44 SEP / OCT 2023 I HEALTHCARE JOURNAL OF ARKANSAS POLICY COLUMN POLICY A STUDY published in the Journal of the American Medical Association found that maternal deaths in the U.S. rose from 12.7 per 100,000 live births in 1999 to 32.2 per 100,000 live births in 2019, with the greatest increases occurring among Black, Native American, and Alaska Native women. 1 No state is more severely impacted by this crisis than Arkansas. Our state’s maternal mortality rate is 43.5 deaths per 100,000 live births, the highest in the nation, according to a Kaiser Family Foundation analysis of Centers for Disease Control and Prevention data. 2 Arkansas is also the third-worst state, behind Mississippi and Louisiana, for in- fant mortality, with a rate of 7.4 infant deaths per 1,000 live births, according to the CDC. 3 These rankings are not surprising, givenAr- kansas’high rates of chronic conditions such as diabetes, 4 obesity, 5 hypertension, 6 and heart disease 7 — all of which can increase health risks associated with pregnancy and childbirth — but we can and must do better for our mothers and infants. This is not a new problem, but awareness and educational support to parents as they navigate the birthing journey from pregnancy through the postpar- tum period. 4. Safest method of delivery. For most pregnancies, a vaginal delivery is a saf- er method of delivery than a cesarean section, with a lower risk of maternal morbidity and mortality. 5. Family support and bonding. Supports such as parental leave, childcare as- sistance, breastfeeding counseling, and safety education can help newmothers as they adjust to postpartum changes and bond with their children. 6. Depression screening. Mothers should be screened for depression and anxi- ety at least once during pregnancy and again in the first year after deliv- ery. Screening should be coupled with appropriate follow-up and treatment when indicated. 7. Home visits. Home visiting programs provide families with support from trained professionals in the families’ of it is growing. Solving it will require a mul- tifaceted approach that addresses the en- tire birthing journey, from pre-pregnancy through delivery and into the postpartum period. TheArkansas Center for Health Im- provement has identified nine key points on a healthy birthing journey: 1. Pre-pregnancy preparation . This in- cludes health education, planning and access to contraceptives. All of these can help prevent unintended preg- nancies, which have a greater risk of babies being born prematurely or at a low birth weight. 2. Initiation of prenatal care. Prenatal visits should begin in the first trimester. For most pregnancies, visits should oc- cur every four weeks through week 28, then every two weeks though week 36, and weekly thereafter. High-risk preg- nancies require more visits. 3. Education and supports . Prena- tal classes, healthcare providers of choice, and birthing companions such as doulas can provide emotional Addressing Arkansas’ Maternal Mortality Crisis: WHAT A HEALTHY BIRTHING JOURNEY SHOULD LOOK LIKE As one of the wealthiest nations in the world, the United States ought to be one of the safest places to have a baby. Yet while other high-income countries have seen their maternal mortality rates decline in recent decades, maternal mortality in the U.S. has more than doubled since 1999.