a. Population served

According to the most recent Alaska Vital Statistics Annual Report, in 2023 there were 9,022 Alaska resident births (99% of which occurred in Alaska). The number of births has decreased every year over the last five years, down from 9,832 in 2019. Preliminary estimates for 2024 births indicate further declines, to 8,847 in-state births. Over a third of births (39%) are to residents of Anchorage, followed by residents of the Matanuska-Susitna Borough (15%) and Fairbanks North Star Borough (14%).

In 2023, White and Alaska Native/American Indian women delivered 54% and 20% of births, respectively. Hispanic women delivered 9%. Women ages 30-34 years delivered the most births, at 29%, followed very closely by women ages 25-29, at 28%. The majority of births were to women with at least some college or a degree (58%), while women with a high school diploma or GED delivered 33% of births. Slightly over one-third of births were to unmarried women (37%).

In 2023, about a quarter of the Alaska population was less than age 18 (24%, n=175,507). Among these, 26% (45,857) were ages 0-4, 40% (70,010) were ages 5-11,  17% (30,161) were 12-14, and 17% (29,479) were 15-17 (Kids Count Data Center). Almost half of the child population was non-Hispanic White Alone (47%), 18% were non-Hispanic Alaska Native/American Indian alone, and 14% were non-Hispanic two or more race groups. 11% were Hispanic or Latino.

In 2023, approximately 21% of children under age 18 in lived in families that received public assistance, while 12% during 2019-2023 lived in families with incomes below the federal poverty level (Kids Count Data Center).

Prenatal care timing and utilization are key indicators of the system of care for mothers that the MCH Epidemiology Unit tracks and updates on the Alaska MCH Indicators Data Hub. In 2023, 72.3% of live births in Alaska were to residents who received prenatal care in the first trimester of pregnancy. One of the Healthy Alaskans 2030 objectives is to raise this percentage to 81.8%.

In 2016, 68.2% of live births in Alaska were to residents categorized as receiving early and adequate prenatal care (using the APNCU Index).  Over the past two decades, this percentage in Alaska has remained relatively stable, declining slightly to 66.6% by 2023. In 2022, Alaska ranked 48th in the nation for adequate prenatal care, just above Florida (64.4%) and Hawaii (63.0%)[1].

There was no clear trend over time by maternal race, except among Asian mothers, for whom the percentage of births with prenatal care in the first trimester increased from 67.6% in 2013-2017 to 73.8% in 2019-2023. By Alaska borough and census areas, the lowest proportions from the 10-year period of 2014-2023 were in Kusilvak (48.1%), Southeast Fairbanks (56.7%), Aleutians West (57.7%), and Bethel (60.3%).

Alaska PRAMS data from 2016 to 2022 shows that the prevalence of Alaskans who received prenatal care as early as they wanted increased slightly from 83.3% to 85.0%. Common barriers to early prenatal care included unawareness of pregnancy (40.0%), appointment availability (39.2%), and being too busy (30.9%).

b. Health services infrastructure

Note: Much of the information in this section is from a comprehensive report expected to be released in late summer 2025 by the Alaska Hospital and Healthcare Association on the state of maternal healthcare in Alaska. This report was commissioned by the Division of Public Health through a collaboration between Title V and the Section of Rural and Community Health Systems.

During 2019-2023, Alaska had 29 birthing facilities, including 19 hospitals, averaging 10 or more births annually. The average number of births at these facilities ranged from 12 to 2,257 per year. Eight of these birthing hospitals are critical access hospitals; six of these are tribally-run. Over the past 20 years, five hospitals have discontinued providing birth services. Some hospitals, including the Alaska Native Medical Center (ANMC), have a strong midwifery model for deliveries.

