Population Overview

A snapshot of South Carolina’s maternal and infant health indicators, population overview and social determinants is as follows:

(Note: Data sources include US Census Bureau, BRFSS, SC Community Assessment Network)

Geographic Description

South Carolina (SC), also known as the Palmetto State, is a southeastern state known for its shoreline of subtropical beaches and marsh-like sea islands. SC covers 30,109 square miles, with a 2022 population estimate of 5,282,634.

 

Figure 1. State Map of Public Health Regions

The state is divided into 46 counties with 56 public health clinics across DHEC’s four Public Health Regions (shown in Figure 1 above). In 2022, the five most populous counties in the state were Greenville (547,950), Richland (421,566), Charleston (419,279), Horry (383,101), and Spartanburg (345,831). Columbia, located in Richland County, is the state capital. The state’s most populous cities are Charleston, Columbia, and North Charleston.

 

Organizational Overview

DHEC (www.dhec.sc.gov) is the state’s Title V agency and provides the ten essential services of public health as outlined by the National Public Health Performance Standards. Additionally, DHEC serves to fill gaps in the healthcare system, offering support services, resources, and financial assistance in areas such as immunizations, family planning, and care coordination for Children and Youth with Special Healthcare Needs (CYSHCN) to complement South Carolina’s healthcare systems. DHEC is a centralized health department delivering Title V funding, programs, and services throughout its four Public Health Regions.

 

In September 2022, DHEC launched its 2022 to 2024 Bridge Strategic Plan which builds on the foundation of the 2016 Strategic Plan. This plan abbreviated plan will allow the agency to critically evaluation and strengthen its workforce, infrastructure, processes, and partnerships. The agency’s Core Values remain strong as: 1) Pursuing Excellence – Commitment to the highest achievable standards of quality and professionalism in our pursuit of healthy people living in healthy communities; 2) Inspiring Innovation – Encourages and empowers its teams to find creative solutions to promote and protect the health of the public and the environment; 3) Promoting Teamwork – Fosters an inclusive and collaborative environment; valuing the diversity of thoughts, experience and expertise of every team member, stakeholders, and communities; and 4) Embracing Service – Reliably serve its communities, customers, and staff in a respectful manner, relying upon clear and uncompromised commitments to integrity, trust, dependability, and responsiveness. As part of the 2022 update, the agency added Advancing Equity to highlight our commitment to giving all South Carolinians the opportunity to attain optimal health by fostering a culture of fairness, equity, and inclusion.

 

The SC Title V program likewise embraces the agency core values and ensures our MCH-specific priorities align with the agency mission and vision. Title V priorities selected for the 2021-2025 State Action Plan are to: 1) Increase developmental screenings and referral to early intervention services for children; 2) Improve utilization of preventive health visits to promote women’s health before, during, and after pregnancy; 3) Improve access to risk- appropriate care through evidence- based enhancements to perinatal systems of care; 4) Strengthen implementation of evidence-based practices that keep infants safe, healthy and prevent mortality; 5) Improve coordinated and comprehensive health promotion efforts among the child and adolescent populations; 6) Improve care coordination for CYSHCN; 7) Enhance and expand transition in care/services for CYSHCN from pediatric/adolescent to adulthood; and 8) Reduce racial/ethnic disparities in social determinants of health, including insurance coverage, other barriers to medical care, especially behavioral and mental health care, fatherhood involvement, and racism/discrimination.

 

As the state Title V agency, DHEC determines the importance, magnitude, value, and priority of competing factors that impact health services delivery in the state. The agency is currently leading the charge of updating the state’s 2018 State Health Assessment and accompanying State Health Improvement Plan. These documents served as tools to prioritize public health activities over the last five years and were essential to SC DHEC being awarded national accreditation through the Public Health Accreditation Board in early 2021. In order to maintain accreditation, DHEC is required to perform a State Health Assessment every five years. The second State Health Assessment is currently in development and is being built on lessons learned throughout the first iteration. The primary changes with the new assessment are: 1) findings structured through a life course lens, as opposed to organizational units; 2) addition of a dedicated health equity section; and 3) increased collaboration with external partners.

