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Covering infant mortality’s grip in South Carolina Date: 06/15/15

Journalists Doug Pardue and Lauren Sausser of The Post and Courier in South Carolina almost saw their story tackling the perpetually high infant deaths in their southern state slip away when officials released updated statistics that appeared to show the problem ebbing. But a closer look at the data — and its geographical divide — showed that the overall numbers weren’t really what they seemed. What resulted when Pardue, part of the paper’s Pulitzer Prize-winning team this year, and Sausser, also an award-winning reporter, teamed up was a powerful investigative series on the tight hold of South Carolina’s infant mortality rate and a deeper look at where the state was getting it right, and where it wasn’t. Here’s how they did it.

 

 
Doug Pardue and Lauren Sausser

By Doug Pardue and Lauren Sausser

Months before we published our four-part “Cradle of Shame” series on South Carolina’s perpetually high infant mortality rate, the state health department made an announcement that almost caused us to give up about midway through reporting the investigative project.  

Year after year, South Carolina infants have died at rates that are among the highest in the nation, rates that mirror some developing countries. We had written about this problem off-and-on through the years, but usually as a daily or weekend story that reported the sorry statistics, delving little into the key question: Why?

We’d considered launching a deeper dive into the issue for more than a year. Finally, in September 2014, we teamed up to take an in-depth look at the problem to learn what was wrong and what could be done to save babies from unnecessary deaths before their first birthdays.

The next month, the state’s Health Department announced a stunning achievement: The state’s infant mortality rate had dropped in 2013 to the lowest level in history — 6.9 deaths per 1,000 live births, only slightly above the national average.

BOOM! Our story just blew up.

But statistics can both reveal and obscure the truth. And if South Carolina’s Health Department does anything well, it’s gather health statistics. Sausser did a quick dive into the department’s massive database and discovered that our original project thesis was still true. The state’s historic drop in infant mortality concealed a sad reality: Across much of rural South Carolina infants continue to die at nearly double the national rate and black babies, even in urban settings, die at markedly higher rates.

We could clearly see that the state’s success in reducing infant mortality was an urban phenomenon, enjoyed by those within easy reach of world-class hospitals, medical facilities, prenatal care and social services.

So we set out with a two-fold purpose:

  1. find out what was working in the urban areas to reduce infant mortality
  2. find out what was missing in the state’s rural pockets

Unlike many investigative stories, the hard data necessary was readily accessible through the health department’s online portal. The key need for us was to personalize the data with real mothers whose babies were saved and those whose babies died.

Physicians proved to be our best sources for locating mothers. A doctor or nurse usually approached these mothers about our project first so that they felt more at ease. All of the mothers that we interviewed were very appreciative of the care that they had received or they felt that what had happened to them could serve as a cautionary tale for other women.  

We also discovered a rural hospital in Oconee County where a small team of doctors runs a special residency program — one of only 25 in the nation — to train family physicians to perform rural obstetrical medical services for both prenatal care and possible C-sections. One of the chronic needs for pregnant women in rural South Carolina is obstetrical care, and this residency, if expanded, offered a major means to fix this key missing element.

Physicians at the Medical University of South Carolina in Charleston also showed us how they have provided specialized medical care for problem pregnancies through telemedicine connections with rural doctors and hospitals.

In rural Florence County, we discovered a program that hooked up nurses with poor, rural pregnant women to form bonds, help them have healthy pregnancies and spread the knowledge to family and friends.

As a result, we found the real examples that brought the problem of rural infant mortality vividly to our readers. We also found real solutions that could work statewide, if the state did a better job of focusing money and coordinating services.

Unfortunately, we also were able to show that, in the state’s rural corners, 200 newborns have died on average during each of the past three years from preventable problems.

These rural counties have remained untouched by a four-year state campaign to prevent unnecessary infant deaths because the health programs that save babies elsewhere are not available there.  Instead, babies in these counties continue to face a toxic mix of poverty, chronically sick mothers, premature birth and daunting barriers to health care.

Read the full series online.


Lauren Sausser (@laurenmsausser ) is a health care reporter at The Post and Courier in Charleston, South Carolina. She won a 2014 AHCJ Award for Excellence in Health Care Journalism for her coverage of rural hospitals.

Doug Pardue (@dpardue1) is a projects reporter for The Post and Courier in Charleston, S.C. He was part of a team that was awarded the 2015 Pulitzer Prize for Public Service for "Till Death Do Us Part” about domestic violence killings in South Carolina. Before joining The Post and Courier, Pardue served as investigations editor for USA Today. He also has served as a projects and investigations editor at The Tampa Tribune and The State (Columbia, S.C.).