CHARLESTON, S.C. (WCBD)- A growing number of women in South Carolina are living without access to maternity care, according to a new map.
The map, released by the University of South Carolina (USC), shows the number of clinics, hospitals, licensed midwives, and other women’s health providers available in the state.
Thousands of women in the state are living in a maternity care desert—an area without a hospital or birth center offering obstetric care and without any obstetric providers.
The map also highlights the inadequacy of maternity care in rural parts of the state. Five counties in South Carolina currently have limited or no pregnancy and childbirth-related health services, including Allendale, Barnwell, Greenwood, Saluda, and Williamsburg counties.
“You’ve got several counties where someone would have to travel more than 30 minutes to an hour to get to a prenatal care provider,” Kathryn Luchok, a senior instructor of women’s and gender studies at USC said.” “It essentially affects all of the rural residents of South Carolina.”
And, the problem of rural healthcare disparities is worsening across the state, according to advocates.
“Our numbers for care deserts is up,” March of Dimes’ Director of Maternal Infant Health for South Carolina Tameca Wilson said. “During the period of COVID, we’ve lost some providers and some practices may have closed in our rural areas.”
Maternity care deserts can contribute to a lack of prenatal care during pregnancy or treatment for pregnancy complications.
A 2022 March of Dimes report found that 18 percent of South Carolina mothers received inadequate prenatal care compared to 14.5 percent nationally.
“Some kinds of problems that might develop during pregnancy can be targeted and addressed during that time,” she said. “So, if you have someone who has missed a lot of those visits, you might miss a problem that’s going to come up in delivery that you weren’t expecting.”
Those regions with fewer services also tend to have lower quality birth outcomes, Luchok said, which includes higher infant and maternal mortality rates.
“A lot of people go in and out of care and they don’t have those [preexisting conditions] well addressed, so they come into pregnancy already at a deficit that makes them more high risk,” “So they’re going to come into delivery perhaps with something major unaddressed that’s going to cause a problem during delivery.”
A DHEC study found that roughly 62% of maternal deaths between 2016 and 2020 in South Carolina were pregnancy-related and that more than two-thirds of those deaths were preventable.
But those results are even starker for women of color who have a maternal mortality rate 2.4 times higher than White women, according to the same study.
“That’s been like a 200-year disparity that has not gotten much better,” Luchok said.
Overall, March of Dimes gave the state an “F” grade for preterm births—a contributing factor to infant mortality. The 2022 infant mortality rate in South Carolina was 6.5 compared to 5.4 nationally.
“If we could make prenatal care very accessible to the maximum number of people in the state, we would probably see better birth outcomes,” Luchok said.
That sentiment is shared by Wilson who said, “Unfortunately, your zip code impacts the health of your baby.”
The disparity can be explained, in part, by the disproportionate access to healthcare and some expectant mothers needing to travel long distances to receive services.
For example, there are no obstetric service providers in Allendale, S.C., meaning a pregnant woman would have to travel at least 15 miles to reach the nearest clinic in Hampton, S.C. Depending on the circumstances, traveling may not be a feasible option for some women.
“If you are in a rural area without care, what else is missing in that area?” Wilson asked. “Is there limited access to food and grocery stores, is transportation a problem, are you an hourly employee which can also make a difference.”
Wilson added that the obstacles force some women to forgo prenatal care and education that would be beneficial for themselves, the baby, and their families.
Lawmakers and advocates pushing for policy changes
The March of Dimes highlights several policy changes which would improve the issue of maternity care deserts across South Carolina, many of which are echoed by Luchok.
One of those solutions would be to expand Medicaid coverage in the state to individuals who fall at or below 138% of the federal poverty level. Nonprofit organization KFF estimates that more than 105,000 uninsured adults in the coverage gap would become eligible if Medicaid was expanded statewide.
“The state has a huge number of births that are covered by Medicaid,” Luchok said. “There’s an extension of the women on income that expands when someone is pregnant, so once someone becomes pregnant, they can get Medicaid even if they weren’t eligible for it prior to their pregnancy.”
The organization also advocates for using alternative birthing services, such as midwives and doulas–who are licensed in South Carolina to carry equipment and medications and are required to have years of training and apprenticeships. The problem, however, is that most are clustered in urban areas and often not covered by insurance.
“A doula can be a person who can help in that education component and that care component just to bridge the gap—not replacing an obstetrics visit but just filling the gap,” Wilson explained. “Nationwide, we’re working on legislation to help make doula care something that is reimbursable so patients can use insurance to pay for this extended care.”
The rural healthcare disparity has also grabbed attention at the Statehouse where lawmakers have touted it as a top priority heading into the 2023 legislative session.
One step to improving healthcare in rural areas, according to S.C. Senate Majority Leader Shane Massey (R-Edgefield), would be to repeal the Certificate of Need requirement for new and expanding facilities across the state.
The Certificate of Need is approved by DHEC and can be challenged by competing for health systems, a process that can take years.
Supporters of the repeal like Sen. Massey believe that process is outdated, but opponents like the South Carolina Hospital Association say it protects rural hospitals and can prevent hospitals from overspending because of competition.
Legislation to repeal the requirement passed the Senate last year but stalled in the House. Sen. Massey said he expects the issue to be taken up again in the Senate again early in the session.
South Carolinians living in maternity care deserts can use the USC map to find services and providers closest to them.