HJAR May/Jun 2025

PRENATAL CARE 16 MAY / JUN 2025 I  HEALTHCARE JOURNAL OF ARKANSAS   mothers has identified several barriers to prenatal care including difficulty under- standing and navigating Medicaid, a lack of transportation to get to appointments, and language barriers (Ayers et al., 2018). Prior research with Marshallese mothers also identified a lack of understanding of the importance of early and consistent pre- natal care as well as experiences with dis- crimination and fear when seeking prenatal care (Ayers et al., 2018). Our findings that Black mothers com- pleted fewer prenatal care visits, regardless of insurance coverage, is concerning given that prior studies have documented higher rates of comorbidities among Black mater- nity patients (Brown et al., 2020). While the typical prenatal visit schedule includes 12 to 14 visits, the current Guidelines for Perina- tal Care recommend that the frequency of prenatal care visits be individualized based on each patient’s risks and needs (Ameri- can Academy of Pediatrics and American College of Obstetricians and Gynecologists, 2017). Mothers with comorbidities require more frequent visits (AmericanAcademy of Pediatrics and American College of Obste- tricians and Gynecologists, 2017). Racially and ethnically minoritized moth- ers experience higher rates of maternal morbidity and mortality (Hoyert, 2024), and their children have higher rates of preterm birth, low birthweight, and infant death (MacDorman and Mathews, 2011). Early and adequate prenatal care has con- sistently been demonstrated to reduce nega- tive outcomes for both mothers and babies (Partridge et al., 2012; Moaddab et al., 2016). Therefore, it is imperative to address racial disparities in prenatal care utilization. There was a small but statistically sig- nificant difference in prenatal care utiliza- tion between mothers living in rural and urban areas. Rural women have less access to obstetrical services (Maron, 2017), and rural populations generally have farther distances to travel when seeking prena- tal care. This is particularly true in coun- ties with higher proportions of minori- tized women and lower median household incomes (Hung et al., 2017). These factors may all contribute to the differences in pre- natal care utilization. 4.1. Recommendations for policy and practice Arkansas currently has among the worst maternal and infant outcomes in the U.S (US Department of Health and Human Ser- vices HRSA, 2024; Centers for Disease Con- trol and Prevention, 2024). Early and ade- quate prenatal care is associated with better maternal and infant outcomes (Liu et al., 2015; Partridge et al., 2012; Moaddab et al., 2016). This research can inform health care providers and policy makers as Arkansas seeks to improve maternal and infant health outcomes by improving the utilization of prenatal care. Several policy changes have the potential to improve these outcomes. First, Arkansas should consider implement- ing presumptive eligibility for pregnancy Medicaid, which allows mothers to have temporary eligibility while their applica- tion is being processed. States that imple- mented presumptive eligibility have shown an increase in early prenatal care (Eliason and Daw, 2022). Second, Arkansas should consider expanding the use of and reim- bursement for community health workers and doulas. Community health workers and doulas have demonstrated the ability to improve prenatal care utilization by help- ing mothers overcome socio-economic bar- riers such as transportation, language, low- health literacy, and fear or uncertainty when navigating the health care system (McCue et al., 2022). Community health workers and doulas have also helped mitigate racial/eth- nic inequalities within the health system (Moore et al., 2020). Several states pro- vide some Medicaid coverage for commu- nity health workers and community-based doulas (Institute for Medicaid Innovation, 2023). Third, Arkansas could also consider changes to the way Medicaid reimburses for prenatal care. Currently, Arkansas uses global bundled payment which pays at delivery. Arkansas could consider perfor- mance-based incentives for providers to provide the recommended number of vis- its or meet other quality measures. Fourth, there also may be opportunities to better leverage the mobile prenatal care and local health units to reduce transportation bur- dens, particularly in rural areas, which may improve early prenatal care and increase the number of prenatal care visits (Edger- ley et al., 2007). Fifth, Arkansas could also consider the promotion of group prena- tal care programs such as CenteringPreg- nancy, which has been demonstrated to increase the amount of prenatal education and care a mother receives and has dem- onstrated health benefits for mothers and infants, especially among Black mothers (Crockett et al., 2022). Sixth, targeted, cul- turally-appropriate prenatal care outreach and educational programs may be needed to reach NHPI community members who have the lowest prenatal care utilization. While the study was conducted in Arkan- sas, these recommendations are relevant for other states with large Medicaid populations and those serving NHPI communities. 4.2. Limitations Findings from this study should be inter- preted with some limitations. First, we uti- lized data from birth records in the state of Arkansas, and our results may not be gen- eralizable to other states. Second, we have examined associations; our results do not establish causality. Third, some questions remain regarding the reliability and validity of birth certificate data (Martin et al., 2013). Fourth, our assessment of timing and quan- tity of prenatal care does not tell us about the content or quality of the care. Fifth, we could not adjust for a mother’s risk level and the number of visits needed, and therefore, we cannot speak to whether utilization was “adequate”for high-risk women. These limi- tations may create potential biases. How- ever, even with these limitations, the results yield valuable insights into prenatal care utilization and the potential risk of moth- ers who live in rural areas, are covered by Medicaid, and/or are from specific racial/ ethnic groups. The study is also strength- ened by the large sample size. n