Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework - 2010

1.19 Infant mortality

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Why is it important?:

Infant mortality 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 Indigenous children under 5 years by 2018. Infant mortality contributes 82% of mortality for children under 5 years of age. It reflects the health status and health care of the population, the effectiveness of preventive care and the attention paid to child and maternal health, as well as broader social factors such as socioeconomic deprivation, maternal education, smoking and other behavioural risk factors (NIHEC 2010a). 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 SIDS.

In the Aboriginal and Torres Strait Islander population, dramatic reductions in post-neonatal infant mortality, such as in the Northern Territory in the 20 years up to the late 1980s, reflected improved access to primary health care (including antibiotics for acute infection) and earlier evacuation to hospital for severe illness. However, infant mortality remains high for Aboriginal and Torres Strait Islander peoples because many have not benefitted from the improved physical and social environment that most other Australians achieved more than fifty years ago.

Findings:

Infant mortality is the death of infants in the first year of life. Reliable data on infant mortality for Aboriginal and Torres Strait Islander peoples are only available for WA, SA, NT, Qld and now NSW. For these five jurisdictions combined, for the period 2004–08, infant mortality for Aboriginal and Torres Strait Islander infants was 10 per 1,000 live births, compared with 4 for non-Indigenous infants. Rates were higher for Indigenous male infants (11 per 1,000 live births) compared with Indigenous female infants (8 per 1,000).

The most common cause of death for Aboriginal and Torres Strait Islander infants between 2004 and 2008 were conditions originating in the perinatal period (46%) such as birth trauma, fetal growth, 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 7% of infant deaths. The third most common cause was congenital malformations accounting for 13% of infant deaths.

Over this period in these jurisdictions there were 566 deaths of Indigenous infants, around 2 times the rate for non-Indigenous children in this age group. Around 79% of the gap between Indigenous and non-Indigenous child deaths was caused by three groups of conditions: conditions originating in the perinatal period; signs, symptoms and ill-defined conditions includ­ing SIDS; and congenital malformations.

In the period 2004–08, infant mortality rates varied across jurisdictions, from 8 per 1,000 in New South Wales and South Australia, to 15 per 1,000 in the Northern Territory.

Data on longer-term time-trends are available for Western Australia, South Australia and the Northern Territory. For these three jurisdictions, the Aboriginal and Torres Strait Islander infant mortality rate declined between 1991 and 2008 by 55%, compared with a reduction of 43% for non-Indigenous infants and the gap has closed significantly. Recent trends (2001–08) for these three jurisdictions combined with New South Wales and Queensland show a 32% decline in Indigenous infant mortality rates. Over this period the gap in rates between Indigenous and non-Indigenous declined from around 6.3 to 3.8 infant deaths per 1,000 live births.

International statistics show that indigenous infants in the US, Canada and New Zealand have higher mortality rates than infants in the general population but the gap is not as great as for Aboriginal and Torres Strait Islander infants (Smylie & Adomako 2009).

Implications:

The infant mortality rate for Aboriginal and Torres Strait Islander infants is declining. While infant mortality for other Australian infants is also declining the gap in infant mortality between Indigenous and other Australian infants is reducing in both absolute and relative terms. Improvements have been most notice­able in the jurisdictions with the highest rates (Northern Territory and Western Australia).

The improvement in Aboriginal and Torres Strait Islander infant mortality rates is partly due to reduced perinatal mortality (i.e. deaths in the first 28 days after birth; see measure 1.20) and reduced mortality of infants after the perinatal period. Deaths during the perinatal period are due predominantly to problems during pregnancy and birth, while in the post-neonatal period (1–11 months of age), nutritional and environmental problems predominate.

