Alabama remains one of the most restrictive and challenging reproductive health environments in the country. The state’s laws, healthcare infrastructure, and political climate combine to create conditions where access to basic reproductive care is inconsistent, limited, and often unsafe. Black women experience maternal mortality rates three times higher than their white counterparts, meaning the burden of this hostile landscape is not shared equally. Philanthropy must respond with more than think-pieces and reports. This moment demands deep relationship and monetary investment into the solutions created by Birth Justice Leaders in Alabama and the Deep South.
In 2022, reproductive health, rights, and justice organizations across Alabama began preparing for significant changes when the Dobbs decision leaked, signaling that already fragile abortion access would face further erosion. As a trigger law state, Alabama immediately outlawed abortion following the overturn of Roe v. Wade. In the aftermath, the attorney general threatened prosecution against individuals assisting others in traveling out of state for care. Alabama Department of Public Health attempted to introduce regulations targeting birth centers and midwifery care that would have severely limited their ability to operate, while hospitals known for providing safer care for Black women closed their doors.
For rural communities, the absence of services shapes daily life. More than one third of Alabama counties lack obstetric care, forcing families to navigate long distances to access essential services. For low-income families, the cumulative costs of appointments, transportation, and childcare combined with race-based criminalization place care out of reach even when it technically exists. People living with disabilities face additional barriers through provider bias and inadequate accommodations, further reinforcing exclusion from essential reproductive and maternal health services.
We must do more than grieve. We must do more than witness. We must do more than write. Alabama Birth Equity Initiative (ABEI) is a statewide, community-driven effort that confronts Alabama’s maternal health crisis through a holistic, Reproductive Justice-centered approach rooted in the leadership, knowledge, and survival strategies of those most impacted.
The call for Alabama Birth Equity Initiative’s work is as ancestral as granny midwives, as natural as birthing in the room where your child was conceived, as familiar as scratching and surviving.
As Qiana Lewis of Holy H.O.E. Institute reminds us, “Our grandmothers caught babies in conditions that many of us would not survive. Their suffering wasn’t magical; they had an intense sense of responsibility for the people around them. We have to take the lessons and the history and build upon them.”
While ABEI is new in its public-facing form, it is not a new partnership nor a new body of work.