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1.21 Perinatal mortality

Why is it important?

The perinatal mortality rate includes foetal deaths (stillbirths) and deaths of live-born babies within the first 28 days after birth. Almost all of these deaths are due to factors that occur during pregnancy and childbirth. Perinatal mortality reflects the health status and health care of the general population, access to and quality of preconception, reproductive, antenatal and obstetric services for women, and health care in the neonatal period. Broader social factors such as maternal education, nutrition, smoking, alcohol use in pregnancy, and socio-economic disadvantage are also significant.

Findings

Reliable data on foetal and neonatal deaths for Aboriginal and Torres Strait Islander peoples are only available for NSW, Qld, WA, SA and the NT. Based on the combined data for these jurisdictions for the period 2008–12, the perinatal mortality rate for Aboriginal and Torres Strait Islander babies was around 9.6 per 1,000 births compared with 8.1 per 1,000 births for non-Indigenous babies. Foetal deaths (stillbirths) account for around 60% of perinatal deaths for Aboriginal and Torres Strait Islander babies and 67% of perinatal deaths for non-Indigenous Australian babies.

Due to small numbers, time-series data for perinatal mortality are volatile. The perinatal mortality rate for Aboriginal and Torres Strait Islander peoples decreased by around 52% between 1998 and 2012—an average yearly decline of 0.7 deaths per 1,000 births. The perinatal mortality rate for non-Indigenous Australians also decreased, but by a smaller amount, so that the gap between Indigenous Australians and non-Indigenous Australians decreased significantly over this period. Foetal death rates for Indigenous Australians declined by 44% and neonatal deaths by 61%. Estimated rates for perinatal mortality vary between jurisdictions from 3.7 deaths per 1,000 births to Aboriginal and Torres Strait Islander mothers in SA, to 18 per 1,000 births in the NT. The largest gap was in the NT with Indigenous rates 2.6 times the non-Indigenous rates. Indigenous perinatal mortality rates were lower than non-Indigenous rates in NSW and SA.

The two leading causes of Aboriginal and Torres Strait Islander perinatal mortality were premature birth/ inadequate foetal growth and a group of conditions originating in the perinatal period including birth trauma and disorders specific to the foetus/newborn (together accounting for 72% of deaths). Congenital malformations, deformations and chromosomal abnormalities were the third most common group of conditions (15%). The main conditions in the mother leading to perinatal deaths were complications of pregnancy (14%) followed by complications of the placenta, cord and membranes (13%). A higher proportion of deaths in the first 28 days were due to disorders related to length of gestation and foetal growth (36% Indigenous compared with 31% non-Indigenous) and a lower proportion due to congenital malformations (19% Indigenous compared with 28% non-Indigenous).

Implications

Reductions in perinatal mortality rates among Indigenous Australians have occurred since the 1990s. Rates of low birthweight for Aboriginal and Torres Strait Islander babies have improved by 9% between 2000 and 2011 (see measure 1.01). A study of avoidable mortality in the NT between 1985 and 2004 found a significant improvement in mortality for conditions amenable to medical care for Indigenous Australians in the NT, including perinatal survival. The authors noted that a broad range of medical care improvements such as an increased number of births in hospital, improved neonatal and paediatric care, and the establishment of pre-natal screening for congenital abnormalities have likely contributed to this improvement (Li et al. 2009). Due to small numbers it is not possible to detect statistically significant changes in particular causes of perinatal deaths.

Enhanced primary care services and continued improvement in antenatal care have the capacity to support improvements in the health of the mother and baby. Recognising this, the 2014–15 Federal Budget provides 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 includes $54 million to increase the number of sites providing 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; supporting parents to improve their child's health and development; and helping parents develop a vision for their own future, including continuing education and finding work. A study of the impact of the US Nurse Family Partnership programme, on which the ANFPP is modelled, has shown reductions in all-cause mortality among mothers and preventable-cause mortality in children in disadvantaged settings (Olds et al. 2014).

The 2014–15 Federal Budget also commits $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. Implemented by states and territories, these services will provide information to young people to make informed decisions about their reproductive health and health behaviours during pregnancy in order to influence the health of young mothers and their babies.