 

Programmatic Overview

Selected MCH programs supported by Title V in SC are described below, organized by the HRSA framework of MCH population health domains:

 

Women/Maternal Health Domain Programs

 

Maternal Morbidity and Mortality Review (MMMR): This review process allows SC to better understand the circumstances around maternal deaths, and to determine the leading causes of preventable maternal mortality in the state. This review committee makes systems-level recommendations aimed at reducing preventable maternal morbidity and mortality across the state. DHEC’s Title V program is responsible for organizing and convening the quarterly reviews as well as the analysis and reporting of the data.

 

Best Chance Network (BCN) Program: DHEC’s BCN provides free breast and cervical cancer screening for SC women who meet program eligibility requirements. The program goal is to reduce deaths from breast and cervical cancer by providing medically underserved women in SC access to breast and cervical screening and other BCN services.

 

WISEWOMAN: The WW program in the Division of Cancer Prevention and Control is a cardiovascular disease prevention program that extends services to women enrolled in the BCN Breast & Cervical Cancer Early Detection Program. These women receive screenings for cardiovascular disease risk, risk reduction counseling, medical evaluation and referral for abnormal findings, linkages to free or low-cost medication resources, referrals to community resources that support healthy behaviors, and opportunities to participate in health coaching or lifestyle programs.

 

Sexual Violence Services Program: The Sexual Violence Services Program (SVSP) funds rape crisis centers serving all 46 counties and the SC Coalition Against Domestic Violence and Sexual Assault. The SVSP provides funding for services for direct and secondary victims of sexual assault through the 15 sexual assault centers. It also provides funding for sexual violence prevention programs across the state. Additionally, the program is responsible for domestic violence training within DHEC.

 

Preventive Health and Family Planning (FP) Program in the Division of Women’s Health: The DHEC FP Program, or Preventive Health program, is a preventive services program that promotes positive birth outcomes, reduction of unintended pregnancies, and patient-centered health through clinical and educational services. The program provides access to contraceptive services, supplies, and information to all who want and need them. Preconception counseling and family planning are also available for women.

 

Perinatal/Infant Health Domain Programs

 

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): South Carolina WIC (SC WIC) is a public health nutrition program under the Food and Nutrition Service of United States Department of Agriculture providing nutrition education, nutritious foods, breastfeeding support, and healthcare referrals to income-eligible women who are pregnant or postpartum, breastfeeding, infants, and children through five years old. The WIC program is housed within DHEC’s Bureau of Community Nutrition Services.

 

Perinatal Regionalization System (PRS): The SC PRS ensures that women and high-risk infants have access to an appropriate level of care through a well-established regional perinatal system. The PRS is widely supported across SC and has been in practice for over 30 years. DHEC’s MCH Bureau provides Title V funding to support this system and maintains an active role in monitoring the PRS across four perinatal regions.

 

South Carolina Birth Outcomes Initiative (BOI): The BOI was launched in 2011 to decrease infant mortality and low birth weight births, two of the state’s most pressing public health problems. The goal of the BOI is to address these issues and reduce health care costs while improving the health outcomes of mothers and babies in the state. Some of the collaborative work by BOI includes policy changes to support the following: Early elective delivery reduction, Screening Brief Intervention and Referral to Treatment, Baby-Friendly USA certification, CenteringPregnancy, and the use of long-acting reversible contraceptives. The DHEC continues to be a strong supporter and partner of BOI, serving on the Leadership team and several workgroups.

 

Safe Sleep Work Group: Safe sleep practices have long been a priority to reduce infant mortality in the state. The previous Safe Sleep Coalition, under the leadership of Children’s Trust, has been reorganized as a work group with the Birth Outcomes Initiative. Staff from the MCH Bureau are actively involved members of this work group.

 

The Care Line: The Care Line now operates through Blue Cross and Blue Shield, PGBA. The Care Line is the state’s Title V statewide information and referral hotline that provides support to women and their families by making it easier to get the services they need. The Care Line provides referrals, assistance, and support to the residents of SC to empower them to access health care and social services. 

 

First Sound: First Sound is SC’s legislatively-mandated Early Hearing Detection and Intervention (EHDI) Program. SC delivery hospitals with 100 or more births per year screen each newborn baby for hearing difficulties, and the results are sent to DHEC. On average, 97.5 percent of newborns in SC are screened. Infants who do not pass the initial hearing screening in the hospital or who have certain risk factors are referred for rescreening.

