Arkansas calls itself the ‘most pro-life state.’ But moms there keep dying.

WARREN, Ark. - The pregnant teen had already picked out a name for her baby, already felt him kick, which made the sight of blood in her underwear all the more frightening as she was getting ready for bed that fall night.

Her mother, Ronica Lawson, called for an ambulance to take them to the hospital five minutes away. As the sirens blared and the EMTs tried to reassure 15-year-old Sa’Ryiah Lincoln, bad news crackled out of the radio. Head to the next county, the EMTs were told. The local hospital no longer delivered babies.

In a state that touts itself as “the most pro-life state in the country,” where abortion is prohibited except to save the life of the mother, timber country in southeast Arkansas is an especially dangerous place to give birth.

Arkansas already has one of the nation’s worst maternal mortality rates, and mothers in this area die at a rate exceeding the state average. Ninety-two percent of recent maternal deaths were preventable, a state review committee found.

In November, two hospitals in the region abruptly closed their birthing units, sending patients like Sa’Ryiah scrambling to find a new obstetrician. And now she was in an ambulance at midnight, speeding through dark pine forests on a tense half-hour trip to a bigger hospital. Doctors were able to get her stabilized and eventually sent her home.

With a ride that long, “anything could have happened,” said Hajime White, one of the teen’s doulas. “When hospitals are turning you away and you have to go on to the next one, any complication can develop whether you’re in an ambulance or not. You’re putting the mother at risk and the baby at risk.”

Since Arkansas banned nearly all abortions after Roe v. Wade was overturned in 2022, doctors and others have sounded the alarm on what they say is a deepening crisis in maternal health. They point to other markers, too, particularly the state’s very high rates of teen pregnancy, infant mortality and food insecurity.

“If we really say to the world we’re pro-life, we need to put our money where our mouth is and make sure these women are treated and have the care they need,” said Republican state Rep. Aaron Pilkington, an abortion opponent who has led a push for legislation and funding to improve outcomes.

This spring, facing pressure from business leaders and the medical community, Republican Gov. Sarah Huckabee Sanders launched an initiative to address maternal health, an issue that she acknowledged “we’ve ignored for far too long.” Yet she declined to support extending Medicaid postpartum coverage to a year from 60 days, saying the state’s existing insurance system was enough. Arkansas will soon be one of only two states not adopting such coverage.

In Warren, White met the news of possible assistance with skepticism. In addition to her work as a doula, she runs a local network for expectant moms. She founded Precious Jewels Birthing Project in 2015 but has struggled to find resources to offer car seats, diapers and other basics.

“We’re on our own,” said White, who is 50 and often teams with her 24-year-old daughter, Gwen, also a doula. “We’re the main ones that’s actually dying out here, and no one really understands.”

You good? How you feelin’? White asked as Sa’Ryiah waited for a checkup with her new doctor earlier this year.

“Tired,” the teen answered, shifting awkwardly in her chair. Her loose black hoodie nearly obscured her belly. “Really ready for this to all be over.”

“Aren’t we all?” her mother said.

The three, plus White’s daughter, were sitting in the crowded waiting room of Mainline Health, a federally supported health clinic about 30 minutes from Warren. Posters of chubby babies decorated the walls.

Sa’Ryiah ended up here for prenatal care after Bradley County Medical Center, the facility that serves Warren, shut down its labor and delivery service. It was another painful loss for this rural area, where lumber jobs have dried up and tomato farms have disappeared in recent years. The majority White county, with a population of about 10,100, has lower levels of education and income and a higher share of uninsured people than the state average, data shows.

Many expectant moms already were driving miles for their appointments. Now they flooded Mainline’s clinic - so many that a new staff hired to do home visits saw individual caseloads quadruple. Sa’Ryiah’s obstetrician, Constance Chapman, had delivered 30 babies in February, more than one a day.

Sa’Ryiah emerged from her checkup with a wide smile.

“How much did you weigh?” her mother asked.

“I gained three pounds,” she said. “The doctor said I have to come every week now.”

She was far enough along now for her son to be out of danger if she suddenly went into labor, Gwen assured her. “If you want to have this baby, you can have him,” she said.

Both White and Gwen were relieved that Sa’Ryiah had reached this milestone. The teen’s pregnancy had been difficult, with two episodes of bleeding and emotional turmoil. Things at school were not going well. Friends had abandoned her. Another classmate pushed her to the ground outside school, kneed her in the belly and accused her of not actually being pregnant.

And the baby’s father? “In the beginning he supported me,” Sa’Ryiah said. “But … feelings change.”

Though teen birth rates are falling nationally, federal data shows the statistic for Arkansas is almost twice the U.S. average. Lack of access to contraception is a major factor; the rate at which teens in Arkansas have unprotected sex is 75 percent higher, according to a report from the nonprofit Arkansas Advocates for Children and Families.

Lawmakers generally have made it harder for teens to get birth control, the advocacy group’s report noted. School-based clinics need parental consent and can’t use state funds to provide contraceptives. The state does not require sex education in schools - if taught, lessons must stress abstinence - but an hour of adoption awareness instruction is mandated for grades six through 12. Topics to be covered include “the reasons adoption is preferable to abortion.”

