Why is it important?:Serious, sometimes life-threatening, complications occasionally occur during pregnancy and childbirth. The death of a woman as a result of pregnancy or childbirth is now a rare event in Australia, but in developing countries a considerable risk of serious damage or death with each pregnancy continues to exist (IIMMHR 2010). Improvements in the general health and fitness of Australian women, and advances in medical care during the twentieth century, have reduced the frequency and consequences of complications during pregnancy and childbirth for both mothers and babies.
The risk of death from complications of pregnancy and childbirth has also been reduced for Aboriginal and Torres Strait Islander women, but not to the same level as for other Australian women. The maternal mortality rate for Aboriginal and Torres Strait Islander women remains higher than for other Australian women; although deaths as a result of pregnancy or childbirth are also rare for Aboriginal and Torres Strait Islander women, they are not as rare as they should be.
Findings:The maternal mortality rate is the total of direct, indirect and incidental maternal deaths. A direct maternal death is one caused by complications of the pregnancy itself. An indirect maternal death is the death of a woman during or shortly after pregnancy as the result of a disease that did not arise because of the pregnancy (e.g. heart disease, diabetes, renal disease) but was made worse by the physiological effects of pregnancy. An incidental death is the death of a woman as the result of a condition or event that occurred during pregnancy, where the pregnancy is unlikely to have contributed significantly to the death, such as cancer or a motor vehicle accident.
In the period 2003–05, there were 6 maternal deaths of Aboriginal and Torres Strait Islander women—2 direct maternal deaths and 4 indirect maternal deaths. These deaths accounted for 10% of the 60 maternal deaths where Indigenous status was known.
The maternal mortality rate for Aboriginal and Torres Strait Islander women was 23 per 100,000 confinements in 1991–93, 17 in 1994–96, 24 in 1997–99, 46 in 2000–02 and 22 in 2003–05. The maternal mortality rates for Indigenous women were between 2 and 5 times the maternal mortality rate for non-Indigenous women in these periods. The rate leveled out in the last three-year cycle, but this could be due to random variation.
The small number of deaths and problems in under-identification of Aboriginal and Torres Strait Islander mothers in the numerator (maternal deaths) and denominator (number of confinements) makes it difficult to interpret trends.
Implications:If Aboriginal and Torres Strait Islander women had the same maternal mortality rate as other Australian women, there would have been 9 maternal deaths of Aboriginal and Torres Strait Islander women between 1991 and 2005 rather than the 33 that actually occurred. Therefore, in this 15-year period, there were 24 excess maternal deaths of Aboriginal and Torres Strait Islander women, an average of 1or 2 excess deaths per year. Detecting changes in maternal mortality is difficult when the average number of maternal deaths amongst Aboriginal and Torres Strait Islander women each year is fewer than 10.
The excessive maternal mortality rate among Aboriginal and Torres Strait Islander women is an indicator that their health and wellbeing during pregnancy is not what it should be.
Timely access to safe and effective medical interventions is essential to achieving the best possible outcomes for Aboriginal and Torres Strait Islander women during pregnancy and childbirth. However, obstetric medical services to treat serious illness when it arises during pregnancy and childbirth is only part of the answer.
Strategies that improve the overall health of Aboriginal and Torres Strait Islander women before, during and after pregnancy will all have an impact on improving their pregnancy outcomes and the health and future prospects of their babies. A focus on improved antenatal care is also relevant here (see measure 3.01).
Programs seeking to improve child and maternal health include the COAG National Partnership Agreement on Indigenous Early Childhood Development and the New Directions: Mothers and Babies Services program. These 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 maternal mortality, and effect positive life-course decisions.
Figure 64 – Maternal mortality rates and rate ratios by Indigenous status, 1991–1993 to 2003–2005
Note: Includes direct and indirect deaths only.
Source: National Maternal Deaths Data Collection
Text description of figure 64 (TXT 1KB)
Table 36 – Number of maternal deaths and maternal mortality rates, by Indigenous status, 1991–1993 to 2003–2005
Aboriginal & Torres Strait Islander :
Non-Indigenous maternal mortality rate per 100,000 confinements
Direct & indirect deaths
Maternal mortality rate per 100,000 confinements
Sources: Slaytor et al. 2004; Sullivan et al. 2008; Sullivan & King 2006