Honour Hill’s story | March of Dimes

Alabama’s maternity care crisis mirrors a national collapse in access

A leading maternal health advocate in Alabama, Honour Hill uses March of Dimes data to spotlight preterm birth and maternal mortality disparities while pushing for expanded postpartum Medicaid coverage, chronic disease prevention, and action on the state’s growing maternity care crisis.

Honour Hill has a clear-eyed view of what’s happening to mothers and babies in Alabama, and it isn’t good.

As Director of Maternal & Infant Health Initiatives for March of Dimes in Alabama, Hill tracks the numbers closely. The state’s preterm birth rate, one of the highest in the nation, sits at roughly 12.7%, with 7,379 babies born too early in 2024. But the harm isn’t evenly shared.

“We have low rates among our white women and then higher rates among our Black women that then disproportionately push our rates up,” Hill said. “If we really look at those disparities, that’s where we’re going to see a change in maternal and child health here in Alabama.”

Black infants in Alabama die at more than twice the rate of White, Hispanic, or Asian infants.

Meanwhile, the infrastructure of care itself is disappearing. Labor and delivery units are closing across the state, especially in rural areas — and what remains isn’t a continuum of care. In much of rural Alabama, it’s a desert.

Alabama’s crisis mirrors a broader national collapse in maternity care access. More than one-third of U.S. counties lack adequate maternity care, according to March of Dimes, whose 2026 report “Nowhere to Go: Maternity Care Deserts Across the U.S.” found that hospital closures, workforce shortages, and insurance barriers are leaving growing numbers of mothers without consistent prenatal or delivery care. Alabama has lost roughly 10 rural labor and delivery units in the past decade alone, accelerating the strain on families already traveling long distances to give birth.

“In Alabama, you go from having very little to no care to a lot of care. We don’t really have any of those medium level of care things,” Hill said.

Providers follow resources. Doctors, nurses, and certified nurse midwives concentrate in areas with higher pay, stronger school systems, and established referral networks. Rural communities struggle to attract or retain them, and even when recruitment efforts exist, the math rarely works.

“You start trying to entice people out into these areas that have no care,” Hill said, “but why would they practice there and then have to tell their patients you still have to drive 40 minutes to give birth?”

The structural imbalance becomes a burden providers can’t sustain.

“There’s this burden that gets put on our providers that says, hey, pay more to work with less. So they just don’t go there.”

For families, the provider shortage translates into exhausting, costly tradeoffs — time off work, lost wages, childcare, transportation — just to access routine prenatal care or reach a delivery room. In 2024, Medicaid covered roughly 42% of all live births in Alabama, underscoring how deeply the state’s maternal health system depends on public insurance even as access points continue to shrink.

Because Alabama has not expanded Medicaid, more hospitals may struggle to cover costs, and potentially shut down, if even more of their patients become uninsured.

The problem reaches beyond any single system. Hill moves between conversations with community doulas, Medicaid administrators, hospital executives, and state legislators, carrying information across sectors that rarely talk to each other.

“There’s not going to be just one person who can do everything and come from all different angles. I might go one hour to have a conversation with a community partner, and then the next conversation I’m having with Medicaid, and then later that day I’m on the phone with one of our legislators.”

Underlying much of the structural failure is a question the healthcare system has largely avoided asking.

“I don’t think we know anything other than healthcare being profitable,” she said. “I don’t think people have ever had the true conversation of what it looks like for healthcare not to be profitable.”

The principle at the core of her work is simple: a mother in rural Alabama deserves the same quality of care as a mother in an urban one. What frustrates her is that the warning signs of collapse are already visible, and too often, the response is inaction.

“We have physicians, we have patients that are saying, this is the problem, this is what we need. And yet some people are like, well, we’re just going to keep doing what we’re doing.”

Part of what makes this work complicated is understanding how families experience these barriers. Many navigate real hardships — getting to appointments, affording prescriptions, making arrangements most people never have to think about. And they make it work, because they have to. To them, these realities aren’t extraordinary. They’re just life.

That context matters when it comes to telling stories. Expecting a family to frame their experience as a crisis can feel at odds with how they’ve lived it.

“These are realities. Women, families, men — they make it work because they have to. And to them, this isn’t something that feels abnormal. We have to respect the fact that to them, this is normal. And we want to paint a picture of: it doesn’t have to be.”

Sharing your story means inviting people to look at something painful, and doing it knowing that vulnerability can feel uncomfortably close to shame.

“It’s human nature not to want to feel pity or like a victim, even though we’re not perpetuating that. Telling your story takes bravery and courage. So, honoring and lifting up the voices of families who do take that step — that matters.”

Still, she finds hope in the people who keep speaking up.

“I find so much hope in the fact that people are stepping up and having this conversation — pinpointing, this is what we need.”

The question now is whether the systems meant to serve Alabama’s mothers and babies will listen.

March of Dimes is working to identify gaps in care, advance evidence-based solutions, and bring communities, policymakers, and healthcare leaders together to ensure every family has access to the care they need.

Honour Hill, MPH is Director of Maternal & Infant Health Initiatives at March of Dimes in Alabama, where she serves as a leading voice on the state’s preterm birth rates and maternal mortality crisis. Drawing on data from the March of Dimes Report Card, she advocates for policies that advance health equity — including extended postpartum Medicaid coverage and solutions to Alabama’s growing maternity care crisis. Her work centers on addressing chronic maternal health conditions such as hypertension and diabetes, alongside the social drivers of health that shape outcomes for mothers and babies across the state.