A Checkup for Arkansas’ Maternal Momentum

The state of maternal health in Arkansas has been a central conversation for medical experts, advocates and legislators for several years.

“There’s been so much great attention around maternal health, but it’s for a super somber reason,” says Dr. Nirvana Manning, chairman of the UAMS Department of Obstetrics and Gynecology.

“We’re 50th in the nation with regards to maternal mortality, and then even more so maternal morbidity, which is women who have lifelong ramifications from the pregnancy, the delivery or the postpartum period.”

Other Arkansas statistics on maternal health are just as troubling: 19.2% of pregnant women receive inadequate prenatal care, often seeing an OB-GYN for the first time in their fifth month of pregnancy or later; 45.3% of counties are maternity care deserts, meaning there are no delivering hospitals or practicing obstetric providers in the area; and, according to the Arkansas Maternal Mortality Review Committee, 95% of pregnancy-related deaths in Arkansas were preventable.

Yet, better beginnings could be on the horizon for Arkansas moms and babies. The 2025 legislative session, and particularly the passing of the Healthy Moms, Healthy Babies Act, marks positive progress for maternal health across The Natural State.

“This bill is a meaningful step forward, but there’s more to do,” says Olivia Walton, CEO of Ingeborg Investments and Ingeborg Initiatives. “I applaud Gov. Sarah Huckabee Sanders, Rep. Aaron Pilkington, Sen. Missy Irvin and the legislature for partnering to pass this big step for moms.”

Seasoned advocate Ashley Bearden Campbell, executive director of Arkansans for Improving Maternal Health, is also encouraged.

“It’s been incredible to see maternal health move to the forefront and be recognized as a statewide priority,” she says. “I’m proud that lawmakers increasingly understand this is not just a women’s issue — it’s a family, community and economic one.”

A Positive Push

It was during this fraught time for Arkansas women that Gov. Sanders tapped Dr. Kay H. Chandler to serve as Arkansas Surgeon General. An OB-GYN, Chandler has been treating patients in her clinic for decades. She brings the same energy, excitement and heart to her first public health position that defines her clinical work.

“I don’t think when I was appointed that there was an idea that we need an OB-GYN, but I think working in this field, taking care of women for over 30 years, learning and seeing what helps them, what harms them, what works for them, what doesn’t work — it’s really given me a good breadth of background information that makes me comfortable and excited, because this is what I do.”

Just before she was contacted by the governor’s office, Chandler had been inspired to help improve maternal health for all Arkansas moms.

“I had been at a conference and they were talking about increasing maternal mortality, and particularly the discrepancy between Black moms and women of other races, and how that’s a higher rate. It just really grabbed my heart,” she says. “I was like, wow, this is something I really want to work on.”

Dr. Kay H. Chandler, Arkansas Surgeon General

And through her role as surgeon general, she was able to get to work. As a part of the Arkansas Strategic Committee for Maternal Health, she and her fellow committee members set out to create a comprehensive road map for better maternal health. The committee partnered with more than 100 invested Arkansans to suggest policies and programs to support new moms and babies.

“It was so helpful to connect and understand, to go out and get to meet so many people from throughout the state — legislators, hospital directors, resource pregnancy center directors and community service organizations, everybody who’s so engaged and committed to working on this to make a positive impact. It has been incredible,” Chandler says.

The core committee soon established four subcommittees, each given a distinct but interlocking focus to tackle the issue of maternal health in a holistic and tangible way. The data, reporting and technology team worked to ensure Arkansas has the best tools to track and analyze maternal health from every angle.

“We know if we have the data, we can better target our initiatives,” Chandler says.

Through her work with this subcommittee, she joined the AMMRC, a group established in 2019 to investigate Arkansas’ poor maternal health. Manning, also a member of AMMRC, recognized its crucial work.

“[AMMRC] has been a guiding light,” Manning says. “It itemizes maternal deaths in the state. How many do we think are preventable? Are they related to cardiovascular disease? Are they sepsis? Are they bleeding? Is it the rural aspect? Is there some element we could change? It has served as a compass for many of us.”

The next subcommittee focused on clinical and practice improvements. According to Chandler, this includes increasing the workforce that can serve pregnant women through strategies like expanded obstetrics residences for family medicine doctors and increasing the number of nurse midwives and doulas in the state.

Being a rural state gives Arkansas distinct challenges. More than half of the counties are maternity care deserts, which means some women drive up to an hour to the closest obstetrics provider, a situation that has worsened since 2020.

“Before COVID, there were 39 delivering hospitals,” Manning says. “I think now we’re hovering around 33, and there’s probably at least two to four on the bubble to close their labor and delivery units. Maternity units have to stay open 24 hours a day, seven days a week, but that business may not necessarily be there in some of these smaller communities.”

The education and outreach subcommittee worked on suggestions to modernize and streamline communications with new and pregnant moms throughout the state.

“To be a good physician, you have to be a great educator. Some patients don’t know how important prenatal care is, how important it is to be sure you’re as healthy as you can be before you get pregnant,” Chandler says.