 

Newborn Screening (NBS) Program: The SC NBS Program is a legally-mandated newborn screening program. The test panel includes over 60 core and secondary metabolic and genetic conditions that are recommended by HRSA’s Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC), the American College of Medical Genetics (ACMG), and the March of Dimes to identify infants born with these conditions.

 

Postpartum Newborn Home Visits (PPNBHV) Program: The PPNBHV program serves families with newborn infants, focusing resources on mothers and infants with priority medical needs or diagnoses. The family receiving services voluntarily receives the visit and, in most instances, a single visit is provided within one to two weeks from the time that the mother and infant are discharged from the hospital. Services include an assessment of the home environment of the mother and infant, observation of feeding and bonding, a complete physical assessment of the infant, and a limited, but more strategic, physical assessment of the mother. Title V provides funding for visits to high-risk mothers and infants who are not Medicaid-eligible.

 

South Carolina Birth Defects Surveillance Program (SCBDP): In 2004, the SC Birth Defects Act (Title 44-44-10) mandated the creation of a statewide birth defects surveillance system. The resulting SCBDP, housed within DHEC, collects active surveillance data of birth defects recommended by the National Birth Defects Prevention Network (NBDPN) for children up to two years old. In recent years, the scope of the program has expanded from surveillance to prevention, research, and referrals as allowed by the legislation. 

 

Nurse Family Partnership (NFP): Nurse-Family Partnership pairs qualified vulnerable first-time parents with specially trained nurses. During home visits from early pregnancy through the child’s second birthday, the nurses support first-time moms to have healthy pregnancies, become knowledgeable and responsible parents, and give their babies the best possible start in life. DHEC is one of the NFP partners, providing nurse home visits from four locations, one in each of the Public Health Regions. 

 

Children’s Health Domain Programs

 

Child Well-Being Coalition (CWBC): The Child Well-Being Coalition (CWBC) is an initiative established by the Maternal and Child Health (MCH) Bureau and strategic partners. In late 2020, the CWBC experienced leadership changes on its Core Team, and the group decided to embark upon Strategic Planning for the future of the Coalition. During the initial stages of Strategic Planning, the Core Team began revising the existing charter, examined data that was used to determine the existing priorities, and began looking at current data to identify new priorities. The top child health priorities that were identified as priority needs for the CWBC to address include developmental screening, child safety/injury prevention and childhood obesity. 

 

The South Carolina Muscular Dystrophy Surveillance, Tracking, and Research Network (MD STARnet): The MD STARnet is a CDC-sponsored collaborative effort between DHEC and the University of SC to: 1) Maintain a dynamic surveillance system for muscular dystrophy that capitalizes on the strengths of the medical record and administrative data available in SC; and 2) Develop and manage a data system that allows for ongoing analyses of health care utilization, costs, and community participation of people with these conditions.

 

State School Nurse Program: The State School Nurse Program (SNP) is a collaborative relationship that exists between the SC Department of Education (DOE) and DHEC. This dual partnership supports and funds the state’s School Nurse Consultant (SNC) position. Title V funds 50% of this position, and the other 50% is supported with DOE state funds.  The SNC provides statewide leadership and expertise in using evidence-based practice standards for delivery of school nursing services. The SNC serves every public school district, public charter school, and other local education agencies, the students, school personnel, parents/family, and community. The SNC also provides a linkage to healthcare agencies and providers of care.

 

Lead Screening Program: Through the Bureau of Maternal and Child Health and Environmental Affairs, DHEC provides educational materials for healthcare professionals and families, conducts surveillance of blood lead testing, conducts case consultation for children up to 16 years of age with elevated blood lead levels (EBLLs), and provides environmental assessments for children with qualifying elevated blood lead levels. Title V funds some of the educational materials and portions of the salaries of staff providing program oversight. The long-established working relationship between Title V and SC DHHS expedited changes in the Medicaid Enhanced Services Provider Manual and agreements for Medicaid funding of increased numbers of environmental assessments when the intervention threshold changed to a single EBLL of 10 mcg/dl in 2017. 

 

Adolescent Health Domain Programs

 

“The Point” DHEC Clinics: The FP program within DHEC provides confidential reproductive health care services, counseling and education by caring professionals in teen-friendly clinics, called, “The Point”. Some of the many services provided in “The Point” sites are: birth control methods (including emergency contraception) and up to one year’s supply; pregnancy testing; Sexually Transmitted Infection (STI) screening; abstinence education; and training on resisting coercion.

