The United States lags far behind our peers in maternal and infant health outcomes. Arkansas is a particularly dangerous place to give birth. Nearly half of its counties are considered maternal care deserts. The state has poor maternal and reproductive health access and one of the highest maternal mortality rates in the nation. Black women are nearly twice as likely to die compared to White women in the state and Marshallese women in Arkansas also have a pregnancy mortality rate significantly higher than the state average. Devastatingly, outcomes have worsened in recent years and 95 percent of pregnancy-related deaths in Arkansas are preventable.
According to Camille Richoux, Director of Health Policy at Arkansas Advocates for Children and Families (AACF), “There are different choke points with financing, provider training, continuity and access to care. For disproportionately impacted women, it becomes literally a death by a thousand cuts issue where it’s not one thing but a bunch of contributors that add up.”
Maternal mortality, and the deep racial and economic disparities driving it, have become impossible to ignore. AACF has sounded the alarm for many years, but recently the tide has begun to turn. “There was a point when public interest and legislative interest hit a boiling point,” said Richoux. As a result, Governor Huckabee Sanders convened a task force in 2023 that included health and policy experts, community advocates, and members from organizations across the state who developed a high-level plan to improve maternal health and stop preventable pregnancy-related deaths.
Acting on task force recommendations, the Healthy Moms, Healthy Babies Act was enacted this year. It includes provisions that AACF has fought years to pass, including presumptive Medicaid eligibility for pregnant people, coverage for remotely provided care such as ultrasounds and blood pressure monitoring, Medicaid coverage and reimbursement for doulas, and unbundling global payments for prenatal care. These changes allow pregnant women to receive care sooner, have ongoing care throughout pregnancy, and access care even when living in maternal health deserts.
While the Healthy Moms, Healthy Babies Act does confront some of the barriers fueling poor maternal health outcomes, it is only a first step. Advocates throughout the state are determined to keep up the drumbeat and press for stronger policies and broader reforms. Here’s what they believe should come next.
Continue forming partnerships and coalitions.
The Governor’s task force helped lay the foundation for the Healthy Moms, Healthy Babies Act, but ongoing collaboration will be critical to sustaining progress. Dr. Zenobia Harris, Executive Director of the Arkansas Birthing Project, served on the Governor’s task force and is also the Co-Chair of the Arkansas Maternal Health Community of Practice (MHCoP). Established through a five-year maternal health innovation award, MHCoP brings together providers, advocates, program managers, and funders quarterly to help tackle this crisis. “It gives all of us an opportunity to meet together,” Harris explained. “Often, the work is fragmented. People are doing their own thing in their own silos, and we’re not working together or using resources as well as we could.”
Creating more opportunities for the people in the maternal and child health space to collaborate is vital. Equally important is involving community-based organizations with deep ties to impacted populations. The Arkansas Birthing Project, for example, addresses the social issues that contribute to poor maternal and infant outcomes by pairing pregnant women and new mothers with a “big sister” for guidance and support during their child’s first year. The nonprofit operates primarily in Southeast Arkansas, an area with a large Black population, high levels of poverty, and limited access to maternal care. “Southeast Arkansas is being left out of the equation, and that concerns me greatly, because that’s where a lot of our loss is and where a lot of our concerns lie,” said Harris. She adds that a key element of advancing maternal health is collaborating with, and “recognizing the small organizations like ours that are out there in the trenches providing support to families that traditionally are not recognized or supported by larger programs.”
Involve pregnant and newly postpartum women in the policy conversation.
Hearing directly from those most affected is essential to crafting sound policy. Without their voices, the biggest challenges may go unrecognized and unresolved. “Poverty is a huge indicator and predictor of outcomes, although for Black women, that is not always necessarily the case. Even Black women who are highly educated and are well off financially still tend to have a higher percentage of babies that are born too early, experience postpartum issues, and, unfortunately, sometimes succumb to death after they have their babies. So there is something much deeper at play here than just socioeconomic status and just lack of access to health care,” said Harris. She adds that listening to women and convening more focus groups is a necessary element to understanding these systemic and deep-rooted causes of Arkansas’s maternal health crisis and designing the systems and programs necessary to remedy it.
