UAMS gets to work on fixes for maternal health crisis in Arkansas

State of play: A committee appointed by Gov. Sarah Huckabee Sanders tasked with finding ways to improve maternal health recently wrapped up its work and released a report that offered 24 recommendations including:

• Increase telehealth use and expand options for mobile units.
• Reduce transportation barriers for pregnant women and mothers to improve pre- and post-natal access.
• Establish and expand services for substance use treatment for pregnant and parenting women.
• Have Medicaid reimburse for doula and community health worker services.
• Increase obstetrics education for emergency doctors, and add obstetrics and gynecology residencies for new doctors.
• Establish school of midwifery in Arkansas.
• Expand prenatal care in county health units.
• Develop a maternal health education and advertising campaign to encourage prenatal care and reduce the teen pregnancy rate.

The big picture: The reasons for the state's poor maternal health are multifaceted and feed into one another. Arkansas' rates of health problems like obesity are high, and people in poor health are more likely to have unhealthy pregnancies, said Pearl McElfish, director of the UAMS Institute for Community Health Innovation.

• Poor pre-pregnancy health combined with poverty, a lack of resources like transportation, and being a rural state where many people live in counties with no hospitals containing birthing units all contribute.
• UAMS plans to meet people where they are — literally — by offering prenatal care in mobile units in parking lots of workplaces and churches, offering postpartum home visits and expanding telehealth.

The intrigue: UAMS plans to start a nurse-midwifery school next year that will accept eight students per year and take two to three years for most students to complete, McElfish said.

• Nurse midwives are nurse practitioners who specialize in midwifery and generally work in hospitals in collaboration with doctors. They're shown to have good outcomes in low-risk births, and an infusion of them in rural parts of the state can improve maternal health, McElfish said.
• UAMS has trained 200 community health workers who connect people to social and health services and plans to start an upskill certificate program in perinatal health for those workers. It's also planning to train doulas who provide emotional and physical support during and after childbirth.

By the numbers: Medicaid pays for about 58% of births in Arkansas, but people on Medicaid can't necessarily access community health workers or doulas.

• Doulas generally cost $1,000 to $1,500 out of pocket. Medicaid and most insurance does not cover them, except for Walmart employees' insurance.
• "There are a handful of federally funded grant programs in the state, but it's a patchwork that does not provide sufficient coverage for community health workers, and for doulas absolutely you are paying out of pocket … Doulas have been demonstrated to be the most effective for low-income women, and low-income women are not getting the doulas in Arkansas. They really are more of a luxury service when they should be an essential health care service," McElfish said.

Go deeper: Read the report