HJAR Jul/Aug 2024

36 JUL / AUG 2024 I  HEALTHCARE JOURNAL OF ARKANSAS POLICY communications in primary care settings and increased preventive healthcare utiliza- tion, but anACHI analysis found that moth- ers of color are unlikely to deliver with pro- viders of the same race or ethnicity. 9,10,11 We found that in 2022: • 91.1% of White mothers, 11% of Black mothers, 3.8% of Hispanic mothers, and 3.4% of Asian mothers delivered with a provider of the same race/ ethnicity. • No Pacific Islander or American In- dian/Alaska Native mothers deliv- ered with providers of the same race/ ethnicity. • Of the delivering providers for whom demographic information was avail- able, 87.9% were White, 5.7% were Black, 3.9%wereAsian, 1.8%were His- panic, and 0.7% (two providers) were American Indian/Alaskan Native. Policy considerations As they work with stakeholders across the state to address the maternal health crisis, options that policymakers should consider include: Investing in doulas At least 12 states currently provide Med- icaid coverage for doulas, and at least eight others are in the process of implementing doula coverage. 12 Doula services can be especially valuable for mothers who live in areas with limited access to maternity care. Doulas can also help facilitate moth- ers’ understanding of the birthing process, enhance communication between moth- ers and healthcare providers, and facilitate advocacy for mothers’ interests during the delivery process. Enhancing access to and education about LARCs Among the barriers to the use of these devices are low reimbursement rates, lack of awareness among patients, and a short- age of healthcare providers trained to place or remove the devices. 6 Achieving 12 months of postpartum healthcare coverage Medicaid covers most pregnancies in the state, but coverage ends 60 days fol- lowing delivery. Although coverage op- tions are available, most new mothers are not seamlessly transitioning into ex- tended coverage. Arkansas is one of only two states that have decided not to expand postpartum Medicaid coverage to cover the 12 months after a woman gives birth, as allowed under federal law. 13 Successful and seamless transition into existing coverage options should be achieved, or extension of existing coverage should be considered. Expanding access to home visiting services. Researchers with ACHI and the Uni- versity of Arkansas for Medical Sciences evaluated two home visiting programs in Arkansas — Following Baby Back Home and Healthy Families America — and found that both had positive impacts on health outcomes among at-risk mothers and in- fants. 14,15 In 2021, less than 6% of Arkansas infants in families with incomes less than 150% of the federal poverty level were served by home visiting programs. 16 n REFERENCES 1 KFF. “Maternal deaths and mortality rates per 100,000 live births.” Accessed May 31, 2024. https://www.kff.org/other/state-indicator/mater- nal-deaths-and-mortality-rates-per-100000-live- births/?currentTimeframe=0&selectedDistribut ions=maternal-mortality-rate-per-100000-live- births&sortModel=%7B%22colId%22:%22Matern al%20Mortality%20Rate%20per%20100,000%20 live%20Births%22,%22sort%22:%22desc%22%7D 2 Arkansas Center for Health Improvement. “100 Arkansans.” April 18, 2024. https://achi.net/our- initiatives/100-arkansans/ 3 Arkansas Center for Health Improve- ment. “C-Section Rates in Arkansas.” Oc- tober 2023. https://achi.net/wp-content/ uploads/2023/10/231024D_First-Births-C-Sec- tion-Infographic.pdf 4 Osterman, M.J.K.; Hamilton. B.E.; Martin, J.A.; et al. “Births: Final Data for 2021.” National Vital Sta- tistics Reports 72, No. 1. (Jan. 31, 2023). https:// www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-01. pdf 5 Arkansas Center for Health Improvement. “Teen Births and Teen Birth Spacing in Arkan- sas.” May 2024. https://achi.net/wp-content/ uploads/2024/05/240530G-Teen-Births-and- Spacing-.pdf 6 Arkansas Center for Health Improvement. “Long-Acting Reversible Contraception: An Overview.” Accessed May 31, 2024. https://achi. net/wp-content/uploads/2024/03/240327K_ LARC-Explainer.pdf 7 Arkansas Center for Health Improvement. “Maternal and Infant Health.” Accessed May 31, 2024. https://achi.net/maternal-infant- health/#arkansas-birthing-hospitals 8 Arkansas Center for Health Improve- ment. “Who Is Delivering Babies in Arkan- sas?” April 2024. https://achi.net/wp-content/ uploads/2024/05/240502A_Who-is-Delivering- Babies-in-AR-IG.pdf 9 Street, R.L. Jr.; O’Malley, K.J.; Cooper, L.A.; Haid- et, P. “Understanding concordance in patient- physician relationships: personal and ethnic di- mensions of shared identity.” Annals of Family Medicine 6, Issue 3 (May-June 2008); 198-205. doi: 10.1370/afm.821 10 Ma, A.; Campbell, J.; Sanchez, A.; et al. “Racial concordance on healthcare use within Hispanic population subgroups.” Journal of Racial and Ethnic Health Disparities (July 21, 2023) doi: 10.1007/s40615-023-01700-8 11 Arkansas Center for Health Improve- ment. “Race/Ethnicity Alignment of Moth- ers and Delivering Providers in Arkansas, 2022.” May 2024. https://achi.net/wp-content/ uploads/2024/05/240522A_Racial-Concor- dance-Delivering-Providers-and-Mothers-Draft. pdf 12 Arkansas Center for Health Improvement. “Doulas and the Birthing Journey.” Accessed May 31, 2024. https://achi.net/wp-content/ uploads/2024/05/240122B_Doula-Explainer.pdf 13 KFF. “Medicaid Postpartum Coverage Exten- sion Tracker.” May 10, 2024. https://www.kff.org/ medicaid/issue-brief/medicaid-postpartum-cov- erage-extension-tracker/ 14 Arkansas Center for Health Improvement, Uni- versity of Arkansas for Medical Sciences. “Home- Visiting Support for Low-Birth-Weight Preterm Infants: Evaluation Findings from the Following Baby Back Home Intervention.” December 2019. https://achi.net/wp-content/uploads/2021/05/ FBBH-Evaluation-Report_HomVEE_Final.pdf 15 University of Arkansas for Medical Sciences, Arkansas Center for Health Improvement. “Sup- porting Families: Evaluation of the Healthy Fami- lies America Home Visiting Program in Arkansas.” June 2021. https://medicine.uams.edu/family- medicine/wp-content/uploads/sites/7/2021/10/ HFA-Evaluation-Report_2021_FINAL_2.pdf 16 Prenatal-to-3 Policy Impact Center. “2023 Ar- kansas Roadmap Summary.” Accessed May 31, 2024. https://pn3policy.org/pn-3-state-policy- roadmap-2023/ar/