The birthweight of Aboriginal and Torres Strait Islander babies does not appear to be improving (see measure 1.01) suggesting there are still significant opportunities to improve maternal health during pregnancy and consequently, in the growth and development of the baby in-utero. It may be that the improvements in infant mortal­ity are predominantly due to improvements in acute care for seriously ill new-born babies rather than reduced problems during pregnancy; and in post-natal factors such as nutrition and growth, environment and infectious diseases, and access to primary health and acute care. This suggests that some improvements in post-natal factors have been realised in recent years (and need to continue) but that the overall burden of disease within the child-bearing population and during pregnancy needs more attention. In December 2007, COAG committed to closing the gap in Indigenous disadvantage, and in par­ticular, to halving the gap in mortality rates for Indige­nous children under 5 years by 2018. In October 2008, COAG signed the National Partnership Agreement on Indigenous Early Childhood Development with joint funding of $564 million over six years to address the needs of Indigenous children in their early years. The Australian Government’s New Directions: Mothers and Babies Services provide Aboriginal and Torres Strait Islander children and their mothers with access to antenatal care; standard information about baby care; practical advice and assistance with parenting; monitor­ing of developmental milestones by a primary health care service; and health checks for children. The Australian Nurse Family Partnership Program is focused on providing sustained home visiting to selected Indigenous communities across Australia and aims to improve pregnancy outcomes and childhood development including reducing infant mortality, and effect positive life course decisions.


Figure 53 – Infant mortality rates, Aboriginal and Torres Strait Islander infants and other Australians, WA, SA and NT, 1991–2008, NSW, Qld, WA, SA and NT, 2001–2008


Figure 53 – Infant mortality rates, Aboriginal and Torres Strait Islander infants and other Australians, WA, SA and NT, 1991–2008, NSW, Qld, WA, SA and NT, 2001–2008
Source: ABS and AIHW analysis of ABS Mortality Database
Text description of figure 53 (TXT 1KB)

Figure 54 – Indigenous infant mortality rates per 1,000 live births, Qld, WA, SA and NT, 1996–1998, 1999–2001, 2002–2004, 2005–2006 and 2007–08


Figure 54 – Indigenous infant mortality rates per 1,000 live births, Qld, WA, SA and NT, 1996–1998, 1999–2001, 2002–2004, 2005–2006 and 2007–08
Source: ABS and AIHW analysis of ABS Mortality Database
Text description of figure 54 (TXT 1KB)

Table 28 –Infant mortality rates per 1,000 live births, by Indigenous status, NSW Qld, WA, SA and NT, 2004–2008

Jurisdiction
Number of deaths
Rate per 1,000 live births
Ratio
Rate Difference
Indig.
Non-Indig.
Indig.
Non-Indig.
NSW 1401,876 7.84.4
1.8
3.4
Qld 1781,201 9.24.7
2.0
4.5
WA 106410 10.63.3
3.2
7.3
SA 27311 8.03.6
2.2
4.4
NT 11548 14.94.4
3.4
10.5
Total of 5 jurisdictions 566 3,846 9.7 4.3
2.3
5.4
Source: ABS and AIHW analysis of ABS Mortality Database

Table 29 – Causes of infant death by Indigenous status, NSW, Qld, WA, SA and NT, 2004–2008

Cause of death:
Number of deaths
Rate per 1,000 live births
Ratio
Indig.
Non-Indig.
Indig.
Non-Indig.
Certain conditions originating in the perinatal period 262 1,884 4.4 2.1
2.1
Signs, symptoms & ill-defined conditions 109 407 1.8 0.4
4.1
SIDS (subcategory of Signs, symptoms etc) 39 206 0.7 0.2
2.9
Congenital malformations 75 965 1.3 1.1
1.2
Diseases of the respiratory system 33 98 0.6 0.1
5.2
Injury & poisoning 29 103 0.5 0.1
4.3
Infectious and parasitic diseases 8 44 0.1 -
2.8
Diseases of the circulatory system 16 68 0.3 0.1
3.6
Other conditions 34 277 0.6 0.3
1.9
Total 566 3,846 9.7 4.3
2.3
Source: ABS and AIHW analysis of ABS Mortality Database

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