The ACLU of Alabama on Monday published a report detailing maternal health disparities in the state and recommending changes to improve access to and quality of care.
The report outlines findings from the organization’s 2025 Moms Matter Listening Tour, which included listening sessions and written surveys with pregnant people to identify barriers to care in rural and underserved areas.
Participants answered four open-ended questions about the resources they received and wished they had received during and after pregnancy, their communication with health care providers, whether medical professionals listened to and respected them and what changes Alabama should make to promote safer pregnancies and postpartum experiences.
The ACLU found that access to care is “severely limited” in rural areas and that transportation barriers can create life-threatening delays for pregnant people. The organization also concluded that financial instability has worsened health disparities and that mental health and postpartum support remain inadequate.
The report warned that insufficient health education leaves families without critical information and that health care providers frequently undermine pregnant women’s autonomy.
“Alabama must rethink how we approach maternal health, but that work shouldn’t begin in committee rooms in Montgomery,” ACLU of Alabama Executive Director JaTaune Bosby Gilchrist said. “It should begin in the living rooms and community centers where families have been navigating this reality every day.”
The report said 34 percent of Alabama counties are classified as maternal health care deserts. It also said 43 of the state’s 67 counties, primarily rural areas with predominantly Black and economically disadvantaged populations, have little or no access to maternity care.
Pregnant Alabamians travel an average of more than 17 miles, or at least 23 minutes, to reach the nearest birthing hospital, according to the report.
The ACLU also cited findings that Alabama had the nation’s highest maternal mortality rate in 2025, with 65 deaths per 100,000 births—nearly twice the national average.
The maternal mortality rate among Black women in Alabama was significantly higher, at 100 deaths per 100,000 births.
“The roots of this crisis reflect the decades of inequities in health care access and quality,” the report said. “Contributing factors include limited maternity leave, inadequate postpartum care, delayed recognition and treatment of pregnancy-related complications, and the persistence of maternal health care deserts.”
The report included responses from mothers who participated in the listening tour, including concerns about nearby access to care and discrimination while seeking maternal health services.
“I am concerned about the hospital closures and lack of accessible care in Alabama,” a mother from Alabaster wrote. “I live 30 minutes from my hospital. The hospital 3 minutes from my house closed its OBGYN unit.”
A Tuscaloosa respondent said she depended on a free clinic in her area and had experienced discrimination in medical settings throughout her life.
“I’ve experienced discrimination in health care settings all my life because I am a Black female,” she wrote. “From withholding health information, being repeatedly dismissed, health care workers being aggressive and abrasive to me, etc. I have issues getting the help I really need.”
The report includes findings from six listening sessions held in Tuscaloosa, Selma, Montgomery, Mobile, Birmingham and Anniston.
“Across the six listening sessions, each community highlighted different concerns,” the report said. “Geography, available resources, and local challenges shaped which concerns emerged.”
However, the report said participants statewide consistently called for more accessible mental health care for postpartum depression, timely diagnoses, better education about pregnancy and labor and stronger patient advocacy throughout the birthing process.
The ACLU offered policy recommendations for the Alabama Legislature, health care providers and hospital administrators to address the state’s maternal health crisis.
The organization called on lawmakers to expand Medicaid and private insurance coverage for doulas and community health workers.
Medicaid and most private insurers in Alabama do not currently cover those services. The ACLU recommended legislation modeled after a law Arkansas enacted in 2025.
The organization also called for increased funding for the Alabama Perinatal Quality Collaborative and the reintroduction of legislation proposed in 2024 and 2025 to improve maternal health care.
House Bill 312, introduced in 2024 by state Representative Ben Harrison, R-Elkmont, would have allowed midwives to provide services at freestanding birth centers and authorized the Alabama Board of Midwifery to accept gifts and grants.
“Midwifery is a model of care that will fill the gaps in Alabama’s provider shortage, specifically in maternal health deserts without hospital access,” the ACLU said. “This legislation would allow midwives to practice their full scope of care, reducing the burden on OB-GYNs and emergency departments while increasing access to prenatal care and birthing services for women throughout the state.”
House Bill 322, sponsored by state Representative Frances Holk-Jones, R-Orange Beach, and Senate Bill 191, sponsored by state Senator Vivian Figures, D-Mobile, would have required Medicaid coverage for postpartum depression services and established postpartum education programs and screenings.
Senate Bill 19, sponsored by state Senator Merika Coleman, D-Birmingham, would have recognized individuals’ right to contraception and health care providers’ right to distribute contraceptives and information about their use.
The ACLU’s recommendations for health care providers include mandatory implicit bias training for perinatal care professionals and improved communication between providers and patients.
The organization also recommended six policy changes for hospital administrators, including partnerships with local doula agencies and classifying doulas as nonvisitors. The change would allow both a doula and family members or other loved ones to attend a hospital birth.
The report also recommended that hospitals provide consistent access to postpartum depression screenings and follow-up care, offer classes about childbirth and the postpartum period and complete the Alabama Medicaid Agency’s Presumptive Eligibility for Pregnancy training.
The program, known as PEP, provides temporary Medicaid coverage for maternal care to pregnant women who meet certain requirements. Only qualified providers who have completed the agency’s training may determine whether someone qualifies.
The ACLU also offered recommendations for Alabamians seeking to improve maternal health outcomes in their communities.
The organization encouraged residents to work with local groups to create centralized resource hubs.
“Several listening sessions revealed a desire for a single, easy-to-navigate website listing local maternal health resources and instructions on how to access them,” the organization said. “People can partner with local nonprofits, advocacy groups, or community leaders to collect information about the resources in their community. Once the information is collected, Alabamians can ask their local medical facilities to share the website with patients.”
“Community is the solution in almost any situation,” a mother from Prattville wrote.
The report also encouraged residents to ask medical providers and local facilities to complete Medicaid presumptive eligibility training and to educate pregnant and postpartum people about available services through word of mouth, faith-based communities and neighborhood networks.
