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Comparing South Carolina’s Child and Maternal Health Indicators Internationally

Sean Rusnak, Post-Baccalaureate Fellow

This blog is part of ICS’s series utilizing information from our South Carolina Early Childhood Databook, which highlights 80+ indicators of child and family well-being in South Carolina compared to North Carolina, Georgia, and the national average. More resources from this publication can be accessed here.

South Carolina has a complacency issue. Too often citizens and policymakers are placated by looking at the abysmal state health rankings and quipping, “Thank God for Mississippi.” Somehow, by at least not being last, we’re surely doing alright.

The standard, or lack thereof, that we have set for ourselves as a state is unacceptable, especially when you consider the impact it is having on our future, the children. However, we can’t ignore that we are performing objectively worse in several child and maternal health indicators than developing countries, or more specifically, countries a per capita income below $3,995.* To put the lack of resources of these countries into perspective, South Carolina’s per capita income is $41,633, over ten times that of several countries that it falls behind to in child and maternal health rankings. This complacency with poor child and maternal health is shocking and unacceptable.

So, what if South Carolina seceded (can’t ignore our history can we?) and became a separate country, how would we fare on the international stage? Keep in mind, in most of these metrics, South Carolina usually ranks in the bottom 10 in the United States. Therefore, if all states were to be considered separate country, South Carolina would be even further down in this international comparison. Yet, for simplicity’s sake, we will assume that the United States stayed intact aside from South Carolina.

Infant Mortality

South Carolina had an infant mortality rate of 6.5 per 100,000 live births in 2017 which is higher than the United States average of 5.8. On an international stage, South Carolina would tie for 53rd, behind nearly all developed and high-income countries. South Carolina’s international infant mortality ranking does not seem bad, until you stratify the data. The mortality rate for African American infants is significantly higher at 10.0 deaths per 100,000 births, which is lower than the United States average of 11.1. Yet, when compared internationally, South Carolina’s African American infant mortality ranks 73rd behind Georgia (the country), Ukraine, and Sri Lanka – all countries with per capita incomes of $3,995 or less. The juxtaposition of infant mortality rates in South Carolina illustrates a stark realization of the racial inequity in our state as African American infants die more often than children being born in low-income countries.

Maternal Mortality

The picture is not any less bleak when examining maternal mortality. South Carolina’s maternal mortality rate in 2016 was 27.1 in 2016, significantly higher than the United States’ average of 19.9. Internationally, South Carolina ranks 69th overall. For African American mothers, South Carolina’s maternal mortality rate is 56.7, again significantly higher than the United States’ average of 47.2. South Carolina’s maternal mortality for African American women, compared independently, ranks 97th. The maternal mortality rate for African American women in South Carolina is higher than the maternal mortality rate in 11 developing/low-middle income countries including El Salvador, Vietnam, and the West Bank and Gaza.  As we have recently written, maternal mortality has long been under-reported as data focused more on the health of children – a recent policy focus on this issue is long overdue in overcoming structural issues threatening the lives of mothers.

Teen Birth Rate

In addition to having poor mortality rates for both children and mothers, South Carolina has an exceptionally high birth rate for teens when compared internationally, especially considering the lower age of marriage in many other countries. South Carolina has a teen (adolescent) birth rate of 23.7 per 1,000 girls in 2016 which ranks 73rd in the world. The United States average in 2016 was 20.3. South Carolina’s teen birth rate is higher than that of six low-middle income countries including Djibouti, Kiribati, and Uzbekistan. While progress has been made nationally and at the state level on teen births rates, it is that surprising that South Carolina has a higher teen birth rate than countries that allow child marriage such as Kiribati, where 20% of girls are married before the age of 18.

Moving Forward

Ultimately, South Carolina should be both  sobered  and motivated by how we fare in international comparisons of maternal and child health. Although the scope of the analysis is limited, it encompasses the most significant measure of health in children and mothers, mortality. Living in the most developed country in the world – with a state per capita income more than ten times larger than countries that rank above us in these metrics – is astonishing and requires a renewed focus and energy around child health policy in South Carolina to redeem.

* Per capita income is calculated by diving the gross domestic product of a country, how much money it generates in a year, by the overall population. As a result, the high and low ends of the income are averaged out and give a good estimation of the financial resources of the country

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