State and territory governments provide a comprehensive range of services that aim to improve child and maternal health and prevent perinatal mortality. For example, in the ACT the Aboriginal Midwifery Access Program is provided through the Winnunga Nimmityjah Aboriginal Health Service. This programme offers antenatal and postnatal care, communityat home support, baby health checks, breastfeeding support, immunisations, and a range of women's health services. Improvements in social, environmental and behavioural factors are also needed to achieve healthy outcomes for mothers and their babies.

Figure 1.21-1 Perinatal mortality rate by Indigenous status, NSW, Qld, SA, WA and the NT, 1998 to 2012
chart showing perinatal mortality rate per 1,000 births

Figure 1.21-1 shows the perinatal mortality rate per 1,000 births for Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians in NSW, Qld, SA, WA and NT over the period 1998 to 2012. Due to small numbers, time series data for perinatal mortality are volatile. The perinatal mortality rate for Aboriginal and Torres Strait Islander peoples decreased by around 52% between 1998 and 2012—an average yearly decline of 0.7 deaths per 1,000 births. The perinatal mortality rate for non-Indigenous Australians also decreased, but by a smaller amount, so that the gap between Indigenous Australians and non-Indigenous Australians decreased significantly over this period.

Source: ABS and AIHW analysis of National Mortality Database

Figure 1.21-2 Perinatal mortality rate by state/territory and Indigenous status, 2008–12
chart showing the perinatal mortality rate per 1,000 births

Figure 1.21-2 shows the perinatal mortality rate per 1,000 births for Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians for the period 2008–2012. Data is presented separately for NSW, Queensland, WA, SA, NT, and the total for these 5 jurisdictions. Estimated rates for perinatal mortality vary between jurisdictions from 3.7 deaths per 1,000 births to Aboriginal and Torres Strait Islander mothers in SA, to 18 per 1,000 births in the NT. The largest gap was in the NT with Indigenous rates 2.6 times the non-Indigenous rates. Indigenous perinatal mortality rates were lower than non-Indigenous rates in NSW and SA.

Source: ABS and AIHW analysis of National Mortality Database

Figure 1.21-3 Child and infant mortality, Aboriginal and Torres Strait Islander peoples, 2008–12
chart showing numbers of child and infant deaths

Figure 1.21-3 shows numbers of child and infant deaths for Aboriginal and Torres Strait Islander peoples broken down by age. In the period 2008 to 2012 there were 749 perinatal deaths consisting of 447 foetal deaths (age at least 20 weeks gestation) and 300 neonatal deaths (occuring from birth to 28 days). There were 493 infant deaths, which occur from birth to one year, and 117 child deaths of those aged 1-4 years. The total number of child deaths (aged 0 to 4 years) was 610.

Source: ABS and AIHW analysis of National Mortality Database

Table 1.21-1 Proportion of deaths for perinatal babies by underlying cause of death and Indigenous status, NSW, Qld, WA, SA and NT, 2008–12
Cause of death: Foetal deaths
Indig.
Foetal deaths
Non-Indig.
Neonatal deaths
Indig.
Neonatal deaths
Non-Indig.
Perinatal deaths
Indig.
Perinatal deaths
Non-Indig.
Main condition in the fetus/infant:
Other conditions originating in the perinatal period 48.3% 48.1% 18.3% 20.8% 36.3% 39.1%
Disorders related to length of gestation and fetal growth 35.2% 30.3% 36.3% 30.8% 35.6% 30.5%
Congenital malformations, deformations and chromosomal abnormalities 12.5% 16.2% 19.0% 27.6% 15.1% 19.9%
Respiratory and cardiovascular disorders 3.3% 4.2% 15.7% 11.2% 8.3% 6.5%
Infections n.p. 0.7% 5.0% 3.7% 2.4% 1.7%
Other conditions 0% 0.5% 5.7% 5.8% 2.3% 2.3%
Main condition in the mother:
Complications of placenta, cord and membranes 13.1% 14.9% 12.7% 11.9% 13.0% 13.9%
Maternal complications of pregnancy 10.7% 10.1% 18.7% 19.5% 13.9% 13.2%
Maternal conditions that may be unrelated to present pregnancy 9.8% 5.3% 5.3% 5.7% 8.0% 5.4%
Complications of labour and delivery and noxious influences transmitted via placenta or breast milk 5.8% 5.7% 4.7% 8.2% 5.3% 6.5%
Total deaths (Number) 449 5,515 300 2,685 749 8,200

Source: AIHW analysis of ABS Deaths Registration Database