When asked how Arkansas adults are doing relative to the trendline data for the indicator, the stakeholders stated the following:

• From 2013 through 2015 the rate remained relatively unchanged
• The rate increased in 2016 and peaked in 2017 at 8.1 deaths per 1,000 births
• The rate decreased from 8.1 in 2017 to 7.4 in 2018
• Regardless of the reduced infant mortality rate in 2018, Arkansas still ranks 4th out of all 50 states

Stakeholders identified the following negative factors that may be contributing to infant mortality in Arkansas.

• Access to care, overall and prenatal care
  • Health care coverage through employers or afffordable care options
• Access to contraception
• Age - births to women less than 20 years old or greater than 40 years old (35 years or older at the time of pregnancy strong correlation for mother and baby)
• Availability to "good" insurance not helping
• Access to OB/GYN - many providers not providing OB/GYN care in smaller communities/maternal care desserts, distance to provider and outcomes. Further they have to drive for appt, the worse they are
• Perinatal deaths - surviving babies during neonatal care going home and lack of support at home
• Black women have higher infant mortality when compared to whites or Latinos. In 2017, the infant mortality rate for blacks was 12.6, compared to 6.9 for whites, and 6.2 for Latinos.
  • Black babies die at greater rates than whites, in part because they have low birth weights twice as often.
• Child abuse and neglect
• Co-morbid conditions occurring in disadvantaged populations - preeclampsia, gestational diabetes, etc.
• Educational attainment - Data suggests that women with less than a 12th grade education face higher risks for infant mortality
• Genetic anomalies - leading cause of infant death
• Health literacy, including understanding the importance of prenatal care
• High stress environment - perhaps stress weathering, increases stress and negative outcomes
• Housing insecurity
• Pregnant women experiencing at least one health problem while pregnant
• Mental health
• Physical health of the mother during pregnancy, including health risks associated with obesity
• Sexual violence leading to pregnancy
• Substance abuse addiction, including smoking cigarettes
• Teenage birth rate
• Unintended pregnancy

Stakeholders identified the following positive factors that may be preventing or reducing infant mortality in Arkansas.

• ACH - worked hard with NICHQ alliance and nurse alliance, working with hospitals
• Decrease of elective deliveries
• Good preventative care early/prenatal care.
• Home visiting program efforts increasing awareness of the importance of prenatal care
• Increased access to LARC
• Increased access to Mirena and Nexplanon.  Dr. Manning secured funding for placing device immediately. Supreme Court issue - overall population has increased information with this issue/misinformation (example: Plan B is NOT illegal).  Governor and other efforts to improve education.  More people now trying to figure out where access is lcoated.
• Mitigating risks posed from unintended pregnancy - elective deliveries and C-sections

Stakeholders identified the following potential partners to strengthen the positive factors or address the negative factors impacting the infant mortality rate in Arkanas.

• Arkansas Children's Hospital - operates the largest NICU in the state and also conducts Infant Death Review; working with local hospitals and communities
• CHW - engage directly with women
• Doulas - true grassroots in communities. example: church - gathering around the family. What is a doula - Where is a doula - Who is the right doula conversation.
• Medicaid
• Pharmacies - connection with provider, encouraging pharmacists to have discussion with providers - can I send this to you?
• Schools
• UAMS

Stakeholders proposed the following potential solutions to strengthen the positive factors or address the negative factors impacting the infant mortality rate in Arkanas.

• Address the lack of physical health knowledge in school
• Engage doulas especially on minority populations and on mental health
• Expand Home Visiting programming as a cost effective way to address adverse childhood experiences (ACES) and other things going on in the home. 
• Implement age appropriate educational tools to increase understanding about physical health for youg women
• Nursery Alliance - work with hospitals to provide standard quality of care. Transition occurs sooner rather than later.
• Offer lottery tickets as incentive to attend appointments
• Preconception Health
• Social determinant code that providers aren't using to bill for Medicaid (Z code 009 series?). Needs to be coded so as to know what to do next.
• Southeast hospitals collaborate and designate one to provide obstetric and gynecological services with support from UAMS (example Stuttgart, DeWitt). Residents assigned a site on a rotating basis, proximity to complicated deliveries. Center provides the telehealth. ANGEL had something like this, but not resident program.  However, residents need to be trained full services.
• Two pregnant women plans through Medicaid. Life360 program. Low income and high risk.
• UAMS NICU - does follow-up care with nurses across the state.

Stakeholders prioritized the following strategies because they ranked highest across four criteria: Impact, Feasibility, Specificity, and Value. 

• Expand telehealth medicine specializing in maternal and infant care, especially in under-resourced parts of the state, that would engage trusted partners such as the AR Children’s Hospital Nursery Alliance or the University of Arkansas for Medical Sciences
• Promote the use of doulas amongst women of color as a cost-effective and culturally responsible form of maternal care
• Utilize and/or scale the use of Home Visiting Program models to increase awareness and understanding about the importance of maternal and infant health and how to access services, particularly in underserved communities

Strategy: Expand telehealth medicine specializing in maternal and infant care, especially in under-resourced parts of the state, that would engage trusted partners such as the AR Children’s Hospital Nursery Alliance or the University of Arkansas for Medical Science.

Strategy: Promote the use of doulas amongst women of color as a cost-effective and culturally responsible form of maternal care.

Strategy: Utilize and/or scale the use of Home Visiting Program models to increase awareness and understanding about the importance of maternal and infant health and how to access services, particularly in underserved communities.