Bioethics Forum Essay
A Thousand Double Binds: Alabama, Reproductive Freedom, and Child Health
As two people who have ties to Alabama and grew up in the Deep South, we are frustrated by the state’s ceaseless assault on reproductive freedom, while its politicians continue to ignore child health. Because Alabama lawmakers and its Supreme Court justices profess to care about children–and use this as a reason to restrict reproductive freedom–we believe there is a strong responsibility to aid kids who do not have consistent access to groceries or health care.
Alabama’s Supreme Court ruling on IVF is indicative of the state’s paradoxical interest in protecting embryos, while continuing to effectively ignore the health of children and families in the state. The decision interpreted an Alabama statute, the Wrongful Death of a Minor Act, § 6-5-391, Ala. Code 1975, to confer personhood to embryos created outside of the biological womb. The opinion, authored by Associate Justice Jay Mitchell, argued that Alabama has long held that unborn children are “children” and stated that the Act “applies to all children, born and unborn, without limitation.” Following Alabama’s Supreme Court decision, lawmakers in several states are now considering passing fetal personhood bills. While Alabama’s governor signed a law protecting IVF, problems with conferring full legal personhood on embryos, as well as the failing social safety net in Alabama, persist.
Immediately after the Dobbs decision, Alabama’s total abortion ban went into effect. The ban has no exceptions for rape or incest. Not only that, but Alabama’s state constitution specifically endorses anti-abortion language instead of being neutral on the subject or open to flexible interpretation.
Proponents of these reproductive care restrictions argue that they have been instituted for the well-being of children. However, child health, success, and well-being in Alabama are harmed by the state’s lack of social safety net services. Alabama was one of several states that chose not to expand Medicaid services, despite the federal government paying most of the cost of the expansion. Medicaid plays a vital role in ensuring that low-income families and children have access to healthcare.
One in four children in the state qualify as food insecure, meaning they lack regular access to nutritious food. Children facing food insecurity perform worse in school than their counterparts, often being years behind grade level learning expectations. Additionally, hunger makes children more susceptible to chronic illnesses that would be preventable with a proper diet. Even with these alarming statistics and effects, Alabama was one of 15 states that did not opt into a United States Department of Agriculture program, approved by Congress in 2022, that would provide extra money for food to children during the summer months when they do not receive subsidized school lunches.
Aside from disregarding federal funding initiatives seeking to promote the well-being of children, Alabama also continually falls short in caring for parents. Around 25 counties qualify as “maternity care deserts,” lacking the appropriate number of obstetrician/gynecologists, certified nurse midwives, or medical facilities necessary to ensure that parents have access to the care that they need. This likely exacerbates Alabama’s already dismal maternal mortality rate. In 2020 the overall U.S. rate was 23.8 deaths per 100,000 live births; Alabama’s was 36.4 deaths per 100,000 live births. Furthermore, Alabama is ranked 50th in Temporary Aid to Needy Families Program (TANF) monthly maximum levels. Alabama’s TANF benefit for a family of three is just $215 monthly, which falls far below the national median of $492. For perspective, the USDA’s Cost of Food report indicates that it costs approximately $230 each month to feed a child aged 9-11.
Alabama’s record of health and social policy makes it clear: The state consistently refuses federal assistance to help pull its children out of poverty.
We hope that Alabama lawmakers consider child health more broadly, addressing the unacceptable rates of hunger and maternal mortality. While IVF is an important medical procedure, the technology is often only available to those who are relatively affluent or to people with employee-sponsored insurance. For those who are uninsured or on Medicaid, IVF remains out of reach, while other problems like food security and steady access to health care persist.
As we continue to witness attacks on reproductive freedom, we must remember the already deeply insufficient state of child health services in Alabama. Furthermore, we need to amplify and support the efforts of on-the-ground activists and organizers who are working tirelessly to make Alabama healthier and help it prioritize reproductive justice.
