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1.20 Infant and child mortality

Why is it important?

Infant mortality is the death of a child less than one year of age and is a long established measure of child health, as well as the overall health of the population and its physical and social environment. COAG has committed to halving the gap in mortality rates for Aboriginal and Torres Strait Islander children under 5 years by 2018. Improvements in Australia's infant mortality rates in the last 100 years were largely due to improved social and public health conditions such as sanitation and health education in the first half of the twentieth century, followed by the development of immunisation, and in more recent years by better treatment in neonatal intensive care and interventions for Sudden Infant Death Syndrome (SIDS).

Findings

Between 1998 and 2013 there has been a significant decline in Indigenous child mortality rates of 31% and a significant narrowing of the gap (by 35%) with non-Indigenous children in jurisdictions with reliable data (NSW, Qld, WA, SA and the NT) (see Figure 3). In the 5-year period 2009–13, there were 621 deaths of Aboriginal and Torres Strait Islander children aged 0–4 years, and of these, 502 were infant deaths (81%). The mortality rate for Aboriginal and Torres Strait Islander children aged 0–4 years was 1.9 times the non-Indigenous rate.

In the period 2008–12, the mortality rate for Indigenous infants was 1.7 times the non-Indigenous rate (6.2 per 1,000 live births compared with 3.7 per 1,000 live births). The Indigenous infant mortality rate declined by 64% between 1998 and 2012, compared with a decline of 25% for non-Indigenous infants. The gap between mortality rates for Indigenous infants and non-Indigenous infants narrowed significantly (by 83%). In 2008–12, Aboriginal and Torres Strait Islander infant mortality rates varied across jurisdictions, from 4 per 1,000 in NSW, to 13 per 1,000 in the NT. A study in Victoria involving data linkage to improve the quality of Indigenous identification found the Indigenous infant mortality rate was nearly twice the rate for non-Indigenous infants (Freemantle et al. 2014). Data on trends from 1967 to 2006 in the NT (the only jurisdiction with adequate data quality for this period) show an 81% fall in the Indigenous infant mortality rate with rapid declines until the mid-1980s, followed by slower improvement over the past 20 years. There has been substantial improvement in the NT during the period 1967 to 2006 for both neonatal death rates (up to age 28 days) and post- neonatal death rates (from 28 days to one year) (Wang et al. 2010b).

In 2008–12 the most common causes of death for Aboriginal and Torres Strait Islander infants were conditions originating in the perinatal period (48%) such as birth trauma, foetal growth disorders, complications of pregnancy, and respiratory and cardiovascular disorders specific to the perinatal period. The second leading cause of death was signs, symptoms and ill-defined conditions (19%). This category includes SIDS, which accounted for 9% of infant deaths. The third most common cause of Indigenous infant deaths was congenital malformations accounting for 15% of infant deaths. Among older Indigenous children aged 1–4 years, injury accounted for half of the deaths. Over two-thirds of the decline in Indigenous infant mortality over the last decade is due to a reduction in deaths from signs, symptoms and ill-defined conditions (including SIDS) and certain conditions originating in the perinatal period (such as complications of pregnancy, labour and delivery, foetal growth disorders, infections and respiratory and cardiovascular disorders). For Indigenous children aged 1–4 years there was an increase in mortality rates due to injury, and declines in deaths due to diseases of the nervous system and signs, symptoms and ill-defined conditions (AIHW 2014ad).

International statistics show that indigenous infants in the US and New Zealand have higher mortality rates than infants in the general population and these gaps are similar to the gap between Aboriginal and Torres Strait Islander and non-Indigenous infants. In New Zealand the infant mortality rate for Maoris was 7 per 1,000 live births compared with 4 per 1,000 for other infants in 2011. In the United States, the mortality rate for American Indians/Alaskan Natives was 9 per 1,000 live births compared with 6 per 1,000 live births for the total population in 2009. Caution must be used in comparing data with other countries due to variations in data quality, methods applied for addressing data quality issues and definitions for identifying Indigenous Australians.

Implications

Both child and infant Indigenous mortality rates are declining. While mortality for non-Indigenous children is also declining, the gaps in mortality between Indigenous and non-Indigenous infants and children are reducing. Deaths during the neonatal period (up to 28 days), which account for 61% of infant deaths, have also fallen significantly (see measure 1.21). This significant improvement provides opportunities to understand which aspects of Aboriginal and Torres Strait Islander lives contribute to infant and child mortality and where the health system could be more effective in engaging with Aboriginal and Torres Strait Islander peoples to support healthy pregnancies and childhood development.

