Two weeks ago Alabama added four more amendments to the 892 that have been added to the state constitution since its inception in 1901. However, statewide and around the country, it’s the first two of the four amendments passed on Election Day that have received the lion’s share of attention.
The first — approved by 71 percent of Alabama voters, allows for the display of the Ten Commandments in schools and other public property throughout the state.
The second, approved by 59 percent of Alabama voters, makes it state policy to recognize and support the sanctity of unborn life and the rights of unborn children, and prohibits removal from the state constitution any protections for the right to abortion or its funding.
The third and fourth amendments, while important, have received less attention. The former revises The University of Alabama Board of Trustees’ membership, including the specific removal of the state superintendent of education from the board. The latter amendment allows for legislative vacancies in the House of Representatives or Senate within certain qualifying time guidelines.
Yet missing on the Nov. 6 ballot was an amendment that I believe is of vital importance to the state: an amendment supporting and advancing Alabamians’ right to quality health care access.
Access encompasses having health care facilities and providers locally available, being able to visit them, being able to afford the care and understanding what health care options are available and appropriate.
The plight of many pregnant mothers in Alabama highlights how pressing the issue of health care access is in our state.
Alabama has the highest infant mortality rate in the nation. In 2016, Alabama’s infant mortality rate was 9.1 per 1,000 live births — 537 babies out of the 59,090 born in 2016 did not make it to age 1. This was an increase over the 2015 infant mortality rate, which was 8.3. For African-American mothers in Alabama, the rate is more than twice that of white mothers, at 15.1 infant deaths per 1,000 live births.
Additionally, Alabama ranks third in the nation when it comes to low birthweight babies and babies being born prematurely.
While several factors contribute to these serious problems, one very acute factor is the lack of appropriate health care access.
In 1980, among the 54 counties classified as “rural” by the Alabama Rural Health Association (NHRA), nine lacked local hospital obstetrical services. Today, however, of those 54 rural counties, 38 have no obstetrical services within the county. None. Out of 12 counties in the Black Belt region, only one county offers obstetrical services.
The distance to appointments and securing transportation to get there often become major barriers to pregnant mothers in Alabama getting timely and adequate prenatal care.
It’s not uncommon for expectant mothers to endure hours of labor in a family vehicle or in the back of an ambulance while trying to get to the nearest hospital providing essential obstetrical services. Some have delivered their babies en route.
In Alabama, the lack of access to quality health care makes having a baby a difficult, and at times perilous, experience for many expectant mothers.
It’s not just expectant mothers who are suffering, though. According to the NHRA, Alabama is “ground zero for most of what [is] wrong with rural health care in the nation.” It’s so bad that in some rural areas individuals are going to their local veterinarian for x-rays and basic medical services. As one official has noted, “The greatest barrier to access at this time is the unavailability of local health care facilities and providers.”
A healthy populace is a productive and thriving one. Yet, with an uninsured rate much higher than the national average and health outcomes that put us at or near the top of the list when it comes to the prevalence of obesity, stroke, diabetes, hypertension, etc., we are far from being a healthy populace.
The uninsured rate for Alabama adults with low incomes is 36 percent in rural communities and small towns, compared with 29 percent in metropolitan areas. The national average is 26 percent for rural areas and 18 percent for metropolitan areas.
On Election Day the three red states of Utah, Nebraska and Idaho all approved measures to expand Medicaid in their states. In Utah this means an additional 150,000 people can now be insured, in Nebraska 90,000 and in Idaho 62,000. These measures passed despite the objections of state officials who have been against expansion.
As many are starting to realize: health care matters. It definitely matters in Alabama. All can’t be well if the people themselves aren’t physically well.
Since 1901, we’ve added 896 amendments to the Alabama Constitution. An amendment mandating and supporting that all citizens deserve and have the right to health care access would affirm our basic belief in the value and importance of each Alabamian, and in our commitment to understanding the necessity of facilitating positive health outcomes statewide.