South Carolina to Spend $30M to Cut Infant Mortality Using Value-Based Principles

The Nurse-Family Partnership expansion will bring 3200 new families into the program over 4 years. The nonprofit initiative is backed by 30 years of evidence, including a 2014 study that showed better long-term survival among 20-year-olds whose mothers were among the early participants.

South Carolina Governor Nikki Haley yesterday pledged $30 million to tackle her state’s rural infant mortality rates, through a proven program that pairs nurses with new mothers.

Expanding the Nurse-Family Partnership, which already operates in South Carolina and other states, will give the program a foothold in more of the state’s rural pockets. An investigation by the Charleston Post and Courier found the death toll for African American infants can be 4 times higher than the national average.

The newspaper reported that in South Carolina, 6.5 infants per 1000 live births die before reaching their first birthday; that rate is higher than the national average of 6 per 1000 live births. But in rural areas, the rate exceeds 14 infants per 1000 live births.

The initiative, called South Carolina Nurse-Family Partnership Pay for Success, will bring the program to 3200 more first-time mothers and their babies over the next 4 years in 29 counties. Today, about 1200 families have been helped by the project.

The Nurse-Family Partnership is backed by 30 years’ worth of evidence in multiple states. Registered nurses make ongoing home visits to first-time mothers from low-income backgrounds, starting in pregnancy and following up until the child turns 2 years old. The partnership is designed to build trust and give young mothers confidence to gain skills to break the cycle of poverty.

An evaluation of Nurse-Family Partnership from Memphis, Tennessee, shows the program can have lasting effects. Published in September 2014 in JAMA Pediatrics, the authors looked at how children whose mothers took part in the partnership in 1990 were faring in 2011, compared with children in other groups from the original clinical trial. At age 20, the preventable cause child mortality rate for the group of children who did not get home visits was 1.6%, compared with the 0% for those whose families had received the home visits, for a survival contrast of P = .04.1

The partnership is a nonprofit that is jointly funded by public and private funds. According to a prepared statement, more than half of the expansion funds will come from private sources, including an $8 million gift from the Duke endowment. Public funds will come from Medicaid. Other private funders include Boeing, the Laura and John Arnold Foundation, and the Blue Cross Blue Shield of South Carolina Foundation.

Haley praised the effort yesterday, saying “It’s a perfect example of what we can do when leaders from the private sector and public service work together.”

The program costs $4800 per mother. However, infants aided by the nurses are less likely to be born prematurely, and it has been shown to bring savings equal to 4 times its costs. Avoided costs include treatment in neonatal intensive care.

The program is called “Pay for Success” because it has a pay-for-value component: Funders offer upfront costs to expand social services, and government funds kick in “only if it measurably improves the lives of participants,” according to the prepared statement.

Evaluation of the measurable components, based on pre-determined metrics, will be led by J-PAL of North America, based at the Massachusetts Institute of Technology.


1. Olds DL, Kitzman H, Knudtson MS, et al. Effect of home visiting by nurses on maternal and child mortality: results of a 2-decade follow-up of a randomized clinical trial. JAMA Pediatr. 2014;168(9):800-806. doi:10.1001/jamapediatrics.2014.472.

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