Op-ed: Alabama moms and babies are dying. It doesn’t have to be this way.

By Honour McDaniel Hill for AL.com

Healthy babies need healthy mothers–and not just during pregnancy. Mothers need access to care long before they become pregnant because by the time they qualify for prenatal care, it may be too late to reverse many of the risk factors that can contribute to maternal and infant death and illness.

Preconception care plays a pivotal role in shaping the trajectory of maternal and infant health. However, thousands of Alabama women are either uninsured or cannot access thecare they need and deserve. Alabama has some of the strictest Medicaid eligibility requirements in the country. For a parent in a family of three to qualify for Medicaid, their annual income must be below 18% of the federal poverty level—that’s just $4,656 a year.

And while pregnant women have a more generous income limit of 146% of the federal poverty level to qualify, coverage not starting until conception is insufficient. The care they receive prior to conceiving is almost equally important to the health of their baby. The consequences of being unable to access that care can be deadly. to conceiving is almost equally important to the health of their baby. The consequences of being unable to access that care can be deadly.

Closing the coverage gap would safeguard women’s health before they conceive, saving the lives of Alabama mothers and babies. As the Alabama Director of Maternal and Infant Health Initiatives for March of Dimes, I know all too well the consequences of a lack of health care coverage for moms in our state.

At March of Dimes, we lead the fight nationwide for the health of all moms and babies. Alabama was one of just eight states to receive a failing grade on our yearly report card for preterm birth.What’s more, the state has some of the highest infant and maternal mortality rates in the nation.

Challenges in accessing health care are a significant contributing factor. Alabama women have uninsured rates higher than the national average, with one in six women of reproductive age (18-44) lacking health insurance.

Without coverage, many women here increase their risk for chronic health conditions. Today, 45.1% of Alabama women have at least one chronic health condition, over 7% higher than the national average. This increases the likelihood of having an unsafe, high-risk pregnancy and delivery, endangering both mom and baby.

Alabama’s Medicaid program covers pregnant women throughout their pregnancies and up to 12 months postpartum. After that, women on postpartum Medicaid lose their coverage, creating a coverage gap. Lack of coverage prior to conception and when postpartum coverage ends, leads to costlier maternal care. In direct challenge to the argument that Medicaid expansion would be too costly, our state is spending more money to address women’s health issues during or between pregnancies than it would be if lawmakers closed the coverage gap.

What’s more, more than a third of our counties are classified as maternity care deserts, where there are no obstetric facilities or providers, worsening the problem. After years of closures throughout the state, 25 Alabama counties do not have labor and delivery units. We’re poised to lose more if the trend continues.

Some Alabama women in counties with the highest travel times could travel 78 minutes on average to reach their nearest birthing hospital, hindering their ability to seek care during pregnancy and childbirth. This is a significant threat to the health of mothers and infants during an incredibly vulnerable time for both. States that have expanded Medicaid have seen the likelihood of hospital closures decrease by 62%.

Mothers in Alabama have an incredibly high vulnerability to poor outcomes, making it imperative that they have access to care before, during and after pregnancy to ensure the best outcomes possible. It’s time to close the health care coverage gap to ensure Alabama families are healthy and strong.

Honour McDaniel Hill is Director of Maternal and Infant Health Initiatives in Alabama, March of Dimes