Where Alabama Fares in America's Health Rankings for Women and Children

By Cindy Sanders

Where Alabama Fares in America's Health Rankings for Women and Children

Arethusa Kirk, MD

For three decades, United Health Foundation has worked to quantify areas of challenge and opportunity for states in addressing health outcomes through America's Health Rankings®. Last year, the philanthropic foundation of UnitedHealth Group adopted a new model focused on health at the intersection of the four key drivers - physical environment, social and economic factors, clinical care and behaviors.

In October, the organization released America's Health Rankings 2021, Health of Women and Children, which examines the overall health of the nation. The report looks at the health of more than 58 million women of reproductive age and 73 million children nationwide with data points specific to each state.

"There are 118 measures and 35 data sources," said UnitedHealthcare Regional Chief Medical Officer Arethusa Kirk, MD. "It's America's data. This release is the fifth report on the health of women and children. The data primarily represents pre-pandemic and early pandemic timing, so we need to be aware that the pandemic has likely exacerbated some issues.

"Now, in this stage of the pandemic, we're seeing an increase in overall mental health conditions for children. This is reflected nationwide. In October, the American Academy of Child and Adolescent Psychiatry and the Children's Hospital Association declared a national emergency in children's mental health."

Alabama saw an 18 percent increase in teen suicide, rising from 9.1 to 10.7 deaths per 100,000 adolescents ages 15 to 19 comparing 2014-16 to 2017-19. As jarring as that increase is, the national picture is worse with an increase of 26 percent in teen suicides over the same time period and a rate that rose from 8.9 to 11.2 deaths per 100,000. Mental health concerns span all age groups with anxiety rising 21 percent nationally from 2017-18 to 2019-20 among children ages three to 17. And those data points were largely taken before the isolation and deaths resulting from COVID-19.

On a positive note, Alabama saw a 21 percent decrease in children from newborn to age 17 living in poverty, falling from 27.2 percent to 21.4 percent between 2013 and 2019. Yet, one of the state's highlighted challenges is low prevalence of food sufficiency among children. Although the state has made strides in decreasing childhood poverty, Alabama still ranks 45th in the nation and significantly exceeds the U.S. average of 16.8 percent.

"Look at these measures that seem like they are in contradiction and really drill down to see where the gap may be," Kirk said. "The annual rankings and focused reports are a call to action. One of the key messages is to use the data to highlight strengths and opportunities for improvement. Another message is for everyone who is invested in health and wellness to drill down into our nation's data to understand for their own communities and see what the trends are in order to help determine where resources should be allocated to address challenges."

For more detailed information on national and state findings, go online to AmericasHealthRankings.org. State summaries are available to download from the report's homepage.

Defining Health

America's Health Rankings® uses the World Health Organization's definition of health: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

Alabama Highlights


  • High rate of high school graduation. In fact, Alabama ranks tops in the nation with a high school graduation rate of 91.7 percent. Furthermore, there is a very low racial gap in high school graduation rates.
  • The state also rates well for infant childcare cost, childhood immunizations and adequate insurance for children.
  • Although childhood anxiety rates are on the rise nationwide, Alabama fares better than most with a state rate of 7.4 percent compared to a national rate of 9.1 percent. For depression among children and youth, the state comes in at 2.5 percent compared to 3.9 percent nationwide.
  • In the heading of "flourishing," Alabama ranks 4th in the nation with 71.8 percent of children considered flourishing compared to 69.1 percent nationwide.
  • Women do well with low rates of excessive drinking and e-cigarette use.
  • Women also exceed the national average when it comes to cervical cancer screening (81.5 percent in Alabama vs. 79.9 percent nationally).


  • High childhood mortality rate with the state ranking 47th among children and 46th among infants.
  • Alabama comes in 48th for low birthweight in infants and 47th for breastfeeding. However, the script flips as children age with the state ranking 42nd for overweight and obesity among youth, coming in at a rate of 36.9 percent compared to the national rate of 32.1 percent.
  • The report also found too few children in Alabama get adequate sleep, with only 59.2 percent meeting the criteria for sleep compared to 66.1 percent nationally.
  • Too many women in Alabama face food insecurity, poverty, concentrated economic disadvantage, a high gender pay gap, and violent crime.
  • The state lags in the number of women's health providers with a state value of 31.0 compared to a U.S. value of 48.5, earning Alabama a ranking of 49 in the nation.
  • Alabama ranks 45th in mortality rate for women, coming in at 142.2 compared to the U.S. rate of 97.2. Adding to the issue is the state's poor showing in high blood pressure, obesity and the high prevalence of multiple chronic conditions among women.