Arkansas continues to find itself among the lowest-ranked states for women’s health and reproductive care, according to a new report released Thursday.
The 2024 State Scorecard on Women’s Health and Reproductive Care marks the first comprehensive examination of women’s health care in all 50 states and the District of Columbia by the Commonwealth Fund, a private, nonprofit foundation supporting independent research on health policy and a high-performance health system.
Arkansas received an overall ranking of 47 and ranked last in maternity care providers per 100,000 women ages 15 to 44 with a rate 52.1. The national average is 78.9 providers per 100,000 women.
The state also ranked second to last in infant mortality with a rate of 8.6 deaths per 100,000 live births. The national average is 5.4.
The report uses 32 measures to evaluate each state on health care access, affordability, quality of care and health outcomes for U.S. women. Arkansas ranked 50 on health and reproductive care outcomes, 48 on health care quality and prevention, and 35 on coverage, access and affordability.
The study includes data from 2022, the same year the U.S. Supreme Court overturned Roe v. Wade, which will provide “a vital baseline for tracking the ripple effects of the decision and impacts of new policy restrictions on reproductive care,” Commonwealth Fund President Joseph Betancourt told reporters during a call Wednesday.
“Women’s health in the U.S. is in a very fragile state,” Betancourt said. “There are stark disparities in women’s access to quality health care among states across racial, ethnic and socioeconomic lines. These inequities are longstanding, no doubt, but recent policy choices and judicial decisions restricting access to reproductive care have and may continue to exacerbate them.”
The highest maternal mortality rates are found in the Mississippi Delta, which includes Arkansas, Louisiana, Mississippi and Tennessee, four states that had abortion restrictions prior to the Dobbs decision and now have abortion bans. The exact correlation between abortion bans and maternal mortality is still being studied.
Several counties in these states lack a single hospital or birth center with obstetric providers offering obstetric care. States with abortion restrictions tend to have fewer maternity care providers, according to the report.
Abortion has been illegal in Arkansas except to save the life of the pregnant person since 2022. Secretary of State John Thurston disqualified a proposed constitutional amendment to expand abortion access last week, but the group backing the ballot initiative filed a lawsuit Tuesday that asks the state Supreme Court to overturn Thurston’s rejection.
States in the Mississippi Delta rank low on other potential contributors to maternal mortality, including high rates of low-risk cesarean births, high uninsured rates prior to pregnancy and low rates of postpartum depression screening.
Arkansas Rep. Aaron Pilkington, R-Knoxville, sponsored a law during the 2023 legislative session that requires physicians to offer postpartum depression screenings to new mothers and requires Medicaid to cover the screenings. He also sponsored a law requiring Medicaid depression screenings for women during pregnancy.
Additionally, Pilkington led an unsuccessful attempt to expand postpartum Medicaid coverage. Arkansas is one of three states that has not taken advantage of the federal option to extend postpartum Medicaid coverage from 60 days to 12 months after birth.
After receiving criticism for saying the expanded coverage is unnecessary due to the state’s exciting insurance programs that cover pregnancy care, Gov. Sarah Huckabee Sanders in March created a committee tasked with developing a plan for bolstering maternal health in the state.
Sara Collins, lead author of the Commonwealth Fund report, said the expansion of postpartum Medicaid coverage has provided a huge improvement in coverage for pregnant women. Uninsured rates tend to be high for women before they become pregnant in states that haven’t expanded Medicaid, she said.
“It means that women enter their pregnancy having had less access to health care, particularly if they’re poor or low-income, and probably a much less poorer health situation then they would have been had they had health insurance coverage,” Collins said. “It’s pretty clear that having health insurance that’s adequate, that covers your costs is really necessary to access the health care system.”
Collins noted that “insurance coverage is necessary, but it’s not sufficient” without having other things in place, such as access to providers and good networks, as well as the ability to get health care in a timely fashion.
“We’re seeing in states where we have abortion restrictions or abortion bans, just generally fewer providers enabling people to get the health care that they need,” she said. “So it’s coverage, but it’s also the type of coverage you have and the ability to access the providers with that coverage.”
For all Arkansas’ struggles, the study found that the state performed best on the percent of women ages 18 to 44 without a usual source of care (15%), women with a recent live birth without health insurance coverage during their pregnancy (1.4%) and women ages 18 to 44 who reported not visiting a doctor for a routine checkup in the past two years (13%).
Based on their findings, the report’s authors suggested as policy considerations things that worked well in high-performing states, including investing in health insurance coverage for nearly all residents and making reproductive health care legal and accessible.
Higher-ranked states also achieved lower maternal mortality rates with more maternal health workers, more prenatal and postpartum checkups, and higher rates of postpartum screening.
“My hope is that policymakers can use these findings to identify and address gaps in care, guaranteeing that all women across the United States can live healthy lives with access to quality, affordable care no matter where they live or what their background is,” Betancourt said.
Arkansas Advocate is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Arkansas Advocate maintains editorial independence. Contact Editor Sonny Albarado for questions: info@arkansasadvocate.com
