LaShon June’s voice is equal parts sadness and frustration as she talks about how her daughter went through a difficult pregnancy, was induced to deliver early, and then died three days later.

“She was always a healthy girl before the pregnancy, never any issues,” said June of Sumter. “I still to this day don’t understand what really happened.”

The death of 29-year-old Shaquilla June in May 2021 happens all too oftento women who get pregnant and give birth in South Carolina, particularly to Black women like her, data shows.

An outreach system for new mothers developed by the Medical University of South Carolina shows promising signs of being able to get them the treatment they need. And it appears to address a striking racial gap in receiving care.

South Carolina has the eighth-worst maternal mortality rate in the country at 32.7 deaths per 100,000 live births, according to an analysis of data from 2018 to 2021 by the health policy research group KFF.

Black women in South Carolina were 4.2 times more likely to die than White women, according to 2020 data from the state’s latest maternal mortality report.

It is a racial disparity that has persisted over time. In 2020, “discrimination was recognized as a contributing factor in more than one-third of the pregnancyrelated deaths reviewed,” according to the South Carolina Maternal Morbidity and Mortality Review Committee.

It is one of the barriers those new mothers faced in seeking treatment for mental health or substance use issues, said Dr. Constance Guille, director of the Women’s Reproductive Behavioral Health Division at MUSC.

“For very good reasons, the Black community doesn’t trust the health care system because of a lot of historical mistreatment and racism and structural racism” within the health care system itself, she said.

Overall, mental health and substance use issues were a factor in half of the pregnancy-related deaths in South Carolina in 2020, the review found, and historically has accounted for a high percentage of maternal mortality in the U.S. It is why groups like the American College of Obstetricians and Gynecologists recommend screening for depression and other mental health issues. Yet often neither screening nor treatment is offered.

But a new system of outreach and screening seems to help increase the number of women reached, Guille said.

The Listening to Women and Pregnant and Postpartum People uses text and telephone messages to reach out to those women, screening them for mental health or substance use issues or instances of domestic violence. Compared to the previous system that tried to do those things in person, it appeared to be more effective, Guille said.

“What was so profound about that was the racial disparities,” she said. “We saw with in-person screening and referral, Black women were significantly less likely to make it to treatment in comparison to White women. But that was not the case with this (new) system.”

The MUSC team testedit in a randomized control trial where women were selected to receive either in-person screening and referral or text or telephone screening. Those who got the text- and telephonebased system were 4.4 times more likely to get a referral for treatment and 5.7 times more likely to actually get treatment.

The researchers also followed up with 70 Black patients and the providers to find out why it was working better and found that it helps overcome some of the stigma patients felt when they were discussing their issues in person.

“For some reason, when they are asked via text message, they feel like they are not being judged, that there is an added layer of confidentiality,” Guille said.

“They are just more likely to say that there is a problem. And that there is somebody on the other end that is really open to receiving that information and helping that person navigate the really complex health systems we have to actually get to care.”

Part of that also comes from the experienced care coordinators, who work with patients to help understand what is making them hesitant about seeking help.

Sometimes, the women need to see the treatment in a way that encourages them to follow through with it, and that may involve their child.

“When you’re not doing well, the baby is not doingwell,” Guille said.

MUSC is now continuing to research the approach through a new study called Health Equity Advocacy and Respect or H.E.A.R. 4 Mamas.

At the heart of the approach is a simple idea: providers are “not hearing patients and missing opportunities to provide appropriate care,” Guille said.

LaShon June certainly feels that way about her oldest daughter’s care. Everything seemed fine until Shaquilla June got to her third trimester. A blood test showed she had developed gestational diabetes, which happens in up to 10 percent of pregnancies in women who previously did not have diabetes, according to the Centers for Disease Control and Prevention. It also puts the mother at greater risk of high blood pressure.

Shaquilla’s doctor started her on insulin and referred her to a clinic, and she was getting regular monitoring there and at her OB-GYN, her mother said. Then in mid-May, the clinic sounded an alarm and told Shaquilla she needed to go to the hospital right away because she was at risk of developing preeclampsia, a hazardous condition of high blood pressure that can threaten the life of both mother and baby. But LaShon June said that was never fully explained to her or her daughter.

“No one ever informed me or my daughter about preeclampsia,” she said.

They went to the hospital thinking Shaquilla would be monitored; instead she was scheduled to be induced, even though she was not due for another three weeks. After she gave birth to Johnathan on a Thursday evening, the new mother was told she would be discharged Saturday morning, LaShon June said.

Though the family protested — “She kept saying she wasn’t 100 percent,” LaShon said — Shaquilla went home.

She tried to reassure her worried mother.

“She said, I’m going to be fine, mom. I’ll be fine,” LaShon June said.

But early that Sunday, she was complaining of fluid buildup and not feeling well. Eventually she was back at the hospital. Though Shaquilla walked in on her own, staff assessed her and quickly rushed her to treatment.

By the time LaShon June saw her daughter again, she looked awful and was crying out for her.

“She kept trying to tell me something, but it couldn’t come out,” LaShon June said. “She took that final look at me and then looked at her baby because I was holding her baby.”

Shaquilla died in front of them. Her mother said the cause of death was an enlarged heart and other complications.

It still hurts her to think about it, and her voice grows thick as she talks about it.

Johnathan, who will turn 3 next month, plays with his cousins at her house, one a year older, one a year younger, though he is already the tallest. She shows him pictures of Shaquilla, and he kisses them.

“He only knows her by pictures,” Lashon June said, and what she tells him about her.

Her faith helps her deal with the pain now.

“I know God is in control of everything, I just hate that she’s not here,” she said.

“We got an angel, we’ve got a baby, but it’s not the same. I know I can’t question God because what happened happened. But it’s so sad that you never get the answers you’re looking for.”

Reach Tom Corwin at 843-214-6584. Follow him on Twitter at @AUG_ SciMed.