29-04-2025
As maternal mortality rises, SC report suggests ways of increasing health care access
Lisa Waddell, chair of a task force that evaluated maternal mortality and solutions, speaks to reporters at SCETV on Tuesday, April 29, 2025. (Photo by Skylar Laird/SC Daily Gazette)
COLUMBIA — The rate at which South Carolina women died because of pregnancy complications spiked in 2021, following years of decline, according to an analysis of the most recent data released Tuesday.
More rural health care, group doctor's appointments and telehealth could help reduce the number of health issues women experience during and after pregnancy, suggests a report by the South Carolina Institute of Medicine and Public Health.
Better and more accessible health care could have prevented nearly 90% of pregnancy-related deaths in 2021, the latest year evaluated, the report found.
'We know that we have an infant and maternal mortality crisis in our state,' said Lisa Waddell, chair of the taskforce that wrote the report. 'Moms are dying unnecessarily. Infants continue to die and don't survive until their first year of life. And there are things that we can do.'
In 2021, 47 of every 100,000 live births in the state resulted in the mother's deaths before, during or after delivery, according to a state committee's analysis. The data consistently lags about three years.
For Black women, that ratio was nearly 72 for every 100,000 births. For white women, it was about 37.
That's an increase from 2020, when the statewide maternal mortality rate was 32 for every 100,000 births. While maternal mortality rates for Black mothers steadily increased for at least four years, the rate for white mothers dropped from 2018 to 2020 before spiking again in 2021, according to committee data.
The exact reasons why are not clear because so many factors play into maternal mortality, said Maya Pack, executive director of the Institute of Medicine and Public Health. But it seems like spikes in COVID-19, which complicated risk factors already associated with pregnancy, contributed to the increase, Waddell said.
Between 2018 and 2021, the No. 1 cause of maternal deaths was infection, specifically from COVID-19, according to the report. Despite emerging in 2020, COVID-19 accounted for nearly 14% of deaths for pregnant women and new mothers during those four years, the report found.
With the virus being less of a concern, the hope is that the ratio of maternal deaths caused by COVID-19 infections has decreased in recent years, Waddell said.
Even in that case, though, the maternal mortality rate remains much higher than it should be, Pack said. For years, the state has consistently scored among the worst in the country for maternal and infant health.
'The persistence of this problem is really troubling,' Pack said.
Part of the problem is that pregnancy often exacerbates a woman's existing health issues. For instance, if a woman has diabetes before becoming pregnant, as about one-third of people in the state do, that can cause life-threatening issues during pregnancy, according to the report.
'If we could promote healthier lifestyles and healthier communities throughout our state at all times, the women who are going to become pregnant are going to be more likely to be healthy and therefore have a healthier pregnancy and have a healthier baby,' Pack said.
Women in rural areas, where health care is less accessible, are especially at risk, the report found.
Some women must travel upwards of an hour to reach the closest birthing hospital or obstetrician and gynecologist. Since 2012, 13 labor and delivery units have closed in the state, and about one quarter of hospitals don't offer obstetric care, according to the report.
'The farther a woman travels to their birthing hospital, the greater the risk of maternal morbidity outcomes,' the report states.
Women in rural areas are also less likely to have health insurance and to be able to afford prenatal and postpartum care. That translates to less revenue for the medical services that do exist in rural areas, causing fewer to locate there and worsening the problem, according to the report.
Health issues for rural women often come at a high cost to the state. Rural women are more likely to use Medicaid to pay for health care services, with the state-funded health insurance covering 71% of rural deliveries compared to 60% statewide, according to the report.
Increased Medicaid costs for maternal health, especially for emergency services on which women in rural areas often rely, amounted to about $357 million in 2019, according to the report.
'This is a great state to live in, but we need to ensure that our mothers are safe, that our infants are surviving,' Waddell said. 'Anything less than that is not OK.'
Some solutions are already in place to help pregnant women and new mothers access health care.
In January, the state Medicaid agency received a $17 million grant, to be handed out over the coming decade, 'to invest in improving maternal health care for South Carolinians enrolled in the Health Connections Medicaid program,' according to the report.
The Department of Public Health is expected to launch mobile maternal health clinics over the summer in an effort to help reach women in rural areas without other nearby care.
Expanding programs already in place could address part of the problem, Pack said. Some programs have seen good results but operate only in specific cities or counties, she said.
Those organizations could also use more resources to increase awareness of services for mothers who may not know they have other options, she said.
'Understanding the resources available to one's family at the community level is a big part of that health literacy,' Pack said.
Even as health professionals faced rising maternal mortality rates, the prevalence of programs trying to address the problems give researchers hope, they said Tuesday. That shows people are aware of the problem and trying to help, Waddell said.
Still, there's more to be done. The report makes a dozen recommendations to help increase access to care, bolster the health care workforce and teach both doctors and patients more about maternal care, including other risk factors, such as mental health and substance use issues.
For instance, a grant program similar to the one the state's Medicaid agency used to encourage hospitals to open more behavioral health care units could similarly increase maternal care in areas that need it, according to the report.
Group prenatal classes could encourage women to keep up with their appointments and be more engaged with their care. Opening maternal-specific care units in existing public health departments could create more access, even if it's somewhat limited, the report suggests.
Dedicated transportation systems could help rural women reach health care providers, while more telehealth could allow women in rural areas to chat with their doctors without having to find a way to get to the office, the report suggests.
'All of these various programs that are being recommended will make a difference,' Waddell said. 'I'm convinced that they will. We've got a lot of energy, optimism and excitement around really wanting to do things that are better for women and infants in our state, and I'm convinced that this report will help.'
