Title V program activities are supported through a wide range of MCH data and information systems, including surveys, surveillance systems, and partner data r0esources. Many activities were described in the MCH Epidemiology Workforce Section and SSDI Section of this application. This narrative describes data enhancing partnerships and activities in greater depth.

The ADH’s Health Statistics Branch (HSB) houses the Vital Statistics Section, where vital records such as birth, death, fetal death, marriages, and divorce data are maintained and analyzed, shared with partners, and submitted to CDC for national reporting. Vital statistics are a crucial component to monitoring trends in births, maternal deaths, fetal and infant deaths, and hospitalizations. Vital records data contribute greatly to understanding changing priority needs for the five domains and are used to report progress in achieving Title V NPM, SPM, and ESM annual objectives. Preterm birth rates, very low birthweight births at hospitals with a Level III or greater NICU, infant mortality, and other measures utilize vital records data. As stated, the Family Health Branch and HSB have established a data-sharing use agreement in which individual-level data are made available to the MCH epidemiologist for the Title V grant application and annual report. Limited provisional data sets are available upon request. Arkansas continues its efforts to mobilize partners to reduce infant mortality in the state, and the Memorandum of Agreement allows the raw data to be used to support these efforts.

HSB also houses the Survey Section, where BRFSS and PRAMS staff are located. Within the Epidemiology Branch, the MCH epidemiologist belongs to the Chronic Disease Epidemiology Section, along with epidemiologists working with programs addressing chronic diseases (e.g., tobacco use, cancer registry, cancer screening and prevention, diabetes, stroke, and hypertension), oral health, and other MCH-related programs such as WIC and Arkansas’s Nurse-Family Partnership home visiting program. The Chronic Disease Epidemiology Section has had a long-lasting relationship with the HSB’s BRFSS and PRAMS programs. For Title V grant activities, both surveys provide data on general women’s health and ante-, intra-, and post-partum maternal behaviors, beliefs, health care services, and education. Data on general preventive medical visits, breastfeeding, safe sleep practices and related education efforts have been essential. In 2019 and 2021, the Family Health Branch sponsored the BRFSS Family Planning module to better understand contraceptive use and reasons for not using contraceptives among women of reproductive ages. The Family Health Branch also partnered with PRAMS staff to receive CDC supplemental funding to add COVID-19-related questions to the PRAMS questionnaire (see the MCH Epidemiology Workforce Section for additional details).

In response to the COVID-19 pandemic, the ADH developed a surveillance system linking reported cases from hospitals, clinics, schools, and other sources with laboratory data. The MCH epidemiologist used this real-time data to identify cases for the Arkansas COVID-19 Pregnant Women and Infants Registry. The Registry seeks to identify women infected with the SARS-CoV-2 virus during pregnancy, collect information on their disease progression (i.e., exposure, symptoms, hospitalization, and treatment), prenatal care, birth outcome, and the infant’s development up to six months of age. A contracted team of abstractors obtain information from hospital and clinic medical charts, and data are submitted to CDC monthly. Another component of this grant is to share information and data findings with MCH health care professionals in the state.

Childhood obesity is one of Title V’s priority areas. Arkansas has the ninth highest obesity rate among adults (America’s Health Rankings Annual Report, 2021) and the third highest obesity rate among high school students (CDC Youth Online, 2019). The Arkansas General Assembly passed Act 1220 of 2003, requiring every public school student to have a biannual body mass index (BMI) assessment performed and reported confidentially to their parents. Currently, this includes students in grades K, 2, 4, 6, 8, and 10. The Family Health Branch contracts with the Arkansas Center for Health Improvement (ACHI) to produce an annual statewide BMI statistical report, which is used to inform state, local, and school district program planning and evaluation and to monitor and evaluate activities related to Title V obesity related NPMs and ESMs. The report is posted online and distributed to partners.

The Family Health Branch, Health Statistics Branch, and Epidemiology Branch receive requests for MCH data from legislators, media, partners, students, and other internal and external parties. The program and MCH epidemiologist attempt to respond to data requests in a timely manner. In cases where reports or products are generated for the public or sensitive data are requested such as for small sub-populations (i.e., geographic, race/ethnic, etc.) or requests involving low counts or rates based on small numbers, data must go through a rigorous Epidemiology Branch review process. Products and responses are checked for accuracy, reliability, content, formatting, and other features by another epidemiologist. Afterwards, the product will be reviewed by the Chronic Disease Epidemiology Section Chief, the Epidemiology Branch Chief, the Center for Public Health Practice (CPHP) Science Officer, and the CPHP Director. If some instances, review and approval may be required by the ADH Science Officer and the ADH Science Advisory Committee.

One of the key challenges to obtaining and using MCH-relevant data has been access to Medicaid and prescription drug data. Recently, the ADH and the Arkansas Department of Human Services Division of Medical Services entered into a data-sharing agreement for access to Medicaid data. Medicaid claims data will be used to assess and monitor Medicaid female beneficiaries’ annual preventive visits, dental services accessed during pregnancy, and births paid for by Medicaid. Arkansas’s Maternal Mortality Review Committee (AMMRC) is now working with Medicaid to access and link individual-level claims data to identify points of care and circumstances surrounding maternal deaths. Similarly, AMMRC is collaborating with the state’s Prescription Drug Monitoring Program (PDMP) to seek legislative updates that would allow linkage of maternal death cases to PDMP data. AMMRC data indicate that substance use contributed to one in four pregnancy-related deaths in Arkansas. The AMMRC seeks to use the data to better understand the utilization of health care services and to make recommendations to reduce maternal deaths in the state.  

Another challenge to utilizing data for MCH program planning and sharing with MCH partners has been how to handle small numbers. The agency seeks to protect confidentiality and to ensure the release of accurate and reliable counts and statistics (e.g., rates and percentages) while providing programs and partners with the data necessary to adequately inform state and local activity planning and evaluation.