Changes to Medicaid being proposed by members of Congress could have a significant effect on women in Arkansas who are of childbearing age, according to a recent report from the Center for Children and Families at Georgetown University.

Arkansas is one of the top 10 states with the highest share of women in rural areas ages 19-44.

Camille Richoux, health policy director of Arkansas Advocates for Children and Families, said Medicaid is the only way many women in the state stay healthy before, during and after pregnancy.

"Medicaid covers nearly half of all births in the rural parts of the state, and 20%, or one in five, women rely on Medicaid for health insurance," Richoux reported. "That is a huge number for women in our state. "

Congress is considering changes to Medicaid that could kick millions of beneficiaries off the health insurance program.

The Georgetown report showed many rural hospitals across the country are closing, creating hospital deserts. Experts said the closures put the health of mothers and babies at risk. Richoux stressed any changes will affect entire communities, not just those insured.

"It could just lead to the further closure of the lifeline of rural hospitals or clinics," Richoux pointed out. "And cuts also indirectly lead to the increases in uncompensated care in these clinics. And the nurses (and) the doctors rely on Medicaid dollars for the workforce."

Joan Alker, executive director of the Georgetown University Center for Children and Families, said while women of childbearing age are more likely to live in metropolitan areas, a higher share of women living in rural communities and small towns are covered by Medicaid.

"Rural communities tend to have lower income than metro areas," Alker underscored. "Medicaid, as important as it is for moms and babies nationwide, is even more important in rural areas and small towns."

Abortion rights advocates in Kentucky are concerned as the Department of Health and Human Services has revoked a policy requiring hospitals to provide abortion care in emergency situations.

Known as the Emergency Medical Treatment and Labor Act, the rule offered federal protection for the procedure, particularly in Kentucky and other red states with near total abortion bans.

Tamarra Wieder, Kentucky state director for Planned Parenthood Alliance Advocates, said stripping away protection will be catastrophic for women in rural counties who already face barriers to care.

"We know in a state like Kentucky that people have already turned up at emergency rooms because of our abortion restrictions," Wieder pointed out. "Doctors have been forced to wait until patients were at life-threatening situations, sepsis, hemorrhage, before they are able to provide care."

According to the National Institutes of Health, pregnancy complications are the fifth-most common reason women of reproductive age visit the emergency room.

Weider added rural communities across the Commonwealth suffer the nation's worst family planning and sexual health outcomes and continue to struggle with access to safe and convenient obstetric and reproductive health care.

"I think it's really important to note that 57% of Kentucky's rural hospitals no longer offer obstetric services, 57%," Weider emphasized.

Kentucky's Human Life Protection Act, passed by lawmakers in 2019, banned all abortions except to save the life of the mother and it went into effect immediately after the Supreme Court overturned Roe v. Wade in 2022. The same year, voters in the Commonwealth rejected a ballot measure which would have amended the state constitution to explicitly deny the right to an abortion.

Arizona doctors have filed a lawsuit to overturn a set of restrictions which they argue interfere with access to abortion care. Arizona voters last year passed Proposition 139 which enshrined the fundamental right to an abortion, up until fetal viability, in the state's constitution.

Gail Deady, senior attorney, Center for Reproductive Rights, which is representing some of the plaintiffs in the case, explained that the abortion rights that were secured because of the measure do not go into effect automatically, and existing laws that limit access must be challenged before they can be struck down under Prop 139.

"This lawsuit is intended to honor the will of the voters and it looks to strike down the most onerous abortion restrictions that are currently on the books in Arizona," she said. "The theory behind this case is that these restrictions do not have any medical basis, they do not make abortions safer."

Deady explained that some of the restrictions include forcing doctors to turn away patients if they suspect a fetal genetic diagnosis is the reason for a patient seeking care, requiring patients to wait at least 24 hours before obtaining abortion care, and banning the use of telehealth for abortion. Mailing abortion pills - like mifepristone - is also prohibited. Conservative, anti-abortion advocates have expressed support for the restrictions, its's unclear if they'll oppose the lawsuit.

Deady argues many Arizonans are facing negative consequences as a result of the laws. She adds that it also means a delay in receiving the care most Arizonans supported last year, and added that Arizona has what she calls a "two-trip" law which requires patients make two separate visits to a clinic.

"Just to hear mandatory, state-scripted information about abortion that often is not medically correct, it spreads misinformation and is designed to make people feel ashamed of the decision that they've made which has now been recognized as a constitutional right in Arizona," she explained.

Deady said her organization is currently advocating for the restrictions to be blocked during litigation. The state attorney generals' office is currently examining the complaint.

Perinatal experts said postpartum depression is more common than most people think and those covered by Medicaid are at higher risk.

Two of every five mothers who give birth in Wisconsin are covered by BadgerCare. Federal data show up to 50% of postpartum depression cases are undiagnosed because of the stigma surrounding symptoms.

Jennifer Davis, chapters and international affiliates director for the nonprofit Postpartum Support International, said the condition presented differently for her after both of her pregnancies with symptoms of overwhelming worry and anxiety after her daughter's birth and depression after having her son.

"Crying at night, almost all the time, regretting this decision, feeling emotionally disconnected, but still outwardly smiling," Davis recounted. "Now I really am back in this place of 'I can't share this. I cannot share that I questioned why I had my son.'"

Federal data show the prevalence of postpartum depression is higher among those on Medicaid with an increased likelihood for treatment in Medicaid expansion states. Wisconsin is one of only two states yet to expand Medicaid coverage, although it recently passed legislation to extend Medicaid postpartum coverage from 60 days to a full year.

Even though up to 85% of women experience mood changes in the first few days to weeks after delivery, postpartum depression and anxiety can take months to emerge and involve symptoms lasting longer than two weeks that interfere with daily life.

Jennifer Davis noted she suffered alone after both of her pregnancies but found hope in connecting with like-minded people though Postpartum Support International.

"The weight that lifted off of me first, just knowing that other people are going through this and I am not alone," Davis explained. "Even though we don't talk about it a lot, this is very normal, and that there are so many ways and strategies that you can seek help and support when you are in the midst of it."

Wendy Davis, president and CEO of Postpartum Support International, said even if people are not comfortable speaking with their family, friends or providers, they can utilize resources such as the nonprofit's helpline to get connected with volunteers and resources in their community.

"One thing we know for sure is that families and even health care providers don't know enough about the resources," Davis observed. "That doesn't help a new mom who doesn't even know she has something called postpartum depression or that she could reach out and get support for free."

Common signs of postpartum depression include anxiety, sadness, anger and irritability, difficulty sleeping, and intrusive thoughts, which can include thoughts of harming your baby. Research shows a 98% recovery rate with treatment.


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