HJAR May/Jun 2025

Editor’s Note: In the face of Arkansas’s persistently highmaternal and infant mortality rates, a newly published open-access study from the University of Arkansas for Medical Sciences offers sobering insights — and a clear call to action. This research, led by Pearl McElfish, PhD, MBA, and a multidisciplinary team of Arkansas-based scholars and clinicians, examines the first divide in health outcomes — prenatal care utilization — across nearly a decade of births in the state. “Sociodemographic factors associated with prenatal care utilization in Arkansas” originally published in Preventive Medicine Reports, reveals striking disparities in access and timing of care, particularly among Black mothers, Native Hawaiian and Pacific Islander mothers, Medicaid recipients, and those living in rural areas. When we reached out to Dr. McElfish for additional context, she emphasized several evidence-based policy solutions Arkansas should consider, including: • Implementing presumptive eligibility for pregnancy Medicaid to ensure timely access to care. • Expanding reimbursement for community health workers and doulas, who have been shown to bridge gaps in care and build trust. • Revisiting Arkansas’s bundled payment structure for prenatal care, which currently disincentivizes early and frequent visits. • Investing in mobile clinics, group prenatal care and culturally responsive outreach — particularly to the NHPI community, which reported the lowest rates of prenatal care in the study. In a state where 41% of births are covered by Medicaid, and where geography, race and poverty intersect in ways that threaten maternal and infant health, the question isn’t whether we can afford to act — but whether we can afford not to. THE FIRST DIVIDE: Prenatal Care Utilization Disparities HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2025 9