Improving pregnancy outcomes through health policy: The Arkansas Women's Health Waiver

The Arkansas Women's Health Waiver (WHW) is a policy initiative designed to improve access to family-planning services and pregnancy outcomes for women with incomes at or below 200% of the Federal Poverty Level. The Arkansas waiver is cost-effective. Activities in the most recent report year are estimated to have saved the state $86 million. It has also resulted in improved birth spacing and maternal age at first birth to Waiver women. The purpose of this study was to analyze preventive care and birth outcomes for Waiver women compared to non-Waiver women. The sample included all women participating in the 2005 Arkansas Pregnancy Risk Assessment and Monitoring System (PRAMS) survey (n=2,809). Linking a subset of WHW data with PRAMS data presented a unique opportunity to evaluate the differences between the two groups. Analyses included descriptive statistics, Chi-square analyses with Fisher's Exact Test and two-sample t-tests. We found no significant differences between Waiver and non-Waiver women in gestational age, birth-weight, infant mortality or lack of prenatal care. However, waiver participants were significantly more likely to have heard about folic acid (p<0.001), less likely to have experienced a stillbirth in the most recent delivery (p < 0.05) and more likely to be using birth control after the most recent pregnancy (p< 0.05). Birth intervals for women on the Waiver were somewhat shorter than non-Waiver women but remained well above the recommended interval. In conclusion, the WHW is effectively improving access to family planning services and reducing disparities in birth outcomes for Arkansas women.