Data from the CDC released last month indicate that Arkansas was one of just six states where prenatal care improved between 2021 and 2024. This uptick goes against the national trend, specifically in the data point of late prenatal care or no prenatal care at all.
Pearl McElfish is the founding director of the Institute for Community Health Innovation at the University of Arkansas for Medical Sciences. She came to the Bruce and Ann Applegate News Studio Two last week. She says this data is encouraging because Arkansas is moving in the right direction, but we still have a long way to go.
Pearl McElfish: We still have a long way to go, but we are seeing some of the prenatal care access improve. I'm probably most excited because many of the policies that we've put into place happened in 2025. We were definitely doing great work and had made some changes between 2021 and 2024. But really in 2025, we had a lot of legislation passed and we've implemented several new things. So I'm excited because I think we're going to see this trend really accelerate. And it's really a testament to the partnerships and the great work that has been going on in Arkansas over the past few years.
Moore: We've seen a handful of other states also improve, including Arkansas's neighbor to the east, Tennessee. When you look at what Arkansas did during that time period, what stands out as a very concrete improvement?
McElfish: It really has been several things all at once. If I were to choose one that I think has been most impactful, it is presumptive Medicaid, which allows women to see the doctor if they believe they're eligible for Medicaid but have not yet received approval. It protects the woman from the bill as well as the doctor. And so we are seeing women get into the doctor much quicker. But I also think it is the broad, collaborative commitment to do several things all at once. We got into this difficulty of maternal mortality and poor prenatal care because a lot of things were going wrong. And rather than choosing to address just one thing, we have formed so many partnerships that have said we're going to do everything all at once. So doulas, community health workers, family medicine, obstetrical providers, midwives looking at lactation — just all of the things that are needed to support women. And those are just the providers. On the other side, things like remote monitoring, so that we can understand if something's going wrong. Particularly for rural women, remote monitoring is critical. And so the policy, the program and the health care provider level all working simultaneously is why I'm excited that we're going to see this trend really accelerate.
Moore: We saw an improvement for late or no prenatal care — a jump of about 15 percentage points from the 2021 number to the 2024 number. The national ranking improved just a little bit. But Arkansas is still in the bottom 10 states for maternal mortality. When you think of those two things up against one another — that we've made this marked improvement and yet we are still in the bottom 10 states — how should we approach that sort of data?
McElfish: It's as though we are going on a long road trip, and we have gotten in the car and we've turned the right direction, but we have gone a mile down the road where we have hundreds of miles to go. And so I do think this continued commitment — there are moments where I get a little bit concerned that maternal health was the hot topic for 2025, and are we going to move on to something else in 2026 and 2027? And there has to be this long-term commitment to moms and babies and an understanding that if we get prenatal care and the first years of life correct, we really are going to have health care savings across the lifespan. So by focusing on maternal health, we are focusing on care when someone's 50 and really making that connection. So there has to be sustained effort in order for us to continue to see this trend.
A few months ago, we spoke about how rural women and women on Medicaid were more likely to have late prenatal care and less likely to have early prenatal care. What I'm most excited about in seeing this study and this analysis come out is that we've really improved the prenatal care access for those women who have the most disadvantage or the most access gaps. So we really are focusing on where the need is. And I think that's why we are seeing improvements, and that's why we will see improvements in the future.
Moore: When we say late prenatal care, how late is late?
McElfish: We look at prenatal care as first trimester, second trimester or third trimester. What we've seen in our research here in Arkansas is that women who live in rural areas, or women who are on Medicaid, are more likely to get care in that second or third trimester. They're not getting that early prenatal care. And that early prenatal care is really critical to identifying things like hypertension or gestational diabetes. It's really important about having conversations around nutrition and physical activity. There are so many important things that happen by getting prenatal care in that first trimester. And to see us really making improvements in that, knowing that we've passed policies that will continue to improve, that is really encouraging for every Arkansan.
Moore: When we think about the work that it takes to improve maternal mortality in Arkansas, it's both the medical world and the research, but it's also policy and legislation. What are some ways you're excited about seeing things improve from the 2025 session?
McElfish: Policy is probably the most critical thing for long-term change. I'm most excited about doula reimbursement and community health worker reimbursement. I think those are two of the most transformational things because they work with women where they are — where they are geographically, but also where they are socioeconomically. And I think that they can help them get into the traditional health care system and for the traditional health care system to be more effective. On the other hand, I'm most excited about certified nurse midwives as well as family practice OBs — a family practice doctor who gets an OB fellowship — because these are the health care providers that will be practicing in rural Arkansas. And again, we have to shift to this idea that if we are going to improve, we have to improve care in rural Arkansas where there are lower numbers. But those women matter so incredibly much, and we have to provide solutions that really work in rural Arkansas.
Moore: What do you think it would take to get Arkansas not just out of the bottom 10, but maybe middle of the pack?
McElfish: I'm actually very optimistic that we will continue to improve and not be in that bottom quarter, maybe even be in the top quarter. And I think that what will continue to happen is collaboration around real solutions. I think if we maintain our commitment to working together to get things done, we will see success. Practically, what does that mean? It means every woman having access to prenatal care as quickly as possible. It also means a shift towards people being healthy before they become pregnant. It means things like access to contraception so that there can be pregnancy spacing, and women can have more time between pregnancies. And I think this concept that it is all of these things that come around a woman to ensure that she has the opportunity to be healthy. The other thing that we must focus on in the next session is maternal mental health. Most of the maternal mortality is around some type of behavioral health. And so we can fix hypertension and diabetes, but if we don't address maternal mental health, we will fail. And so I'm excited to see partners coming together and really continuing to talk about what about 2027, what legislation do we need to introduce then to keep this momentum going? And I think maternal mental health will be at the top of the list.
Moore: Maternal health and women's health is something KUAF is very passionate about. We have grant funding from the Women's Giving Circle to focus on it. We have students throughout the calendar year who will be focusing on women's health and maternal health. What are the kinds of things that are being undercovered, underreported at this point?
McElfish: One, I think, is that end of reproduction — perimenopause and menopause. I think that is a topic that we're seeing more in the national media. Again, rural women are often left out of that discussion. Other areas for women's health issues, particularly cancer — breast cancer, ovarian cancer — are really high in Arkansas, and I think that there are ways that we can address and prevent those types of cancers from being so prevalent. I also just think looking at whole-person, whole-body health — understanding that reproductive maternal health is not disconnected from breast cancer, is not disconnected from the way we experience perimenopause and menopause — and that it's really critical to take this whole-person approach that looks at nutrition, physical activity, sleep and mental health and really wraps the services around to support people in preventing disease, as much as we support people in addressing disease after it happens.
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