Some advocates in the state have already taken this important step to help more women in the state be respected, believed, seen, and heard. Last year, AACF conducted focus groups with pregnant women and women who had recently given birth, including dedicated sessions with Black women in the Delta, women residing in a substance-use disorder treatment facility, and Marshallese women in Northwest Arkansas. Participants described difficulty accessing care, feeling rushed and dismissed by providers, and gaps in coverage that left them uninsured postpartum. They also reported systemic barriers, including stigmatizing experiences and judgmental treatment in healthcare settings that made them hesitant to seek care.
Nuclear testing carried out by the U.S. military in the 1940s and 1950s had devastating effects on the Republic of the Marshall Islands, displacing residents and leaving lasting health, environmental, and economic ramifications that can still be felt today. In response, the federal government established the Compact of Free Association (COFA) in the 1980s, which allows Marshallese citizens to live, work, and study in the United States. Arkansas is now home to one of the largest Marshallese communities outside the Marshall Islands, with many drawn to Northwest Arkansas by economic opportunities connected to the region’s substantial poultry industry. Marshallese women in the focus groups discussed unequal access to medical care, in part due to a decades-old federal law that prevented them from qualifying for Medicaid until 2021. They also shared that poorly translated materials being sent by the Department of Human Services as well as cultural attitudes toward postpartum depression create barriers to access. Substance use is a major cause of pregnancy-associated deaths, but those in recovery or active addiction shared that they felt intensely judged by medical staff and often did not feel comfortable seeking treatment. Women in all focus groups, but especially Black women, described not feeling heard or respected by medical staff and not being fully informed to make their own medical decisions. Highlighting these voices in focus groups and including women from these communities in policy discussions is instrumental to addressing stark disparities. Insights from the focus groups have helped guide AACF’s policy and advocacy focus, including advocating for improved postpartum care and eliminating gaps in Medicaid coverage, combating systemic racism and implicit bias in the medical field, creating an education campaign on postpartum depression for Marshallese women, and expanding access to substance use treatment.
Despite the value of their perspectives, pregnant and postpartum women were notably absent from the Governor’s maternal health task force. Going forward, there should be efforts to continue organizing focus groups, promoting direct engagement in policymaking, and allotting dedicated seats on task forces for impacted women. “People with the lived experience need to be brought to the table,” said Dr. Harris. “If we don’t have tables that they can sit around, we need to create some tables so that their wisdom, their knowledge, and experience can be added to the conversation.”
Continue advocating for a Medicaid postpartum extension.
Nearly half of all births in Arkansas are financed by Medicaid, making access to the program a critical driver of maternal health outcomes. Maternal health advocates in the state successfully fought for presumptive eligibility and Medicaid reimbursement for doulas, which, fortunately, were included in the Healthy Moms, Healthy Babies Act. Despite these advancements, however, Arkansas remains the only state in the nation without a 12-month postpartum Medicaid extension, with coverage ending at just 60 days after birth. This forces new mothers who do not already qualify for the state’s Medicaid expansion program to navigate applications and paperwork to find coverage on top of managing the laundry list of stressors that accompany raising a newborn. According to Christin Harper, Policy Director at AACF, many women fall through the cracks as a result and are left uninsured and without access to mental and maternal health care during a high-risk period when more than half of maternal deaths occur.
The extension was not included in the Governor’s task force recommendations or the final Healthy Moms, Healthy Babies Act. A standalone bill to authorize the extension, HB1004, was introduced and passed in the Arkansas House of Representatives. Despite powerful testimony from mothers who lost coverage postpartum, however, it failed in the Senate. Advocates remain steadfast. “We are continuing to see that women, every single month, are falling off coverage postpartum and losing access to care,” said Richoux. “We cannot leave them behind. We cannot forget that there is still work to do.” As federal Medicaid cuts loom, this work becomes even more urgent.
Advocates in Arkansas have shown that persistence pays off. Years of testimony, sharing their personal stories, and engaging with legislators have led to a real reckoning in the state. More policymakers recognize that urgent action is needed to save lives, and that maternal health disparities and unequal access to care are especially magnified for Black and Marshallese women, immigrants and undocumented populations, and families experiencing deep poverty. The Healthy Moms, Healthy Babies Act marks progress, but it is only a starting point. Even a single preventable maternal death is one too many. Advocates are determined to continue pressing forward until every mother and every baby in Arkansas has the chance to live, grow, and thrive.