| In November, voters in 10 states will decide whether to amend their state constitutions to guarantee some form of abortion access. But there was supposed to be an eleventh on that list. Let's talk about what happened in Arkansas.
Arkansas is a Republican stronghold; only twice in the past 40 years has the state voted Democratic, and that was because President Bill Clinton had previously been governor. Republicans hold a supermajority in both the state house and senate. Arkansas also has one of the strictest abortion laws in the country. After Roe v. Wade was overturned, Arkansas banned all abortions, with one exception: "to save the life of a pregnant woman in a medical emergency." There are no exceptions for rape, incest, or if the baby will not survive. A citizen-led group called Arkansans for Limited Government (ALG) sought to change that. "We consulted a lot of healthcare professionals and pulled state polling statistics on abortion," says Gennie Diaz, ALG's communications director. The group found, for example, that while the majority of Arkansans support some abortion restrictions, more than 70% of them supported exceptions in cases of rape, incest, when a woman's health was at risk, or in cases of fatal fetal abnormalities. ALG settled on a ballot initiative that would have legalized abortion through the first 18 weeks after fertilization and, after that, allowed for exceptions in those areas. "It's what we thought we could pass," says Diaz.
They then set out to get their initiative on the ballot. It wasn't easy; for one thing, ALG says that national groups such as the ACLU and Planned Parenthood declined to help, saying the 18-week limit was still too restrictive.
On top of that, Arkansas' state legislature has changed the rules by which citizens can bring ballot proposals several times in the last decade, making the process incredibly confusing. Last year, the legislature passed a law that expanded the number of counties from which ballot initiative groups must collect signatures to 50 from 15. (This new law is currently the subject of an ongoing lawsuit filed by the League of Women Voters of Arkansas, which claims it's unconstitutional.)
ALG ultimately collected 101,525 signatures, more than was required, from all of Arkansas' 75 counties. But when they submitted their paperwork, Arkansas' secretary of state denied their request, saying that they'd filed incorrectly. The specifics of what was wrong with the paperwork are incredibly bureaucratic: the issue was whether it was sufficient for ALG to turn in paperwork about its use of paid canvassers early, or if it needed to re-submit it along with the completed submission. ALG sued, saying that they had filed the necessary paperwork, but the Arkansas State Supreme Court upheld the secretary of state's decision. Arkansans will not have an opportunity to affirm or amend their state's near total abortion ban in November.
All of this is happening, mind you, in the state with the highest maternal mortality rates in the US, averaging 43.5 deaths per 100,000 live births between 2018 to 2021, according to the CDC. According to the March of Dimes, 45% of Arkansas counties do not have a hospital that offers obstetrics care or a local OBGYN. As a result, 28% of pregnant women in Arkansas do not have a prenatal appointment until they're already in their second trimester. There are about 120 hospitals in the state but only 34 of them are formally equipped to deliver babies.
"You really would think that the state that has the worst maternal mortality in the country would do anything and everything to bring that down," says Camille Richoux, health policy director for the nonprofit Arkansas Advocates for Children and Families. "And now with the [abortion] ban, we have people who otherwise would not have given birth, giving birth. It's going to get worse. But not much is happening. There's no sense of urgency."
According to the Arkansas Maternal Mortality Review Committee (AMMRC), in the southwest part of the state, the maternal mortality rate is as high as 63.1 per 100,000 live births — higher than in Mexico or Bhutan. Arkansas is also the only state in the US that has not expanded postpartum Medicaid coverage for new mothers from eight weeks to a year. The state does have a way for new mothers losing Medicaid coverage to apply for private insurance through a different state program, but the eligibility requirements are different so some mothers don't qualify. According to a recent KFF report, the application process is onerous and often leads to gaps in coverage — again, right after women have had a baby. According to data compiled by the insurance company UnitedHealth Group, Arkansas ranks last among states for access to postpartum check-ups.
Earlier this year, AMMRC reported that 95% of pregnancy-related deaths in the state were preventable. Furthermore, given that more than half of babies in Arkansas are born to women on Medicaid, and that the most common time when pregnancy-related deaths occurred was between 43 days and a year postpartum, the AMMRC recommended, among other things, that Arkansas expand its postpartum Medicaid coverage for a year to ensure low-income mothers maintain access to healthcare. Arkansas governor Sarah Huckabee Sanders has opposed Medicaid coverage for new mothers. "Creating more coverage doesn't get more women to the doctor," she said when asked about the issue in March.
I reached out to Governor Sanders' office to find out why she doesn't think expanding new mothers' access to Medicaid was necessary. "Governor Sanders isn't interested in headline-grabbing policies or duplicative government programs that don't actually change maternal health outcomes," Sam Dubke, the governor's communication director, said in an e-mailed statement. "Instead, she convened more than 100 stakeholders representing dozens of organizations across Arkansas to craft a comprehensive, coordinated approach that will help healthier moms have healthier babies."
Dubke was referencing a maternal health committee that Sanders created through an executive order earlier this year. Richoux is part of that committee. "I go to the same meetings, with the same people, over and over again," she says. "I'd like to see action, real policy changes. I'm tired of meetings." |
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