HJAR Sep/Oct 2023

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2023 45 Joseph W. Thompson, MD, MPH President and Chief Executive Officer Arkansas Center for Health Improvement But there is much more we could do. Ar- kansas could extend postpartumMedicaid coverage for newmothers to the maximum of 12 months allowed by federal law, instead of the state’s current limit of 60 days. All but a handful of states have implemented this coverage extension or are planning to. 8 Ar- kansas could also require Medicaid to cover doula services, as eight states have done. 9 Another option is expanding access to home visiting programs, which served only 3% of Arkansas children ages 0-2 years in 2019. 10 And our obstetricians and gynecolo- gists could work to ensure that babies are delivered by the safest appropriate method. A C-section is sometimes appropriate in a high-risk pregnancy, but the procedure is overutilized in our state: An unpublished ACHI analysis found that more than 1 in 3 Arkansas births in 2019 were performed by C-section. These are just a few examples of ways we can address this issue. We will not solve it overnight, and no single fix will be enough. What Arkansas needs now is for stakehold- ers around the state to look at the birthing journey and see where they can contribute tomaking it a safer experience. Our mothers and infants deserve nothing less. More information about the birthing jour- ney and other aspects of maternal and infant health are available on ACHI’s website at: achi.net/maternal-infant-health. n homes. These professionals may in- clude nurses, social workers, or early childhood specialists. 8. Postpartum visits. Mothers should undergo a comprehensive postpartum checkup within 12 weeks after giving birth and should continue to receive medical care during the postpartum period as needed. Contraception and urgent maternal warning signs should be discussed during these visits. 9. Well-child visits. These are preven- tive checkups, beginning at infancy, that allow parents to track growth and development milestones, discuss specific concerns about the health and well-being of their children, and ensure their children receive the appropriate vaccines to protect against illnesses. Encouragingly, momentum is building around this issue. The Arkansas General Assembly and Gov. Sarah Huckabee Sand- ers enacted several laws this year aimed at improving maternal and infant health, including measures that require Medicaid and private insurers to cover depression screening for new mothers, extending pa- rental leave for new mothers who are state employees from four weeks to 12 weeks, re- quiring newborns to be screened for certain health conditions, requiring public schools to excuse absences due to pregnancy, and requiring Medicaid to cover long-acting and reversible contraception for new mothers. REFERENCES 1 Fleszar, L.G.; Bryant, A.S.; Johnson, C.O.; et al. “Trends in State-Level Maternal Mortality by Ra- cial and Ethnic Group in the United States.” Jour- nal of the American Medical Association 330, no. 1 (July 3, 2023). doi:10.1001/jama.2023.9043 2 Kaiser Family Foundation. “Maternal deaths and mortality rates per 100,000 live births.” Ac- cessed July 27, 2023. kff.org/other/state-indica- tor/maternal-deaths-and-mortality-rates-per- 100000-live-births/?currentTimeframe=0&sele ctedDistributions=maternal-mortality-rate-per- 100000-live-births&sortModel=%7B%22colId%2 2:%22Maternal%20Mortality%20Rate%20per%20 100,000%20live%20Births%22,%22sort%22:%22d esc%22%7D 3 Centers for Disease Control and Prevention. “Infant Mortality Rates by State.” Accessed July 27, 2023. https://www.cdc.gov/nchs/pressroom/ sosmap/infant_mortality_rates/infant_mortality. htm 4 Centers for Disease Control and Prevention. “National and State Diabetes Trends.” Accessed July 27, 2023. https://www.cdc.gov/diabetes/ library/reports/reportcard/national-state-diabe- tes-trends.html 5 Trust for America’s Health. “State of Obesity 2022: Better Policies for a Healthier America.” (September 2022). https://www.tfah.org/wp- content/uploads/2022/09/2022ObesityRepo rt_FINAL3923.pdf 6 Centers for Disease Control and Prevention. “Hypertension Mortality by State.” Accessed July 27, 2023. https://www.cdc.gov/nchs/pressroom/ sosmap/hypertension_mortality/hypertension. htm 7 Centers for Disease Control and Prevention. “Heart Disease Mortality by State.” Accessed July 27, 2023. https://www.cdc.gov/nchs/pressroom/ sosmap/heart_disease_mortality/heart_disease. htm 8 Kaiser Family Foundation. “Medicaid Postpar- tum Coverage Extension Tracker.” July 28, 2023. https://www.kff.org/medicaid/issue-brief/medic- aid-postpartum-coverage-extension-tracker/ 9 Knocke, K.; Chappel, A.; Sugar, S.; et al. “Doula Care and Maternal Health: An Evidence Re- view.” Office of the Assistant Secretary for Planning and Evaluation, Office of Health Poli- cy. (December 13, 2022). https://aspe.hhs.gov/ sites/default/files/documents/dfcd768f1caf- 6fabf3d281f762e8d068/ASPE-Doula-Issue- Brief-12-13-22.pdf 10 Prenatal-to-3 Policy Impact Center. “Arkansas Roadmap Summary.” Accessed July 27, 2023. https://pn3policy.org/pn-3-state-policy-road- map-2022/ar/