Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 1—Deaths—1.21 Perinatal mortality

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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 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 socioeconomic 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 2006–10, the perinatal mortality rate for Aboriginal and Torres Strait Islander babies was around 12 per 1,000 births compared with 8 per 1,000 births for other Australian babies. Foetal deaths (stillbirths) account for around 58% of perinatal deaths for Aboriginal and Torres Strait Islander babies and 66% of perinatal deaths for other 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 62% between 1991 and 2010—an average yearly decline of 0.9 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. Foetal deaths declined by 27% and neonatal deaths by 22%.

Estimated rates for perinatal mortality vary between jurisdictions from 5 deaths per 1,000 births to Aboriginal and Torres Strait Islander mothers in SA, to 21 per 1,000 births in the NT.

The most common causes of Aboriginal and Torres Strait Islander perinatal mortality were premature birth/inadequate foetal growth (39%). In 35% of perinatal deaths, a group of conditions originating in the perinatal period including birth trauma and disorders specific to the foetus/newborn were contributing factors. Congenital malformations, deformations and chromosomal abnormalities were the third most common group of conditions (12%). The main conditions in the mother leading to perinatal deaths were complications of the placenta, cord and membranes (13%) followed by complications of pregnancy (12%). A higher proportion of neonatal deaths were due to disorders related to length of gestation and foetal growth (41%) and a lower proportion due to congenital malformations (17%) compared to non-Indigenous neonatal deaths (33% and 26% respectively).

Implications:

Reductions in perinatal mortality rates among Aboriginal and Torres Strait Islander peoples have occurred since the 1990s. Rates of low birthweight for Aboriginal and Torres Strait Islander babies have improved by 7% between 2000 and 2009 (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 prenatal screening for congenital abnormalities have likely contributed to this improvement (Li et al. 2009a).

Due to the small numbers involved 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. 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 This includes Australian Government funding to state and territory governments for sexual health and young parent programs and support for 85 New Directions: Mothers and Babies Services which provide Aboriginal and Torres Strait Islander families with access to antenatal care; practical advice and assistance with parenting; and health checks for children. In addition, the Australian Nurse Family Partnership Program, with over 400 families enrolled in the program, provides sustained home visiting in three Indigenous communities and aims to improve pregnancy outcomes and childhood development, including reducing perinatal mortality, and to effect positive life course decisions.Top of page

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 program offers antenatal and postnatal care, community at home support, baby health checks, breastfeeding support, immunisations, and a range of women's health services.

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 social, environmental and behavioural factors are also needed to achieve healthy outcomes for mothers and their babies.
Figure 71—Perinatal mortality rate by Indigenous status, SA, WA and the NT, 1991-2010
Figure 71—Perinatal mortality rate by Indigenous status, SA, WA and the NT, 1991-2010
Source: AIHW analysis of ABS Deaths Registration Database
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Figure 72—Perinatal mortality rate by state/territory and Indigenous status, 2006–10

Figure 72—Perinatal mortality rate by state/territory and Indigenous status, 2006–10
Source: AIHW analysis of ABS Deaths Registration Database
Table 22—Proportion of deaths for perinatal babies by underlying cause of death and Indigenous status, NSW, Qld, WA, SA and the NT, 2006–10
Total deaths
Cause of deathFoetal deaths—Indigenous (%)Foetal deaths—non-Indigenous
(%)
Neonatal deaths—Indigenous (%)Neonatal deaths—non-Indigenous (%)Perinatal deaths—Indigenous (%)Perinatal deaths—non-Indigenous (%)
Total deaths (Number)
472
5,290
338
2,779
810
8,069
Main condition in the fetus/infant:Top of page
Cause of deathFoetal deaths—Indigenous (%)Foetal deaths—non-Indigenous
(%)
Neonatal deaths—Indigenous (%)Neonatal deaths—non-Indigenous (%)Perinatal deaths—Indigenous (%)Perinatal deaths—non-Indigenous (%)
Disorders related to length of gestation and fetal growth
37.5
37.1
40.5
32.8
38.8
35.6
Other conditions originating in the perinatal period
48.9
44.7
15.1
18.9
34.8
35.8
Congenital malformations, deformations and chromosomal abnormalities
8.9
13.3
17.2
26.0
12.3
17.7
Respiratory and cardiovascular disorders
3.8
4.0
14.8
12.9
8.4
7.1
Infections
0.6
0.6
5.3
3.2
2.6
1.5
Other conditions
0.2
0.3
7.1
6.3
3.1
2.4
Main condition in the mother
Cause of deathFoetal deaths—Indigenous (%)Foetal deaths—non-Indigenous
(%)
Neonatal deaths—Indigenous (%)Neonatal deaths—non-Indigenous (%)Perinatal deaths—Indigenous (%)Perinatal deaths—non-Indigenous (%)
Complications of placenta, cord and membranes
12.9
13.6
11.8
10.6
12.5
12.5
Maternal complications of pregnancy
9.7
9.7
14.5
16.0
11.7
11.9
Maternal conditions that may be unrelated to present pregnancy
8.5
4.8
6.5
4.9
7.7
4.8
Complications of labour and delivery and noxious influences transmitted via placenta or breast milk
3.4
3.1
3.0
4.9
3.2
3.7
Source: AIHW analysis of ABS Deaths Registration Database
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