Beyond conversations with their practitioner, Chandler highlights the importance of community outreach and, to that end, the committee is readying the launch of a large public service announcement centered on maternal health.

The final subcommittee concentrated on health care access and Medicaid. With 50-60% of all pregnancies in Arkansas covered by Medicaid, expanding access is a crucial component to supporting the most vulnerable women in our state, especially with Medicaid funding making recent national headlines.

The work of the Arkansas Strategic Committee for Maternal Health directly inspired the passage of Healthy Moms, Healthy Babies. With this act in place, qualified women are able to see their doctors sooner through presumptive Medicaid coverage, making access to insurance for pregnant women nearly immediate. And the act doesn’t stop at streamlining the Medicaid approval process, but expands coverage. Pregnant women are now able to visit their doctors more often both during and after their pregnancy, while doula services and telemedicine are also eligible for reimbursement.

Women will also have expanded options when it comes to picking their provider thanks to a provision that unbundles Medicaid payments, meaning doctors will be paid for each visit instead of receiving one lump sum.

“Doctors want to go where they have family, where they have community and where they feel like [they] can make a difference. Without those reimbursements, they feel like ‘I’m gonna have a harder time keeping staff paid,’” Chandler says. “Making sure that their practice is adequately reimbursed is important to have a long term impact.”

Expanding access and removing barriers was a throughline for other new laws focused on maternal health from this session. HB1333 requires insurance coverage for lactation support services, and HB1296 expands access for rural moms through mobile health units. Campbell has travelled the state and can attest to the quality of the mobile units.

“They are nicer than a lot of hospital rooms,” she says. “They’re amazing for a mom that’s working two jobs and might not be able to take off to drive two hours for her appointment. That’s a lifesaver for her. Getting people to understand things like that has been incredible.”

A Look Forward

With more than a decade in public service and government relations, Campbell understands the importance of telling a clear story. Her advocacy-focused nonprofit AIM was created in response to her own pregnancy. Her daughter was born at 28 weeks and stayed in the NICU for 70 days.

“I was very lost,” Campbell says. “Thank God one of her nurses could see signs that I was having some mental health struggles. I went and got the mental health help that I needed and was diagnosed with postpartum anxiety, depression and PTSD. And that completely changed my life. … I can’t imagine how hard this must be for other moms who don’t have access to the same resources that I did.”

She created AIM to give her and moms like her a platform to share their stories.

“Once somebody gets something off their chest, usually the next step is, ‘okay, now what can we do?’” she says.

THE LONG GAME: Dr. Nirvana Manning, Olivia Walton and Christy Turlington Burns discuss the maternal health crisis at the 2023 Soirée Women’s Leadership Symposium.

Campbell’s “now what?” was working to make sure legislators kept maternal health a priority. Now that new policies have passed, she’s turning to her next focus: implementation.

“We don’t want these laws to take two years to implement. We need to see them to start getting implemented immediately,” Campbell says. “That’s the only way Arkansas is going to be able to move from first in the nation for maternal and infant mortality. We can put sound bites out all day.”

Campbell and her team are also focused on creating easy-to-read guides for any new legislation.

“We want to make sure moms and families have access to this information so they don’t slip through the cracks and don’t miss out on programs, funding and resources they now have access to and deserve,” Campbell says.

Walton makes it her business to invest in women through Ingeborg Investments and Ingeborg Initiatives. Ingeborg Investments supports women-led and women-focused businesses, many in industries centered on mothers and young children. Ingeborg Initiatives is focused specifically on supporting moms in Arkansas and their unique challenges. In fact, Ingeborg Initiatives helped found the Doula Alliance of Arkansas with a $250,000 grant. This group provides women with much needed support through pregnancy and the postpartum period.

Walton pushes the “now what?” conversation beyond pregnancy and postpartum to the support women need at work.

“If we’re serious about supporting families, we need to create conditions where women don’t have to choose between their health, their children and their paychecks. That means expanding the Child Tax Credit, supporting paid family leave and building a child care system that meets families where they are,” Walton says.

“Offering paid family leave, flexible schedules and access to quality child care isn’t just the right thing to do. It’s a competitive advantage. The best talent, especially women, are choosing companies that understand caregiving is a part of life, not a disruption to it. Employers in Arkansas have an opportunity to set a national example by treating parental support as an investment, not a perk.”

While maternal health advocates are encouraged by the recent momentum, they agree the work is far from done.

“I think moms in our state deserve us to see this through, deserve to see our statistics improve … even when the grant funding or the novelty of it is dimmed,” says Manning, who is currently piloting a three-tier program through the Arkansas Center for Women and Infants’ Health at UAMS. The program will eventually provide infant supply kits and postpartum bracelets to every new mom in Arkansas, plus establish a reverse call center that will proactively check in with each postpartum woman.

Chandler, for her part, is filled with a sense of hope and purpose as she continues her public service tenure.

“Perhaps I’ve come to this position for such a time as this,” she says, recalling the timing of her surgeon general appointment after feeling motivated to address the maternal health crisis. “That gives me inspiration.”

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