,” she added.
She also highlighted that the initial collaborations that have come about through the initiative have helped build a stronger support network for patients.
“In my relationship with Alabama Birth Center, we have found that there are so many other areas where our patients that we’re trying to serve; they fall through the gaps,” Robinson said.
“The thing that I’ve appreciated with this partnership is that there’s no one organization that can meet all of the needs of our clients and really do it well,” she added.
Robinson explained that connections with partner organizations have allowed her to better serve patients by referring them to financial, childcare and lactation support services.
“In working with this initial initiative with Yellowhammer Fund, we’ve been able to provide, you know, some of those wraparound services, making sure that people have that financial support, they have support for postpartum and mental health support, have support for lactation and education,” said Robinson.
She went on to express gratitude for the Yellowhammer Fund’s support for Alabama Birth Center, and her hope that the initiative will expand ways the center can assist patients.
“They have been vital even before this initiative, in helping, sometimes with organizations like ours, with grant writing and helping to connect us with financial resources to be able to continue the work that we’re doing,” Robinson said. “So now, this partnership kind of gives us a little bit more expertise in all of these different areas so that we can do a better job of serving our community.”
