Op-Ed: Alabama should expand Medicaid to reduce birth defects


By Britta Cedergren, MPH, MPA, Associate Director of Postpartum Care, Acting Director of Maternal Infant Health & Government Affairs, March of Dimes, Alabama

January is National Birth Defects Prevention Month. At March of Dimes, we know the health of a community is reflected by the health and well-being of its babies, and in Alabama, one in eight babies is born too sick, too soon. That’s nearly 7,000 babies a year.

When babies are born before 37 weeks, the likelihood of a child suffering from acute and chronic health issues goes up exponentially. Babies born too soon often have defects with their lungs, hearts, eyes or intestinal tracts, and they are at higher risk for long-term intellectual and developmental delays. Black women are at a 50% higher risk of preterm birth than their white counterparts, and nearly three to four times more likely to die from pregnancy-related causes. By these numbers alone, the health and well-being of Alabama is not looking great.

We are still learning more each day about the underlying causes of birth defects and preterm birth. But we do know that when a mother becomes pregnant while suffering from uncontrolled chronic conditions including hypertension, diabetes, asthma, substance abuse or autoimmune diseases, their pregnancies are at higher risk of complications.

One of the best ways to reduce preventable birth defects is by providing women with adequate, accessible and affordable health coverage before, during and after a pregnancy. The average reproductive lifespan for a woman ages 15 to 44 is about 1,580 weeks. A healthy pregnancy lasts between 38 and 42 weeks. If a woman is only insured during a single pregnancy, that means she is only insured for 2.5% of her reproductive life.

March of Dimes releases an annual report card grading each state on its preterm birth rate, maternal health and policy factors impacting both. In 2020, Alabama received a failing score for the second year in a row. The report card shows we are failing at reducing preterm birth, and as a result, we have babies suffering from preventable birth defects as their moms are going without care for preexisting conditions.

It does not have to be this way. What we are really failing are the families here in our state.

Expanding Medicaid to cover individuals up to 138% of the federal poverty level can play an essential role in improving maternal and infant health. A growing number of studies in states across the country indicate that Medicaid expansion plays a role in reducing the rate of preterm birth and maternal mortality in women of child-bearing age.

Medicaid expansion demonstrates improved health outcomes and is shown to play a role in the reduction of disparities in preterm birth and low birthweight, especially for Black infants in expansion states. Expansion is one of the top recommendations cited in the Alabama Maternal Mortality Review Committee report published in 2020 as a way of reducing maternal death.

We must do better. While some birth defects cannot be prevented due to genetic abnormalities, maternal age or other risk factors out of the control of current science, there are a host of defects that CAN be prevented by recognizing the importance of a healthy mom throughout the course of her life.

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