A year after abortion effectively ended in Arkansas, more Arkansans than ever are seeking permanent sterilization, and abortion access groups have seen their costs increase.
A renewed focus to implement policies experts say would improve maternal health saw mixed results, and Arkansas’ maternal mortality rate continues to be among the worst in the U.S.
Arkansas was one of several states with a “trigger law” that banned abortion in June 2022 almost immediately following the Dobbs v. Jackson Women’s Health decision by the U.S. Supreme Court that overturned Roe v. Wade.
The only exception to the state’s ban is to save the life of the mother in a “medical emergency.” Arkansas’ Republican-supermajority Legislature rejected several measures this year to broaden the state’s exceptions to the ban.
A complete picture of what happened to Arkansas’ maternal health landscape post-Dobbs is still a ways off as health data reporting typically lags by a year or more.
But health experts and those who work with pregnant Arkansans expressed both reasons for optimism and disappointments from the last 12 months.
Medical professionals and patients had “a lot of uncertainty” in the days and weeks immediately following the Dobbs ruling, said Dr. Nirvana Manning, chair of the Department of Obstetrics and Gynecology and a practicing OB/GYN at the University of Arkansas for Medical Sciences.
While there isn’t available statewide data on contraceptive use or sterilization, Manning said UAMS saw significant increases in both reversible and permanent birth control after Dobbs. Furthermore, the number of patients requesting permanent sterilization increased by four to five times, surprising Manning and other clinicians.
“We were not necessarily expecting that sort of a response, and in hindsight now, I completely understand it,” she said.
Demand for long-acting reversible contraception (LARC) also spiked after Dobbs, Manning said.
A new state law that goes into effect Aug. 1 requires Medicaid to reimburse physicians for providing LARC. Arkansas Advocates for Children and Families praised Act 581 as a cost-saving measure for both individuals and the state.
Manning agreed, especially since Arkansas has the nation’s highest teen birth rate. According to a new report, Arkansas’s teen birth rate was 27 births per 1,000 teens in 2021, nearly twice the national average. Access to contraception is the primary reason for this discrepancy, according to AACF.
Additionally, 30% of teenage pregnancies are the person’s second or third, and Act 581 can “dramatically” lower this statistic, Manning said.
To implement this law, health care providers at all 37 Arkansas hospitals that deliver babies must know how to administer LARC and receive Medicaid reimbursement for it, she said.
“[We should also be] making sure our family practice partners and women’s health advanced practice partners are all very comfortable with counseling the different contraception options and comfortable placing them, should someone in their community want them,” Manning said.
Abortion access
Over the last year, groups like the Arkansas Abortion Support Network and Ozark Circle for Choice have shifted their focus to helping Arkansans access out-of-state abortions, which is more expensive.
AASN Executive Director Ali Taylor said the network still operates an abortion fund, but it also partnered with other groups like Midwest Access Coalition. The much larger organization has the capacity and infrastructure to do things like buy a plane ticket for a third party or make hotel reservations that don’t require a credit card, Taylor said. Through their partnership, AASN refers clients to MAC and reimburses them quarterly.
“It’s obviously going to be a few years before we know the full impact, before we really have all the numbers, but starting out as one of the states with one of the highest maternal mortality rates wasn’t a great place to start, and banning abortion certainly isn’t going to help that statistic,” she said.
In response to the increasing prevalence of crisis pregnancy centers “that basically exist to talk people out of abortion,” according to Taylor, AASN opened the “first-of-its-kind for Arkansas abortion and pregnancy resource center” called the YOU (Your Options Understood) Center last fall.
Located in the former Little Rock Family Planning Services building, YOU Center clients can access abortion, parenting or adoption resources, as well as free emergency contraceptives, condoms and pregnancy tests, Taylor said.
Eventually, Taylor said the center hopes to provide sexually transmitted infection (STI) testing and establish satellite YOU centers on college campuses across the state.
“Arkansans still have options, and I think that there are too many people out there who don’t realize that…It’s not illegal to go out of the state, it’s not illegal to get help to go out of the state, and we’re here to help folks when they need that,” she said.
Taylor Hern, an organizer with the mutual aid reproductive justice organization Ozark Circle for Choice, said it relies heavily on abortion funds, like AASN.
The increased cost of abortion access disproportionately affects low-income Americans who are always going to be shut out of the medical system, even with less-controversial medical care, Hern said.
“Those gaps have always been there, and the work we’re doing and we’re contributing to is getting harder,” Hern said. “A year out…we’re kind of finding our footing with the new landscape that we’re in, but we are going to stay flexible and we’re going to stay available.”
Crisis pregnancy centers
Since Dobbs, Arkansas Pregnancy Resource Center Executive Director Shelley Lewis said she’s encountered more people concerned they won’t be able to get care for ectopic pregnancies and miscarriages.