On average during 2019-2023, there were 235 annual births outside of hospitals or birthing facilities (both planned and unplanned), 116 births at out-of-state facilities, and 67 births at small in-state facilities (fewer than 10 births annually). Alaska’s percentage of births in settings outside of the hospital during these five years (7.6%) was more than three times higher than the 2020 U.S. average of 2%. Community births (those occurring outside of a hospital setting) include 4.8% in freestanding birthing centers and 2.5% home births. There are significant regional differences; Mat Su (15.8%) and Kenai (12%) have the highest percentage of community births while Northwest (2.4%) and Y-K Delta (2.0%) have a very low percentage. Most community births are attended by midwives, either certified nurse midwives or direct entry midwives.

Figure 1: Statewide Births by Facility, 2019-2023.

Approximately 75% of Alaskan communities, including the capital city of Juneau, are not connected to a road system. Geographic isolation means significant challenges in assuring all MCH populations have access to routine preventive care (including prenatal and postpartum care), as well as acute medical and specialty care. For residents off the road system, accessing "nearby health services" or specialized health care can mean travel by commercial jet, small plane, the marine ferry system, all-terrain vehicles, small boats, or snow machines. Severe weather can render travel impossible, creating especially critical situations in medical emergencies. Not all birthing hospitals provide surgical care, and women are transported intrapartum if an unexpected emergency occurs or if a cesarean birth is indicated. Any delivery deemed “at-risk” requires travel to Anchorage at approximately 36 to 37 weeks gestation. Some residents may travel distances equivalent to Washington, D.C. to New Orleans for care.

The only facility with more than 2,000 births per year is in Anchorage. Two other facilities (located in Anchorage and Fairbanks) averaged >1,000-1,500 births per year. Medicaid-approved hotels in Anchorage provide prematernal housing for Medicaid recipients who travel to Anchorage to deliver. The ANMC offers lodging and meals through Quyana House and ANMC patient housing for those who must relocate to Anchorage for delivery. In addition, Providence Alaska Medical Center supports the Hickel House to provide housing for out-of-town patients and families. Other hub regions also offer similar prematernal homes for patients who travel there to deliver, for example, a 32-bed home in Bethel provided by the Yukon-Kuskokwim Health Corporation with funding from Medicaid.

The Providence Alaska Children’s Hospital in Anchorage offers a 66 bed Level 3 NICU and pediatric hospitalist and specialty care. The maternity center and Providence contains 10 triage beds, 10 labor rooms, 31 postpartum beds, and seven antenatal rooms. It is the busiest maternity facility and offers the highest level of NICU care available in Alaska. Increasing NICU services has been discussed at some hospitals in recent years. WCFH continues to monitor this in terms of any effects to regionalization of care.

Figure 2: Illustration of distances traveled by Alaska residents to deliver at Anchorage birth facilities during 2017-2021.

Specialty perinatal health care, even in urban areas of the state, is limited. Recruiting and retaining physicians and primary health care providers for non-urban practices is an ongoing barrier to providing health care services. The majority of physicians in Alaska (69%) are located in the Anchorage/Mat-Su region. In 2024, Alaska had 111 Certified Nurse Midwives, 70 licensed OB/GYN physicians, and 43 licensed/certified Direct Entry Midwives. According to the AHHA report, Alaska relies on strong collaboration between different healthcare professionals involved in maternity care—including OB/GYN, maternal fetal specialists, family medicine physicians, certified nurse-midwives (CNM), OB nurses, community health aides/practitioners (CHA/P), and doulas—who are finding creative solutions to meet the needs of Alaskans. CNMs are licensed in Alaska as Advanced Practice Registered Nurses (APRNs), with full prescriptive authority and one of the strongest scopes of practice in the country. CNMs provide comprehensive women’s healthcare, including gynecologic, prenatal, postpartum, and newborn care. The CHA/P model is unique to Alaska; CHA/P provide initial prenatal care in villages throughout rural Alaska and connect with higher levels of care when necessary.