The key risk factors associated with infant and child mortality include low birthweight and pre-term births, maternal health and behaviours (smoking, alcohol, nutrition during pregnancy), socio-economic status, and access to health services (AIHW 2014ad). There have been improvements for Indigenous Australians for several of these risk factors in recent years, for example a 9% decline in low birthweight between 2000 and 2011 (see measure 1.01). However, there remains a significant disparity between the Indigenous and non-Indigenous rates of low birthweight (2 times higher for Indigenous), smoking during pregnancy (4 times higher), immunisation at age 1 (4 percentage points lower), and antenatal care in the first trimester (15 percentage points less). A study of avoidable mortality in the NT between 1985 and 2004 found the largest improvements in deaths were for conditions amenable to medical care such as increased number of births in hospital, improved neonatal and paediatric care and the establishment of pre-natal screening for congenital abnormalities (Li et al. 2009). The long term study in the NT from 1967 found improvements in both neonatal deaths (usually indicative of pregnancy related health and services) and post-neonatal deaths (indicative of conditions) (Wang et al. 2010b).

In December 2007, COAG committed to closing the gap in Indigenous disadvantage and, in particular, to halving the gap in mortality rates for Aboriginal and Torres Strait Islander children under 5 years of age by 2018. Australian governments are investing in a range of initiatives to improve child and maternal health. The 2014–15 Federal Budget provided funding of $94 million from July 2015 for the Better Start to Life approach to expand efforts in child and maternal health to support Indigenous children to be healthy and ready for school. The Better Start to Life approach included $54 million to increase the number of New Directions: Mothers and Babies services from 85 to 136. These services provide Aboriginal and Torres Strait Islander families with access to antenatal care, practical advice and assistance with parenting, and health checks for children. The Better Start to life approach will also provide $40 million to expand the Australian Nurse Family Partnership Program (ANFPP) from 3 to 13 sites. The ANFPP aims to improve pregnancy outcomes by helping women engage in good preventive health practices, support parents to improve their child's health and development, and help parents develop a vision for their own future, including continuing education and finding work. The 2014–15 Federal Budget also committed $25.9 million in 2014–15 for a new Indigenous Teenage Sexual and Reproductive Health and Young Parent Support measure to continue Indigenous teenage sexual and reproductive health and antenatal care services to provide information to young people to make informed decisions about their reproductive health and health behaviours during pregnancy.

Figure 1.20-1 Infant mortality rates per 1,000 live births, by Indigenous status, NSW, Qld, WA, SA and the NT, 1998 to 2012
chart showing annual infant mortality rates

Figure 1.20-1 shows annual infant mortality rates by Indigenous status over the period 1998 to 2012. The Indigenous infant mortality rate declined between 1998 and 2012 by 64%, compared with a reduction of 25% for non-Indigenous infants. The gap between Indigenous infants and non-Indigenous infants narrowed significantly (83%).

Source: ABS and AIHW analysis of National Mortality Database

Figure 1.20-2 Infant mortality rates per 1,000 live births, by Indigenous status, NT, 1967–2006
chart showing infant mortality rates per 1,000 live births

Figure 1.20-2 shows infant mortality rates per 1,000 live births by Indigenous status for the NT over the period 1967 to 2006. Data on trends from 1967 to 2006 in the NT (the only jurisdiction with adequate data quality for this period) show an 81% fall in the Indigenous infant mortality rate with rapid declines until the mid-1980s, followed by slower improvement over the past 20 years.

Note: Rates are for 4- and 5-year averages

Source: Wang et al. (2010b)

Table 1.20-1 Infant mortality rates per 1,000 live births, by Indigenous status, NSW, Qld, WA, SA and the NT, 2008–12
Jurisdiction Number of deaths
Indig.
Number of deaths
Non-Indig.
Rate per 1,000 live births
Indig.
Rate per 1,000 live births
Non-Indig.
Ratio Rate Difference
NSW 103 1,745 3.6 3.7 1.0 -
Qld 182 1,320 6.9 4.5 1.5 2.4
WA 85 396 7.3 2.8 2.6 4.4
SA 26 290 5.5 3.1 1.8 2.4
NT 97 45 12.5 3.8 3.2 8.6
Total of 5 jurisdictions 493 3,796 6.2 3.7 1.7 2.5

Source: ABS and AIHW analysis of National Mortality Database

Table 1.20-2 Causes of infant death by Indigenous status, NSW, Qld, WA, SA and the NT, 2008–12
Cause of death: Number of deaths
Indig.
Number of deaths
Non-Indig.
Rate per 1,000 live births
Indig.
Rate per 1,000 live births
Non-Indig.
Ratio Rate difference
Certain conditions originating in the perinatal period 237 1,893 3.0 1.9 1.6 1.1
Signs, symptoms & ill-defined conditions 96 386 1.2 0.4 3.3 0.9
SIDS (subcategory of Signs, symptoms etc.) 46 245 0.6 0.2 2.4 0.3
Congenital malformations 74 992 0.9 1.0 1.0 -
Other conditions 21 247 0.3 0.1 3.7 -
Diseases of the respiratory system 20 69 0.3 0.1 3.7 0.2
Infectious and parasitic diseases 19 51 0.2 0.1 2.1 0.2
Injury & poisoning 17 104 0.2 0.1 2.1 0.1
Diseases of the circulatory system 9 72 0.1 0.1 1.6 -
Total 493 3,796 6.2 3.7 1.7 2.5

Source: ABS and AIHW analysis of National Mortality Database