The S.C. League of Women Voters hosted a virtual panel from the Alliance for a Healthier South Carolina (AHSC), the state Department of Health and Environmental Control (DHEC), Charleston Birth Place (CBP) and the Medical University of South Carolina (MUSC) Thursday night to share data and experiences related to maternal health. Nearly 400 virtual guests attended. 

“In recent years, and maybe a lot of this can be attributed to Covid, we’ve seen infant mortality rates start to rise,” Monty Robertson, executive director of AHSC, said during the webinar. “Black moms and babies are not doing as well. This is really an urgent issue, and we have to figure out why we are seeing these disparities that exist today.” 

Scary data

The conversation follows the 2022 March of Dimes Report Card, released late last year, which gave the U.S. a D+ in maternal health. South Carolina received an F. According to the report, South Carolina’s preterm birth rate has steadily climbed since 2014, increasing from 10.8% to 12.1% statewide in 2021. The nationwide rate in 2021 was 10.5%.

South Carolina also has a rate of 6.5 infant deaths per 1,000 live births, above the national average of 5.4, according to the report. And that number increased 12.3% by 2021, said Kristen Shealy, deputy director of DHEC’s Bureau of Maternal and Child Health. Furthermore, it’s twice as high for Black women compared to White, she said. Similarly, rural counties made up 14 of the top 15 counties for highest IMR in 2021. 

And there are other areas in which women face discrimination too, said Dr. Eugene Chang, a maternal and fetal medicine specialist at MUSC.

“Discrimination is often thought of as just a racial issue, but being part of the maternal mortality review committee has really opened my eyes,” he said during Thursday’s webinar. “There’s a lot of different discriminations to include — substance abuse and special needs are two of the most prevalent.” 

One of the biggest factors in maternal and infant care, however, is prenatal care, the experts agreed. According to the March of Dimes report, 18% of pregnant South Carolina women in 2021 did not receive adequate prenatal care, which is defined by the percentage of women who receive less than 50% the appropriate number of visits for the infant’s gestational age or who did not receive care until the fifth month of pregnancy or later. 

Preventable deaths

According to DHEC, more than four of every five pregnancy-related deaths in 2019 were preventable. Prenatal care can and should cover a wide range of complications before they arise, Shealy said. 

“Pre-pregnancy and prenatal care is important to see health care providers and manage health concerns prior to pregnancy,” she said in the webinar. “Mental health can be addressed early … particularly substance abuse.” 

Robertson said prenatal care often gets overlooked because the issues are not clinical.

“We’re going to have to go beyond just the clinical care we provide to women,” he said. “Clinical care only accounts for about 20% of our health. Other issues like diet, exercise, smoking, all of these health behaviors are about 30% of health outcomes. The rest — most of your health is really attributed to those social and economic factors. … Those are the issues really driving the poor outcomes we see today.”

Doulas and midwives can cover some of those issues, said Lesly Rathbun, a nurse practitioner and midwife and director of CBP. 

“Many health care providers are unsure what midwives do, where their training and qualifications are, or that their outcomes are so stellar compared to traditional health care in the U.S.,” she said in Thursday’s webinar. “Doulas do not provide health care — they are labor support, emotional and physical. Studies show they are very beneficial, and we’ve seen a big push for doula care in South Carolina.” 

Rathbun said low pay, low opportunities and legislative restrictions make it difficult for doulas and midwives to practice in the Palmetto State.

Chang said there are several opportunities in several areas to address concerns and inequities in maternal health, but none are “low-hanging fruit,” he said. 

Skyler Baldwin is a reporter for the Charleston City Paper.

Recording of program on Zoom:   Maternal Health on Decline in SC