SC Birth Outcomes Initiative (BOI)

Birth Outcomes

Healthier Moms and Babies

In 2008, South Carolina had never received a grade higher than D on its March of Dimes premature birth report card. Dangerous complications can come with an early birth. Ending the increasingly common practice of scheduling unnecessary deliveries was a major opportunity to not only save our state millions of dollars, but to save babies.

The South Birth Outcomes Initiative (SC BOI) took action by educating future moms about why it was crucial to wait 39 weeks before they gave birth. Providers were engaged and offered support as they worked to change their policies and processes. Later, an innovative approach to payment reform meant hospitals and doctors would no longer be paid for delivering babies early without a medical reason.

The initiative has made incredible progress. Fewer babies are dying. Fewer are born with low birth weights. Fewer are spending their first weeks of life in the neonatal intensive care unit. Early elective delivery rates have been cut by half. And 60 percent of our birthing hospitals have completely eliminated unnecessary early deliveries.

South Carolina’s highly effective, successful Birth Outcomes Initiative work in these areas has received national press and acclaim, and is now used as a case study for other states.

RESULTS: Early elective deliveries reduced by 51%; elective inductions reduced by 55%

COST SAVINGS: $6,076,000

PARTNERS: All 45 South Carolina birthing hospitals, BlueCross BlueShield of SC, SC American College of Obstetricians and Gynecologists, SC Department of Health and Environmental Control, SC Department of Health and Human Services, SC March of Dimes, SC Neonatology Consortium, SC OBGYN Society

The Duke Endowment Logo

This work is made possible by the generosity of The Duke Endowment. South Carolina’s hospitals are grateful for the vision of James B. Duke, who established The Duke Endowment in December of 1924. For more information on the legacy of Mr. Duke and the work of The Duke Endowment, visit