Anna Kutbay is a second-year student at Georgetown University Law Center interested in poverty law, health equity, and economic justice. linkedin.com/in/anna-kutbay/
Danielle M. Pacia, MBE, is a research associate at The Hastings Center. @DaniellePacia linkedin.com/in/daniellepacia/
Thank you.
I, too, am an lifelong Southerner living in a region of exceptional health, education, economic, safety/security and other disparities. See the US map from leading (Princeton) researchers on disadvantage and place: https://www.princeton.edu/news/2023/11/15/kathryn-edins-new-book-offers-groundbreaking-insights-american-poverty-and-where. My husband and I retired (I from UVA, School of Medicine), purposefully, into the northernmost range of the ‘tobacco extraction’ region of exceptional disadvantage, that extend into and through other Southern states. The map reveals other regions where extraction depleted resources while leaving desperate depletion of assets, devastation of landscapes, and diminution of communities: ‘coal extraction regions’ (e.g. Appalachian region), ‘other energy extraction’, ‘cotton/fiber extraction’, ‘other agricultural product extraction’. Academic writing and journalism have revealed this long-lived pattern or making vast areas and communities of the US ‘sacrifice zones’: https://inthesetimes.com/article/financial-capital-sacrifice-zones-robbing-rural-america Some academic literature discusses sacrifice zones as a form of colonization.
Sadly, your piece continues a form of ideological colonization: a. by neglecting to name and engage this economic and political history of extraction-colonization, b. neglecting the hidden and overt structural urbanism of federal and other funding. We see both in your contention: “Alabama’s record of health and social policy makes it clear: The state consistently refuses federal assistance to help pull its children out of poverty.”
I know nothing about AL political history but I know VA political history and perhaps there are similarities. Extraction-colonization where I chose to retire is centuries old. Extraction-colonization rewarded few – not many – local rural residents in alliance with urban-located financial (and later industrial) interests who were primarily and greatly rewarded by flows of products acquired by unpaid, enslaved labor and then by poorly compensated, corruptly manipulated labor. IN the early 19th century our small rural town was a hopeful, entrepreneurial multiracial community. This is documented in Bancroft (history) prize winning book. The structural and other violence of the Civil War ended that. But that was ended nearby in Appomattox (a lovely place these days to visit the historical building and walk through restored native prairie and ancient trees). In the early years of Reconstruction after the Civil War a multiracial society sent black legislators to the Virginia General Assembly to propose policies favorable to all working class residents. It was Northern financial, industrial and political interests – feckless Republicans who abandoned the ideals of the Gettysburg Address – that decided they liked money and power more than justice (from the 1877 Compromise that intended to manipulate the Electoral College: sound familiar?) . The North’s well developed industrial base needed all that ‘extraction colonization’ of the largely agrarian, under-developed Southern states.
I can’t speak for AL but I can plug my state VA into your formula to say that
– for decades VA resisted federal programs that would support working class, and particularly rural working class, households and communities
– but even after ‘expanding Medicaid’ and being among the higher TANF subsidies ( https://www.cbpp.org/research/family-income-support/more-states-raising-tanf-benefits-to-boost-families-economic-security ) – metrics you note – rural working class health, education, social safety and other disparities persist and are expanding
– because structural urbanism persists in federal and state funding formulas and allocations, through health professional schools lack of investment in rural working class communities (without fellowships, internships, research teams, clinical services appropriately and equitably responsive to health and other disparities), through lack of corporate and foundation sustained attention, etc
I encourage you to consider that AL’s disadvantages reside not only in ‘refusal of federal assistance’. That is an inadequate analysis and bespeaks a tendency to dismiss a complex history and its social forces, distract from many other morally culpable social institutions (including perhaps your own institutions), and breathes in and expels the unwholesome air of structural urbanism and other forms of social in-justice: the community and ecological devastation left behind by financial overseers, exploitative industries and extraction enterprises that ‘sacrificed’ our health for their own purposes and that intentionally deformed structures of law and policy to suit themselves.
Thank you,