Following the Dobbs decision, then-Gov. Asa Hutchinson issued a statement clarifying that Arkansas’ “trigger law” does not affect ectopic pregnancy treatment.
Founded in 1977, the nonprofit, faith-based organization provides free services, including pregnancy and STI testing and limited OB ultrasounds, regardless of clients’ insurance or legal status. The center hired a social worker and a mental health professional in the last year.
“We saw it being more important post-Dobbs, but knowing that we always wanted to do it all along, we just had a little bit more incentive to do so,” she said.
Both part-time positions are supported through a $1 million grant program created by the Arkansas Legislature to help fund crisis pregnancy centers. Arkansas Pregnancy Resource Center received about $50,000, which also supported advertising, Lewis said.
The center is located next to Arkansas Abortion Support Network’s YOU Center, and Lewis said she’s thankful to see the direction their neighbors are taking.
“I think we all need to give each other grace and understanding of what women need,” she said. “Trying to point fingers at each other really keeps us from seeing who needs help, and it’s women and families in the area, so we’re committed to working with anyone that wants to help our community regardless of what political beliefs they might have.”
Medicaid for pregnant and postpartum Arkansans
Although the Dobbs decision shifted state policymakers’ focus toward maternal health, Arkansas remains one of the few states that have not taken advantage of the option to extend postpartum Medicaid coverage.
Extending postpartum coverage from 60 days to a full year after giving birth would be a boon to maternal health in Arkansas, Manning said.
A bill to create this policy did not advance in the Arkansas Legislature earlier this year.
Last August, then-Gov. Asa Hutchinson announced plans to seek waivers from federal authorities to expand two existing Medicaid-based initiatives aimed at serving pregnant and postpartum Arkansans, especially in rural areas.
One waiver would allow an additional 5,000 Arkansans to receive at-home visits during a high-risk pregnancy via the Department of Human Services’ Life360 program.
The second would allow Arkansans with incomes up to 214% of the federal poverty level to receive Medicaid coverage for all health care needs for 60 days after giving birth.
The Centers for Medicare and Medicaid Services (CMS) approved the amendment to create Life360 HOMEs as part of the Arkansas Health and Opportunity for Me (ARHOME) program in November, DHS spokesman Gavin Lesnick said. DHS has received eight letters of intent for Life360 HOMEs and three applications.
Approval is pending to allow women in Medicaid programs other than ARHOME to participate in Maternal Life360 HOMEs, Lesnick said.
“We cover pregnancy in all categories for 60 days and beyond if the beneficiary is eligible,” he said. “For those pregnant women who are not eligible for another category, full Medicaid coverage is available up to 214% of the federal poverty level until the end of the month 60 days after giving birth.”
More than half of all Arkansas pregnancies are covered by Medicaid, Manning said. To take advantage of Medicaid coverage for LARC, a postpartum mother must attend a doctor’s appointment before the current 60-day coverage deadline.
Not all mothers, especially in poor and rural areas, have the support systems to access this care in a timely manner, Manning said.
“So many… are alone in that delivery room or in that postpartum period because the rest of their families have jobs that they need to be at in order to help sustain their families,” she said.
Maternal mortality
Additionally, Manning said, extending postpartum Medicaid coverage would also help address postpartum health complications that contribute to maternal mortality, especially since most complications and deaths occur at least 42 days postpartum.
Arkansas has the nation’s highest maternal mortality rate and the third highest infant mortality rate, according to the Arkansas Center for Health Improvement which launched a project last week to raise awareness about the issue.
Arkansas Surgeon General Dr. Kay Chandler, a gynecologist, told lawmakers during a committee meeting Tuesday that one of her goals is to address maternal mortality in the state and that she’s met with members of the state’s maternal mortality review committee.
Last year, Arkansas became the 48th state to join the Alliance for Innovation on Maternal Health (AIM), which creates “patient safety bundles,” or maternal health care plans and best practices, that state health systems distribute to providers.
Manning said having this information is crucial to providing care in “a stressful, high-acuity situation.”
“It’s especially important in places like rural communities that may see these situations very infrequently,” she said. “We call these ‘never events,’ but they occur, and if they only occur once every two years, that staff is not well-versed in how to take care of that maternal emergency.”
UAMS offers the option of terminating a pregnancy only “in cases of severe maternal morbidity,” and those severe cases are usually “clear-cut,” Manning said.
“I don’t think anyone’s going to let a mom’s health get compromised in a waiting game,” she said.
Doctors, patients, risk managers and hospital attorneys must be fully informed of what’s happening in an emergency situation to ensure both compliance with state law and proper health care for the patient, Manning said.
“It takes a high level of health literacy to understand where your risks are, and unfortunately we live in a largely rural state where health literacy is difficult,” she said.
