The number of South Carolina infants who died before their first birthday last year increased significantly, new public health data shows.
In 2018, an average 7.2 infants out of every 1,000 born died within 12 months. In 2017, the average rate was 6.5.
The numbers haven't been so high since 2012, when the state's infant mortality rate was 7.6.
The frequency of deaths increased last year, too. In 2018, 406 babies died, up from 371 deaths the year before, according to the S.C. Department of Health and Environmental Control. More than 50,000 babies are born in South Carolina every year.
In 2018, the leading cause of infant death was congenital malformation and deformation, followed by disorders related to short gestation and low birth weight, and accidents.
Each state is required to track infant deaths because infant mortality rates are considered an important indicator of overall public health. South Carolina's rate of 7.2 is considerably higher than the national rate of 5.9. In 2017, Mississippi had the highest rate in the country at 8.6; Massachusetts had the lowest at 3.7, according to the Centers for Disease Control and Prevention.
South Carolina's 2018 infant mortality rate will likely place it among the 10 highest in the country.
"While it is discouraging to see these numbers going in the wrong way," the 10- and 20-year trends "suggest we are doing some things right," said Kimberly Seals, director of DHEC's Bureau of Maternal and Child Health.
In 1999, South Carolina's infant mortality rate was much higher at 10.3.
But 20 years later, some areas of the state haven't seen much improvement. New DHEC data shows 14 of South Carolina's 46 counties have an infant mortality rate of 10 or higher. An investigation published by The Post and Courier in 2015 found that infants in some rural South Carolina counties are dying at rates similar to the developing world.
The picture looks even worse for black infants in South Carolina, who died at a rate more than twice as high as white infants last year. The white infant mortality rate in 2018 was 5 deaths per 1,000 infants born. The black infant mortality rate was 12.2.
Dr. Thad Bell, a family physician in North Charleston, operates a group called Closing the Gap in Healthcare, a nonprofit dedicated to eradicating health disparities through education.
He said infant mortality is a persistent health disparity and will only be solved by addressing obesity among African American women. Nearly 70 percent of black women who gave birth in South Carolina last year were overweight or obese prior to conception, according to DHEC data. By comparison, about 53 percent of white women were overweight or obese before becoming pregnant.
"No longer can we turn our heads the other way and say the problem doesn’t exist," Bell said. "The problem does exist and it ends up causing a lot of complications."
Women of child-bearing age need to treat their underlying health issues before they become pregnant, he said, but that goal is made more complicated by the fact that most low-income, childless women in South Carolina do not qualify for Medicaid coverage until they conceive.
"Lack of access continues to be an issue," he said.
DHEC data shows more than 1,200 South Carolina women gave birth in 2018 having received no prenatal care at all. Eleven counties don't have a single OB-GYN, according to the state's Office of Healthcare Workforce.
Dr. Rick Foster, executive director of the Alliance for a Healthier South Carolina, said statewide efforts are now focused on improving broadband internet access to rural areas, so that prenatal care can be delivered to women inside their primary care doctor's office or at home.
A group called the South Carolina Birth Outcomes Initiative is focused on a number of initiatives, too, he said, including safe infant sleep practices and the use of folic acid supplements during pregnancy. Hispanic women, particularly, need to be targeted with this message, he said, because their diets typically lack enough folic acid to support a growing fetus. Too little folic acid during pregnancy is tied to neural tube defects.
Dr. Amy Crockett, a maternal-fetal specialist with Prisma Health in Greenville, and the clinical lead for the Birth Outcomes Initiative, said the collaborative group has also recently discussed ways to make sure high-risk women deliver infants at hospitals that offer the highest level of care.
She said she was not discouraged by DHEC's new infant mortality report. She is motivated by her patients.
"We’re going to keep fighting for sure," Crockett said.