In a recent public forum, when a moderator raised the “controversial” topic of sex ed, Arkansas’ education secretary, Jacob Oliva, replied that the state will be reviewing its health education standards. “Are they robust?” he said. “Are they doing a good job?” He said about 600 teen moms are in Arkansas schools every year. “Is that a number or metric we think is too high or too low? Those are some of the questions we need to ask.”

Last summer was when Sa’Ryiah began spending a lot of time outside with other kids - particularly one teen boy - in her neighborhood of drab public housing duplexes. Her mother noticed and was determined to get her a long-acting contraceptive implant, but said she could not find a doctor locally to do the procedure. She finally took Sa’Ryiah to Little Rock - 180 miles round-trip. At a hospital there, she learned that her daughter was already seven weeks pregnant.

This was not welcome news for the teen, who was “terrified,” or for Lawson, who has two younger children, was in the midst of a divorce, had a broken-down car stacked on cinder blocks in her driveway, and was struggling to pick up shifts at the soul food restaurant where she was a manager.

“I was mad, her being so young,” Lawson said. She had gotten pregnant with Sa’Ryiah as a teen and didn’t know how to cope when she suffered crippling postpartum depression. That was not going to happen this time, she vowed.

She sought out White and Gwen, who signed on to be Sa’Ryiah’s doulas and serve as a sounding board for the girl’s questions - What kind of vitamins should I take? Is spotting normal? - as well as offer mental health support. They would calm her during anxiety attacks - to keep her asthma from flaring, which would decrease oxygen to the fetus - and coax her to go on walks on Fridays after school.

With an infant tucked under one arm, the governor in March signed an “Executive Order to Support Moms, Protect Babies and Improve Maternal Health.” E.O. 24-03 hailed Arkansas as “the most pro-life state in the country.” Sanders’s administration has embraced that distinction since Americans United for Life, an antiabortion group based in Washington, first bestowed the title three years ago. Its rankings reflect “states’ protection of life from conception to natural death,” with a strong focus on abortion.

Arkansas has taken some measures aimed at improving maternal health, planning a midwife certification program at the University of Arkansas for Medical Sciences and requiring Medicaid to cover long-acting contraception for postpartum mothers.

Other efforts have lagged. Officials hoped to have hospitals throughout the state run home-visit programs for at-risk mothers. Only four have been approved, with one expected to launch before the year ends.

While Sanders didn’t endorse expanded postpartum coverage through Medicaid, she has said she wants to do a better job of educating women before and after giving birth about existing resources and insurance options.

“The solution is not more government programs. The solution is getting women to take advantage of the programs we already have,” she said in issuing her directive. Advocates worry that her overall focus on cutting taxes signals that she may not be willing to fund any significant projects associated with reproductive health. A special panel is expected to give Sanders its recommendations next month.

Ninety miles south of the capital, White caught up on the governor’s news on her battered laptop at the secondhand appliance store she runs with her husband of more than 30 years, Wayne, a veteran and school bus driver. They’re well-known civic boosters in Warren, where they raised their six girls.

“She said there’s resources. Where are the resources?” White said as she read about Sanders’s announcement.

The room smelled like motor oil and rubber, and the front door chirped as customers stopped in for lawn mowers and spare parts. Even at midday, her eyes were bleary from fatigue. She works remotely overnight as a resolution specialist coordinating repairs for Walmart stores and otherwise maintains a fitful sleep schedule to be available if a mom in distress calls.

Over the years she has helped more than two dozen women through their pregnancies. These days she also counts on 10 “sister-friend” volunteers, deputized as part of the Precious Jewels birthing network to mentor new moms.

Yet White, who holds a degree in early-childhood education, has struggled to get broader support. She says she tried to start a food pantry for mothers-to-be and was told by the regional food bank that there already were enough food programs in town. And she says she has been passed over for public and private grants. She looked into becoming a state-certified car-seat specialist, but the training was too far away.

Ultimately, she bought a “tiny house” that she aims to turn into a center for new moms. It’s parked by the shop, empty but for a lone package of diapers.

Another idea: celebrating the first year of life for the infants and mothers in her program. She planned a community baby shower and “graduation,” even ordering tiny graduation caps and gowns online. Then she drove around town to post fliers and ask for support from local stores. The manager at SuperValu would, she hoped, be among those to say yes.

“If Doug could donate that would be great,” she told a cashier. “Could he call me?”

On the way home, White passed HopePlace Warren, a small brick building that houses a Christian-based pregnancy counseling center. She follows it on Facebook and is often pained to see that it has money to do the things she wants to do, like hold parenting classes. A flashing message board out front, advertising free car seats, always rankles.

Since the state’s abortion ban took effect, Arkansas has given $2 million to similar crisis centers, many of them faith-based, and the legislature recently authorized another $2 million for this fiscal year. HopePlace Warren relies on private contributions, but a HopePlace center founded by the same woman in the nearby town of Monticello has received $68,000 from the state in the last two years.

