HJAR May/Jun 2025

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2025 15 = 1.05, 95 % CI [1.00, 1.10]) and reported fewer prenatal care visits (ARR = 0.99, 95 % CI [0.97, 1.00]; Table 4). After adjusting for covariates, there were no significant differ- ences in having no prenatal care utilization or having fewer than the recommended number of prenatal care visits between individuals living in urban and rural areas. 4. DISCUSSION Early and adequate prenatal care utiliza- tion has consistently been demonstrated to improve health outcomes for both mothers and babies (Partridge et al., 2012; Moaddab et al., 2016). This study used Arkansas birth records to examine if sociodemographic (payer, race/ethnicity, rural/urban resi- dence) factors were associated with prena- tal care utilization. Mothers whose births were paid by Medicaid reported fewer pre- natal care visits overall, were more likely to have fewer than the recommended num- ber of prenatal care visits, were less likely to have early prenatal care, and were more likely to have no prenatal care at all. Preg- nant women in Arkansas are eligible for Medicaid if their household income is at or below 214 % of the federal poverty limit (Healthinsurance.org, 2024). Although this study does not examine why Medicaid was associated with significantly less prenatal care utilization, several policies and prac- tices may contribute. Arkansas did not have presumptive Medicaid during the period analyzed, which means women must wait until their Medicaid application is complete and approved to utilize prenatal care. Many health care providers will not see a patient until their Medicaid is approved (Bellerose et al., 2022). Some studies have shown an increase in early prenatal care after imple- menting presumptive eligibility (Eliason and Daw, 2022). Furthermore, many health care providers limit the number of Medic- aid patients they will take, and patients may have to make several attempts to find a pro- vider and schedule an appointment (Bel- lerose et al., 2022). In addition, during the study period, Arkansas Medicaid utilized a bundled payment approach for perinatal care, reducing financial incentive for more prenatal care visits or for seeing women early in their pregnancy (Arkansas Perina- tal Episode of Care, 2021). Because Medicaid eligibility is based on income, individuals on Medicaid have lower household incomes, and they may face other barriers to prena- tal care utilization such as lower health lit- eracy and challenges with transportation and childcare (Bellerose et al., 2022). Prenatal care utilization also varied based on race/ethnicity. The total number of pre- natal care visits was lower for all racial/ ethnic groups relative to white women. The largest differences were found for NHPI mothers, who reported almost half the num- ber of visits compared to white mothers. Both Black and NHPI mothers were more likely to have no prenatal care at all, with NHPI mothers being four times more likely to receive no prenatal care. Interestingly, Hispanic mothers were less likely to have no prenatal care comparted to white women. All racially and ethnically minoritized groups were more likely to have late initi- ation of prenatal care, and all racially and ethnically minoritized groups (except for AIAN) were more likely to have fewer than the recommended number of prenatal care visits compared to white mothers, with the greatest difference between NHPI and white mothers. These findings are consistent with the limited literature examining fac- tors associated with prenatal care utilization which have documented disparities among Black and Hispanic populations (Moaddab et al., 2016; Green, 2018). This article provides new information documenting disparities in prenatal care utilization among AIAN, Asian, multiracial, and NHPI mothers, who have largely been left out of the literature on maternal health. Many NHPI in Arkansas are Compact of FreeAssociation Migrants from the Repub- lic of the Marshall Islands. Prior qualitative research with Marshallese Pacific Islander