Like many rural areas across the U.S., South Carolina has a shortage of medical facilities and providers that serve its rural population. This problem is particularly acute when it comes to prenatal care, labor and delivery. Ann Lefebvre, DSW ‘24, wanted to address this disparity for the rural residents of her adopted home state. She already had an exceptional 25-year career as director of a $17 million statewide health care workforce development agency and the associate dean for a medical school. However, she felt a calling to do something more in her career, something personal. 

When Lefebvre found the Doctor of Social Work (DSW) program at the USC Suzanne Dworak-Peck School of Social Work, she discovered how she could make this greater personal impact. Through her studies, Lefebvre developed a new community-based network to meet the maternal health care needs of underserved women in rural areas throughout the state. 

South Carolina has one of the top five highest maternal vulnerability rates in the nation, yet one in five women do not receive adequate prenatal care and at least 13 labor and delivery units have closed across the state since 2012. Lefebvre conducted in-depth analysis to identify 15 counties where obstetricians or labor and delivery services are not available. Four of these counties are contiguous, requiring women to drive up to two hours just to receive routine prenatal care or to deliver their baby. The danger is compounded by the fact that 29 percent of women giving birth in South Carolina rural areas are Black and poverty rates are as high as 36 percent in some counties, both of these being known risk factors for maternal health outcomes. 

“There is a lot of evidence out there about Black women having poor birth rates even in a hospital where they're known, where they have a provider and a birthing plan, and they still have poor birth outcomes,” Lefebvre said. “So, imagine what happens in the circumstances that we're talking about. We can’t just wish that there was a physician there. We have to build in other supportive mechanisms to do this.” 

Finding a community of professional peers

When seeking the right institution and program for her next academic journey, Lefebvre had no shortage of choices, but she was immediately drawn to the DSW program at USC. 

“I liked that the USC DSW is very embedded in the most difficult of problems with its focus on the 13 Grand Challenges for Social Work,” Lefebvre said. “I was seeking a peer group to think through these really difficult societal challenges with people who are invested in knowing something needs to change and learning how we might be able to create that change.” 

The central focus of the DSW program is the development of a capstone project, designed to address a critical societal issue. Lefebvre created The Sprout Project: Growing and Connecting Community Resources for Healthy Moms and Babies — a multi-prong system that uses data to identify the areas with the most need within South Carolina, and a training curriculum for local residents of those areas to better support improved maternal health outcomes. The program encourages people to remain in their communities and contribute to greater local resilience and stability for expecting mothers, and builds trust with the people they serve. It also helps to address another challenge in maternal health care deserts: stigma and judgment from medical-care providers at these distant hospitals. 

“Oftentimes rural birthing mothers are met with bias from the delivery team at a hospital because they haven't received prenatal care, when actually there's nowhere for them to receive prenatal care,” Lefebvre said. “With a community-based doula, the woman giving birth might not be known at a certain hospital, but the doula will be. And the hospital team then recognizes that this doula they know has been taking care of this patient and it becomes the introduction into that birthing team.” 

Lefebvre says the relationships she developed with her mentors and fellow students at USC were invaluable in helping her to identify and grow the concept for the capstone. In particular, the broad range of students with leadership experience in a variety of settings and their experiences challenged her to deepen her transformational change skills and abilities. Lefebvre also points to her faculty advisors for inspiring and empowering her to view her concept from every angle.

“Ann Lefebvre’s capstone, The Sprout Project, is a powerful example of collaborative problem-solving in action,” said Renée Smith-Maddox, teaching professor, who served as chair for Lefebvre’s capstone project. “I got to witness how Ann skillfully created the conditions for a design team of local and state stakeholders and experts to come together and confront the maternal and infant health crisis in rural South Carolina. Through their shared efforts, the team built a maternal health care ecosystem that expands and enhances community-based perinatal services, and addresses the social and ecological factors contributing to poor birth outcomes.”

From concept to realization

Lefebvre is the first to acknowledge that the success of developing The Sprout Project is due to the culmination of partnerships she was able to create with community organizations on the ground that made it come to fruition. In serving these rural areas that are overwhelmingly poor and Black, where many families have lived for generations, she knew that coming in as an outsider and behaving as though she was an expert on their experiences and needs would not work. 

“I'm not from the South, I’m not Black, I'm not from a rural area, I don't have any business being in these communities,” Lefebvre said. “It's not just understanding where they are, but respecting where they are. And then trying to see the good in what they have. It's a different approach than just telling people what they should do. I think I gained a lot of partner organizations because they appreciated the fact that I saw their value and that this was their space.”

Capitalizing on the momentum of community partners in the state and based, in part, on Lefebvre’s findings highlighting the need for improved maternal health services in rural areas, the South Carolina Institute of Medicine & Public Health convened a nine-month task force, for which Lefebvre served on the steering committee. The task force received funding from the governor’s office, state entities and a private endowment, and in April 2025 it released a report of its findings, Improving Maternal and Infant Health: Increasing Access to Care in Rural South Carolina, identifying specific recommendations for the state legislature to consider in their next session. The task force’s recommendations supported efforts to introduce a bill in the state legislature that would require coverage for doula services under both private insurance and Medicaid, as well as creating a doula certification organization, regulations and statewide registry for certified doulas. 

Throughout this process, Lefebvre credits the collective energy, resources and dedication of so many community organizations and governmental agencies that have rallied around the challenge to better serve the maternal health needs of all the residents in their state. 

“So much of what has happened with this is because of a gathering of wills,” Lefebvre said. “It’s like stone soup. We put a pot in the middle of the table and said, ‘here’s the problem, what can you contribute?’ With the right timing, resources, data and influence, people come together.”