Aboriginal and Torres Strait Islander Health Performance Framework - 2010
1.20 Perinatal mortality
Why is it important?:he perinatal mortality rate includes fetal deaths (stillbirths) and deaths of live-born babies within the first 28 days after birth. Almost all of these deaths are due to factors 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.
Perinatal mortality rates are higher for Aboriginal and Torres Strait Islander peoples than for other Australians, indicating that the health status of, and/or health care available to, Aboriginal and Torres Strait Islander mothers is lower than that for other Australian women.
Findings:Reliable data on fetal and neonatal deaths for Aboriginal and Torres Strait Islander peoples are only available for Queensland, Western Australia, South Australia, the Northern Territory and now New South Wales. Over the period 2004–2008 the perinatal mortality rate for Aboriginal and Torres Strait Islander babies was around 13 per 1,000 births compared with 9 per 1,000 births for other Australian babies. Fetal deaths (stillbirths) account for around 58% of perinatal deaths for Indigenous babies and 66% of perinatal deaths for other Australian babies.
The perinatal mortality rate for Aboriginal and Torres Strait Islander peoples decreased by around 34% between 1999 and 2008—an average yearly decline of 0.6 deaths per 1,000 births. The perinatal mortality rate for other Australians also decreased, but by a smaller amount, so that the gap between Aboriginal and Torres Strait Islander peoples and other Australians decreased significantly in both absolute and relative terms over this period.
Estimated rates vary between jurisdictions from 10 deaths per 1,000 births to Indigenous mothers in NSW to 21 per 1,000 births in the Northern Territory. Declines in perinatal mortality were observed for all states and territories included in the analysis.
The most common causes of perinatal mortality were a group of conditions originating in the perinatal period (37%), including birth trauma and disorders specific to the fetus/newborn. Premature birth/inadequate fetal growth were contributing factors in 33% of perinatal deaths in Aboriginal and Torres Strait Islander peoples (compared with 29% of other perinatal deaths). Congenital malformations, deformations and chromosomal abnormalities were the third most common group of conditions (13% for Indigenous and 19% for others). The main conditions in the mother leading to perinatal deaths were complications of the placenta, cord and membranes (18%) followed by complications of pregnancy (13%).
Implications:There have been reductions in perinatal mortality rates for Aboriginal and Torres Strait Islander peoples since the 1990s. In contrast, rates of low birthweight for Aboriginal and Torres Strait Islander babies are increasing (see measure 1.01). It may be that the improvement in the perinatal mortality rate for Aboriginal and Torres Strait Islander babies is predominantly due to improved acute care, which has reduced deaths during late pregnancy and following birth, rather than improvements in the health of mothers during pregnancy and improvements in the growth and development of babies in-utero.
There are insufficient data available to assess whether the decrease in perinatal mortality has occurred because of decreases in particular causes of death.
Enhanced primary care services and continued improvement in antenatal care for Aboriginal and Torres Strait Islander women is very important to achieve further reductions in perinatal mortality rates. Australian governments are investing in a range of initiatives to improve child and maternal health. In October 2008, COAG agreed to 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 perinatal mortality, and effect positive life course decisions.
The Healthy for Life program encourages behavioural change during pregnancy and includes the monitoring of maternal use of tobacco, alcohol and illicit drugs.
Improvements in socioeconomic, environmental and behavioural factors are also needed to achieve healthy outcomes for Aboriginal and Torres Strait Islander mothers and their babies.
Figure 55 – Perinatal mortality rate by Indigenous status, NSW, Qld, WA, SA and NT, 1999 to 2008
Source: AIHW analysis of ABS Deaths Registration Database
Text description of figure 55 (TXT 1KB)
Figure 56 – Perinatal mortality rate for Aboriginal and Torres Strait Islander children, NSW, Qld, WA, SA and NT 1999–2003 and 2004–2008
Source: AIHW analysis of ABS Deaths Registration Database
Text description of figure 56 (TXT 1KB)
Table 30 – Proportion of deaths for perinatal babies by underlying cause of death and Indigenous status, NSW, Qld, WA, SA and NT, 2004–2008
|Cause of death:|
|Main condition in the fetus/infant:|
|Disorders related to length of gestation and fetal growth|
|Respiratory and cardiovascular disorders|
|Other conditions originating in the perinatal period|
|Congenital malformations, deformations and chromosomal abnormalities|
|Main condition in the mother:|
|Complications of placenta, cord and membranes|
|Maternal complications of pregnancy|
|Maternal conditions that may be unrelated to present pregnancy|
|Complications of labour and delivery and noxious influences transmitted via placenta or breast milk|
|Total deaths (Number)|