 

Abstinence Education Program: A part of the MCH Bureau, the Abstinence Education Program, receives federal and state funding to support abstinence-until-marriage education in order to prevent teenage pregnancy and sexually transmitted infections. Partial funding for program oversight is provided by Title V. DHEC works with sub-grantees to implement the program in areas across the state.

 

State Adolescent Health Program: The State Adolescent Health Program in the Division of Women’s Health at DHEC provides leadership and advocacy for adolescent health and development for youth 10-24 years old. The program focuses on supporting healthy and safe lifestyles, improving access and utilization of health care, and increasing school success. The program actively works to prevent teen pregnancy and sexually transmitted diseases through the Personal Responsibility Education Program, and works with internal and external partners with injury, violence, suicide, and substance abuse prevention program.

 

Children and Youth with Special Healthcare Needs Domain Programs

 

CYSHCN Program: Title V funding allows the program to provide care coordination, financial assistance, select premium assistance, information, referrals to appropriate care, transition planning, a residential summer camp, and parent resource partners for children and young adults with special health care needs and their families. The CYSHCN program is working toward building a robust family-centered care coordination system.

 

Crosscutting/Life Course Domain Programs

 

Division of Oral Health (DOH): Many of the activities and programs led by DHEC’s DOH support the oral health of MCH’s target population: pregnant women, infants, children and individuals with special needs. The DOH receives funding from the CDC to maintain the infrastructure that supports a state dental disease prevention program and from DOH to support oral health integration activities for pregnant women and infants through a Perinatal Infant Oral Health Quality Improvement (PIOHQI) Expansion grant.

 

The Division of Nutrition, Physical Activity, and Obesity (DNPAO): The aim of the DNPAO program area in DHEC's Bureau of Community Nutrition Services is to improve access to healthier foods and beverages and opportunities for daily physical activity through policy, systems, and environmental approaches reaching South Carolinians where they live, learn, work, and play. To address child and adolescent health, the division has three full-time employees (School Health Coordinator, SC FitnessGram Coordinator, and Healthy Eating/Active Living Special Projects Coordinator) who work to improve school environments across the state, including incorporation of physical activity before, during, and after school.

 

MCH Epidemiology: The MCH Epidemiology team provides ongoing data collection, analysis, summarization, presentation, program assessment and evaluation, and research interpretation to programs across the MCH Bureau and to external partners. A team of MCH epidemiologists are housed in DHEC’s Bureau of Population Health Data Analytics and Informatics. Title V funding supports several of these positions; and the State Systems Development Initiative (SSDI) grant provides supplemental support for the administration of three population-based data collection systems that provide quality data on maternal and child health indicators used to drive programmatic planning and evaluation.

 

Health Equity: Although health equity is an important part of activities conducted in all bureaus of the public health area, DHEC’s Public Health Office of Diversity, Equity and Inclusion has the responsibility of being a resource for other areas of the agency, including the MCH Bureau, and to provide technical assistance for bureau activities that may include a component health equity.  

 

Division of Tobacco Prevention and Control: Tobacco Cessation is one of four priority program goal areas for the DHEC Division of Tobacco Prevention and Control, a division within the DHEC Bureau of Chronic Disease and Injury Prevention. The Tobacco Division has maintained a long-standing and supportive partnership with the MCH Bureau to advance the goals and objectives within the MCH Title V Block Grant that address tobacco use among this vulnerable population.

 

Immunizations Division: The Immunizations Division at DHEC plays an important role in protecting the MCH population in SC, pursuant to statutory authority, allowing DHEC to have general direction and supervision of vaccination, screening, and immunization in this state. The Federal Vaccines for Children Program in SC is administered by the DHEC Division of Immunization and covers vaccines for children 18 years old and younger. The Immunization Division works closely with the MCH Bureau and common key stakeholder groups.

 

The Division of Injury and Substance Abuse Prevention monitors health status to: identify community health problems; develop plans supportive of individual and community health improvement efforts; research for new insights and innovative solutions to health problems; link people to needed personal health services; assure a competent workforce; inform, educate and empower people; and, mobilize state, regional and county-level partners to better identify and address health problems.