Just as Sanders unveiled her maternal health-care plan, Sa’Ryiah’s blood pressure was rising. The teen was still days from her due date, but her doctor decided to induce because of her risk of developing preeclampsia, a condition that can lead to serious, even fatal complications.

Baby Kaydence slipped into the world at 4:59 p.m. on March 7 - 7 pounds, 4 ounces, with a full head of hair.

At the hospital - the bigger one in Monticello - the nurses held him up, still covered in blood and amniotic fluid. “So slimy,” Sa’Ryiah thought. She wasn’t sure if she wanted to hold him. Later, though, after they cleaned him and laid him on her chest, she cried.

Kaydence’s safe arrival was the first real victory for White after a year of disappointments and grief.

The previous winter, a Warren woman named Megan Patterson died shortly after having her fifth child. Patterson, 32, had experienced swelling that persisted after she went home from the hospital.

“She should never have been discharged,” said her mother, Patsy Newton. The death certificate listed acute respiratory failure, with obesity and heart and chronic kidney disease as contributing factors. Officials at the facility where she gave birth, now called Baptist Health Medical Center-Drew County, declined to comment.

White hadn’t been involved in Patterson’s prenatal care. Even so, she was devastated by her death. In tears, she called her mentor at the organization where she’d trained as a doula.

“I boohooed,” she said. “I felt helpless. I wish somebody would have reached out to me and I might could have helped her. Maybe she would have still been here.”

Obstetrician Kara Worley, who has worked at each of the local hospitals that shuttered their delivery units, says women such as Patterson require complex care.

“I can’t remember the last time I had a patient come in healthy, young, with no medical problems and have a baby and go home,” Worley said. Those she sees routinely suffer chronic health problems, from heart conditions and undiagnosed diabetes to morbid obesity. She says change will take generations.

Worley and reproductive health advocates believe the state’s abortion ban has hurt hospitals’ ability to recruit and retain obstetricians at a time when the number of facilities delivering babies has dropped from 39 in 2020 to 35 today. Nearly half of the counties in Arkansas now lack a hospital or birth center offering obstetric care.

“From where I stand, (lawmakers) haven’t done anything except make it harder to care for the patient,” she said, recounting a case in which she was required to do unnecessary testing that delayed treatment. The patient had an ectopic pregnancy - which ruptured and required emergency surgery, she said.

At the 25-bed Bradley County Medical Center, chief executive Leslie Huitt closed the delivery unit after it dwindled to just one full-time family practice obstetrician. A study showed that the unit was losing $1 million annually. No state aid was available, Huitt said, and she found no partners to apply for a federal grant.

The decision was all the more painful since Huitt had given birth to her three children there.

“Maternal care in Arkansas is starting to be a hot topic,” she said this spring. “But we couldn’t get the attention and help we needed fast enough to save us. Ultimately it was a question of do we want an OB unit, or do we want a hospital at all?”

White was about to turn 16 when she arrived at this same hospital one night long ago, toting two teddy bears and a teddy bear nightgown. She’d begun dating Wayne two years before and gotten pregnant. But a few days earlier, during what she expected to be a regular prenatal exam, she had suddenly heard the fetal heartbeat stop. Her doctor soon confirmed that the baby did not have a fully formed brain.

She was left alone by medical staff for much of the excruciating labor that followed, with Wayne finally allowed in the room just before their son arrived. Over his motionless body, she asked Wayne, “What should we name him?” They settled on Jonathan Ali.

More than three decades later, the birthing ward’s demise was personally wrenching.

“It feels like tumbleweeds are coming through town,” White said. “When things you grew up with and are familiar with leave in the blink of an eye, it’s almost like a death.”

At the baby shower and graduation ceremony, White filled a community room at the housing authority with purple and white balloons. The mayor and several reproductive health advocates came, and White counted 22 adults and little ones by the end. Though some of the moms who’d promised to attend were absent, White considered the event a success.

Not long after, she stopped by Lawson’s to check on Sa’Ryiah and the baby. The last few weeks had not been easy on the new mom. When Kaydence cried, she cried. Gwen had come more than once to try to calm them both and teach Sa’Ryiah how to properly swaddle.

White cooed over the infant and then gave Sa’Ryiah two small glass jars. They held the remnants of her placenta, which the doula had dried, ground into a powder and packed into capsules - a practice of traditional medicine that some believe has health benefits for mother and baby.

“Now you have your show-and-tell,” she told the astonished teen.

Sa’Ryiah was about to head back to high school, and that was making her anxious. She did not want to leave Kaydence behind and was worried she would again be singled out and bullied. She’d kept up remotely with her schoolwork - World History, English, Survey of Business and a test prep class - and her mother was determined she would graduate. “She’s walking that stage,” Lawson said.

“Don’t let the baby be a hinder to finishing it,” White told her. She had gotten her diploma after becoming pregnant, she said. So had Gwen. “Before you know it, it will be time for you to graduate.”

As it turned out, Sa’Ryiah would not be the only new mom. At her school of about 500 students, the principal said, 12 were pregnant or had just had a baby.

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Dan Keating contributed to this report.