c. Integration of Services

One bright spot of the COVID-19 pandemic was the rise in opportunities to offer healthcare services to patients via telehealth, both within Tribal health and in the public and private sectors. When the Public Health Emergency Order was enacted in March 2020, it allowed for changes in the rules for telehealth around reimbursement for services and the location where patients could receive services and providers could offer them. For those receiving care through the State-run Metabolic and Neurodevelopmental Outreach Clinics, access to services increased as healthcare professionals were no longer limited to only providing care when present in a community. For those diagnosed with a metabolic condition through the Newborn Bloodspot Screening Program, parents and caregivers are now able to meet virtually with the metabolic consultant to discuss the newborn’s prognosis within a few days of birth. Parents and caregivers of children with behavioral needs were no longer forced to travel to a strange place for an evaluation. After the pandemic period ended, the Alaska Legislature made permanent the option that providers who have Alaska licenses can see patients via telehealth, even if they have never been seen previously in person. Providers who are licensed in another state can also continue to see patients via telehealth if they have previously seen the patient in person or if they are referred to be seen by an Alaskan provider for a condition deemed life threatening. Continuing to offer these services increases access to services, without increasing the need to travel to receive care.

The pandemic also led to a substantial increase in the provision of health care services using telehealth modalities for the adult population. Anecdotal reports from mental and behavioral health care providers around the state showed that broader use of telehealth platforms allowed people in rural areas of the state in particular, greater access to timely counseling services than was the case pre-pandemic. Some women’s health partners were able to modify their service delivery models to offer other preventive health services via telehealth or other options, including contraceptive quick starts for low-risk clients, at-home test kits for Chlamydia and other STIs, and screening and management of some health conditions. As a result of these experiences, many providers are advocating permanently adopting these service delivery modifications and more flexible reimbursement structures.

There is high demand for perinatal mental health care, but a shortage of providers trained in perinatal mood disorders, postpartum depression, and anxiety which can create long wait times to receive care. Behavioral health telehealth has expanded significantly, improving access to perinatal mental health, postpartum depression support, and substance use counseling without requiring travel. Barriers—including limited rural connectivity—still limits broader adoption. While screening for behavioral health during prenatal, hospital, and postpartum care is widespread, screening tools and protocols vary. Community behavioral health providers offer outpatient services, therapy, and medication management, but standardized approaches remain lacking and are not consistently available statewide.

d. Financing of Services

In over half (54%) of Alaska births, the mother was enrolled in Medicaid during the year of the birth or previous year OR the infant was enrolled in Medicaid during their birth year. Medicaid coverage for pregnant women and children was broadened in the 1980s with an expansion of eligibility based on higher income standards and the addition of EPSDT, which broadened specific services that the state was required to provide children. Alaska implemented Medicaid expansion under the Affordable Care Act in September 2015, extending coverage to childless adults up to 138% FPL. Postpartum Medicaid coverage was extended to 12 months in 2023 (taking effect in 2024).

Challenges cited in the AHHA report include that CNMs receive only 80% of the physician reimbursement rate for the same services, and Medicaid does not reimburse for doula services. Challenges in developing services and securing reimbursement under 1115 waivers also contribute to behavioral health workforce shortages. Alaska Medicaid also doesn’t provide reimbursement for nurse home visitation services like Nurse-Family Partnership.

Medicaid policies limit support for pregnant women who must relocate for prenatal care or delivery. Medical escort travel in these situations is only covered in limited cases. Many people traveling to Anchorage to give birth are unable to have pregnancy and labor support, often increasing stress, isolation, and logistical difficulties, particularly for those with children. Most doulas or birthworkers are located in Anchorage and not in the hub communities.

High out-of-pocket costs for maternity care, even for those with private insurance, can be a barrier, particularly for services like lactation support, postpartum care, and mental health treatment. Insurance plans may limit coverage for midwifery or out-of-hospital births, restricting birth options.

[1] America's Health Rankings analysis of CDC WONDER, Natality Public Use Files, United Health Foundation, AmericasHealthRankings.org, 2024. Accessed July 16, 2025.