Saving Mothers

An interesting thing happens when a group of mothers talk about their personal experiences with maternal health. One mom shares how her provider dismissed troubling symptoms until it was almost too late. Another details an unnecessary cesarean section. And yet another fights back tears as she talks about postpartum depression so severe she couldn’t hold her baby. Before long, many have expressed their own fears and sorrow and that of others close to them. There’s comfort in these shared experiences, but also an unfortunate truth: These stories are far too common, and it’s time for change.

The Maternal Health Landscape in Arkansas

More mothers in Arkansas die during and after birth than anywhere else in the country. The latest data from the Centers for Disease Control and Prevention ranks The Natural State last for maternal health outcomes, citing a maternal mortality rate nearly twice the national average. 

This crisis is gaining public attention, and policymakers are beginning to respond to the needs of Arkansas moms. In 2019, Arkansas legislators established the Arkansas Maternal Mortality Review Committee (AMMRC) to review cases of maternal deaths and provide recommendations to save mothers’ lives. Last year, the U.S. Department of Health and Human Services created the Arkansas Maternal Health Task Force to tackle inequities and increase rural access to care. Also in 2022, the University of Arkansas for Medical Sciences (UAMS) received federal funds to establish a Perinatal Quality Collaborative to improve care. 

In early 2023, the award-winning documentary “Aftershock,” which underscored the toll maternal deaths take on our communities and the racial disparities of our nation’s health system, was screened at Philander Smith University.

Then, this spring, Arkansas gained national attention when three mothers were featured in “Giving Birth in America: Arkansas,” a film produced by Christy Turlington Burns’ nonprofit Every Mother Counts. Premiered in Little Rock and included in the Bentonville Film Festival, the film spotlighted the crisis, inspiring conversations among mothers, physicians and policymakers statewide. 

How We Got Here

How did Arkansas land at the bottom for maternal health? It’s a combination of our geography, high poverty rate, persistent racial disparities and rising mental and physical health issues. 

“I think the issues are complicated but entirely unique to Arkansas,” says Dr. Nirvana Manning, chair of the Department of Obstetrics and Gynecology at UAMS and a member of the AMMRC. “In a state that is largely rural, access to high-quality care can be a challenge. There are so many corners of our state that have absolutely no prenatal and obstetrical care.”

In fact, according to the March of Dimes, 37 of Arkansas’ 75 counties are “maternity care deserts,” meaning almost half the state has no access to obstetric care.

To put this in perspective, a mom from the Delta may have to drive hours for prenatal care — assuming she has reliable transportation, vacation time and child care for her other children. This is especially devastating for women experiencing high-risk pregnancies, preterm birth or mental health challenges. Unfortunately, there are many Arkansas mothers facing these struggles and more.

Now imagine navigating all of this when you’re still only a child yourself. Unfortunately, that’s not an unrealistic scenario. According to the 2023 Annie E. Casey Foundation Kids Count Data Book, the most recent data show that 27 out of every 1,000 births in the state are to teen mothers, edging Arkansas into 50th place for this key health metric.

But Arkansas is not alone. Among developed countries, the U.S. has the highest maternal mortality rate. A recent study published in the Journal of the American Medical Association found maternal mortality in the U.S. more than doubled between 1999 and 2019. This means a mother who gives birth in America today is twice as likely as her own mother to experience a complication or death. 

Potential Solutions

While these statistics are daunting, Arkansas is poised for change.

After two years of in-depth maternal mortality data review, the AMMRC has published a list of recommendations that includes addressing mental health and substance use disorders and promoting healthy behaviors while addressing health and socioeconomic disparities. 

Former Gov. Asa Hutchinson expanded the home visitation program for high-risk pregnancies and added behavioral health support for pregnant women to the Medicaid program. 

This prioritization of mothers continues with Gov. Sarah Huckabee Sanders, a mother of three, who signed a bill reimbursing hospitals for women on Medicaid who choose long-acting reversible contraception immediately after birth. This is particularly helpful for adolescent mothers, nearly half of whom get pregnant again within 12 months.

Anyone who has had a newborn knows the first six weeks are a blur. While caring for a baby, moms may ignore their own troubling health symptoms. For women whose postpartum coverage ends 60 days after birth, this is especially problematic. 

To address this issue, a bill was filed during the last general session to extend postpartum Medicaid coverage from 60 days to 12 months. The bill did not advance, but there’s hope it will be reintroduced. In a state where Medicaid covers 50% of births, and 47% of pregnancy-associated deaths occur more than 43 days after delivery, AMMRC and others support passing this extension. Currently, 30 states and the District of Columbia have extended postpartum Medicaid coverage to one year.

During a recent Talk Business & Politics interview, Olivia Walton, chairperson for Crystal Bridges Museum of American Art, founder of Ingeborg Investments and co-founder of the Heartland Summit, said she is struck by how “pro-family” Arkansas is. The mother and maternal health advocate added that expanding postpartum Medicaid coverage to a full year should be “the state’s No. 1 priority.” 

In an Arkansas Democrat-Gazette editorial, Walton identified several promising initiatives focused on improving maternal health outcomes: UAMS Centering Pregnancy is an innovative pilot program that provides group-based prenatal care, health education and social support; UAMS Remote Patient Monitoring Program connects rural and high-risk patients with providers; Ujima Maternity Network is building a coalition of birth workers dedicated to improving outcomes for Black mothers who, according to the AMMRC, are twice as likely to die from childbirth as white women; and Heartland Forward’s Connecting the Heartland works to improve broadband and telehealth access by developing local broadband plans and increasing enrollment in the federal Affordable Connectivity Program.

“Just like the problem is multifaceted, so are the solutions,” Manning says. “There’s not one initiative that’s going to reduce our maternal deaths in Arkansas. By working together and addressing this issue from multiple angles, we’re going to save lives.” 


4 Key Recommendations by the AMMRC

1. Promote clinical excellence through education and implementation of best practices.

2. Extend maternity coverage from 60 days to one year postpartum.

3. Address mental health and substance use disorders.

4. Increase access to long-acting reversible contraception in the postpartum period.

A Women’s Foundation of Arkansas Initiative

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