Fewer infants died in South Carolina last year, according to numbers published by the S.C. Department of Health and Environmental Control on Wednesday.
In 2017, an average 6.5 infants out of every 1,000 born died before their first birthday. This marks an improvement over 2016, when an average 7 infants per 1,000 died.
DHEC reported that 30 fewer infants died across the state last year. The total number of births declined by about 300 from 2016 to 2017.
Congential malformation and deformations were the leading cause of infant death in 2017, followed by disorders related to short gestation and low birth weight.
The S.C. Birth Outcomes Initiative has, in recent years, focused its efforts on reducing the number of infants who are born before 39 weeks gestation.
The S.C. Medicaid program became the first in the country nearly six years ago when it started refusing to pay doctors and hospitals for elective inductions prior to 39 weeks gestation. BlueCross BlueShield of South Carolina, the state's largest private insurer, agreed to follow the agency's lead.
Mary "BZ" Giese, director of the S.C. Birth Outcomes Initiative, said BlueCross BlueShield and Medicaid collectively pay for 85 percent of all births in the state. Health experts agree that inducing delivery before 39 weeks gestation without a valid medical reason puts an infant's life at risk. But the fact that the largest public and private insurers in South Carolina decided to stop paying for those births was groundbreaking at the time, Giese said.
"You can write a policy and you can put a manual on the shelf and say 'Wow. This is great plan.' ... (But) we are actually bringing our policy to action," she said. "It’s a very, very big deal."
Dr. Rick Foster, executive director for the Alliance for a Healthier South Carolina and a longtime leader within the Birth Outcomes Initiative, said other programs have contributed to the decrease, too. Some of those include widely promoting safe infant sleep practices, offering group prenatal care and improving access to a drug that prevents preterm births.
"All of these programs are starting to have a collective impact on infant mortality and preterm birth," Foster said. "We're thrilled to see that number come down."
The 2017 infant mortality rate matches the 2014 rate — the lowest on record. Infant mortality rates are considered a benchmark for public health. South Carolina's rate remains higher than the national average, which is 5.9.
DHEC reported that black infants in South Carolina died last year at a rate nearly double that of white infants.
"We want all mothers and babies to have the opportunity for the best health outcomes possible," Dr. Lilian Peake, DHEC's director of public health, said in a press release. "By identifying the gaps in outcomes, specific interventions can be designed to overcome them."
The Post and Courier published an investigation in 2015 showing that infant mortality rates are persistently high in South Carolina's rural counties. That trend holds true for 2017.
In Lee County, for example, the infant mortality rate in 2017 was 21.3 — the highest in the state. In Charleston, it was only 4.4.
Lee is one of 11 South Carolina counties without a single OB-GYN, according to the S.C. Office of Healthcare Workforce.
To reduce the risk of infant death, pregnant women are encouraged to take a prenatal vitamin with folic acid, caregivers are discouraged from smoking around babies and parents should practice the "ABCs" of safe sleep.
"Place your baby alone (without any toys or other objects), on their back in their crib to sleep," DHEC recommends.