Focus group: First Nations women and their babies
In order to present detailed and robust statistics for this focus group, data for 2 years – 2020 and 2021 – are combined.
This section presents data on Aboriginal and Torres Strait Islander (First Nations) mothers and their babies where perinatal death occurred. Perinatal death includes where the baby died during pregnancy (stillbirth) as well as soon after birth (neonatal death). Perinatal death is unlikely for most women. In 2020–2021, babies born to First Nations women accounted for 5.0% of all births and 8.7% of all perinatal deaths (8.3% of stillbirths and 9.7% of neonatal deaths).
Trends in perinatal mortality rates
Trends in this section cover the period from 2005 onwards as data on Indigenous status are missing from some states and territories prior to 2005.
The rate of perinatal death for babies born to First Nations women shows two distinct trends in the period from 2005. A downward trend is observed up to 2015, with the rate decreasing from 19.1 to 12.0 deaths per 1,000 births. In the period since 2015 – which represented a 17-year low-point – the rates have shown an upward trend, reaching 17.3 deaths per 1,000 births in 2021 (Figure 1).
Similar trends are observed for the rate of stillbirth, which show an upward trend from 8.3 stillbirths per 1,000 births in 2015 to 13.1 in 2021. The national stillbirth rate has varied between 6.7 and 7.7 stillbirths per 1,000 births over the same period.
In contrast, rates of neonatal death show a single trend in the period from 2005 to 2021, decreasing from 7.4 to 4.3 deaths per 1,000 live births. This is a larger relative decrease (41% decrease for babies born to First Nations women) than the trend observed for the overall population, which decreased from 3.2 to 2.4 neonatal deaths per 1,000 live births over this period (27% decrease). However, it is important to note that there has also been a 57% increase in the number of babies born to First Nations mothers over the same period (9,865 live births in 2005 to 15,473 in 2021). This change might be a factor in the decreasing neonatal death rates, and is an area of interest for further exploration.
Figure 1: Perinatal mortality rates among babies born to First Nations women, 2005–2021
Rates of stillbirth, neonatal death, and overall perinatal death between 2005 and 2021 among babies born to First Nations women.
| Year | Perinatal deaths | Stillbirths | Neonatal deaths |
|---|---|---|---|
| 2005 | 19.1 | 11.8 | 7.4 |
| 2006 | 18.8 | 11.7 | 7.2 |
| 2007 | 20.1 | 13.3 | 6.9 |
| 2008 | 17.3 | 11.2 | 6.2 |
| 2009 | 18.4 | 11.9 | 6.5 |
| 2010 | 18 | 11.1 | 7 |
| 2011 | 19.4 | 13.3 | 6.2 |
| 2012 | 14.9 | 10.8 | 4.1 |
| 2013 | 17.3 | 10.9 | 6.5 |
| 2014 | 14.3 | 8.8 | 5.5 |
| 2015 | 12 | 8.3 | 3.7 |
| 2016 | 14.7 | 10.5 | 4.3 |
| 2017 | 16.4 | 10.8 | 5.7 |
| 2018 | 16.5 | 11.5 | 5 |
| 2019 | 14.8 | 10.4 | 4.4 |
| 2020 | 17 | 11.9 | 5.2 |
| 2021 | 17.3 | 13.1 | 4.3 |
Notes:
- The rate is the number of deaths per 1,000 births. Stillbirth and perinatal mortality rates were calculated using total births (live births and stillbirths). Neonatal mortality rates were calculated using live births.
- Data from Victoria are not available for 2009 so have been excluded from both the numerator and denominator.
Source:
AIHW analysis of the National Perinatal Mortality Data Collection and the National Perinatal Data Collection
|
Data source overview
Maternal characteristics
This section presents data on the mother’s demographic and medical characteristics that have been commonly associated with stillbirth or neonatal death for First Nations women.
While these characteristics are more commonly found in women with pregnancies that result in stillbirth and neonatal death, it is not implied that they are the cause of perinatal death.
It is also important to note that many of the associations noted in this section (see Figure 2) are similar to those observed for all perinatal deaths in Australia (see Stillbirths and neonatal deaths: Maternal characteristics for more details).
The overall rate of perinatal mortality among babies born to First Nations women in 2020–2021 was 17 deaths per 1,000 births. Rates of perinatal death were higher among women:
- who had pre-existing diabetes (52 deaths per 1,000 births)
- who were aged over 40 (33 deaths per 1,000 births)
- who had a previous stillbirth (32 deaths per 1,000 births)
- who have had 4 or more previous births (27 deaths per 1,000 births)
- in Remote and very remote areas (24 deaths per 1,000 births)
- who reported smoking during pregnancy (20 deaths per 1,000 births)
- in the most disadvantaged areas (20 deaths per 1,000 births)
- who were Torres Strait Islander (19 deaths per 1,000 births).
Detailed data on perinatal mortality rates by selected maternal characteristics can be explored in the interactive data visualisation below (Figure 2), with data also presented in Table 12 of the supplementary data tables (Data tables: National Perinatal Mortality Data Collection annual update 2021).
Figure 2: Perinatal mortality rates for babies born to First Nations mothers, by selected maternal characteristic, 2020–2021
Rates of perinatal death in 2020-2021 for babies of First Nations mothers, by various maternal characteristics including mother's age.
Baby characteristics
This section presents data on characteristics of the babies born to First Nations women where perinatal death occurred. These characteristics include gestational age (the duration of the pregnancy in completed weeks), birthweight, and birthweight for gestational age.
The length of pregnancy and the weight of the baby are often related. Using birthweight for gestational age allows for differences in a baby's growth and maturity to be considered in relation to health outcomes. For example, a baby may be small because it has been born early, or it may be small for its gestational age when compared with other babies of the same age. It might be small due to genetic factors, or because of a growth restriction within the uterus. Babies are considered small for gestational age when their birthweight is below the 10th percentile for their gestational age and sex.
Many of the rates and associations noted in this section (see Figure 3) are similar to those observed for all perinatal deaths in Australia (see Stillbirths and neonatal deaths: Baby characteristics for more details).
In 2020–2021, the rate of perinatal deaths in babies born to First Nations women was highest for:
- babies born at less than 23 weeks’ gestation (over 990 deaths per 1,000 births)
- babies born with a birthweight less than 2,500 grams (just under 110 deaths per 1,000 births)
- babies who were small for gestational age (29 deaths per 1,000 births)
- multiple births (29 deaths per 1,000 births).
Detailed data on perinatal mortality rates by birthweight, gestational age and plurality can be explored in the interactive data visualisation below (Figure 3), with data also presented in Table 13 of the supplementary data tables (Data tables: National Perinatal Mortality Data Collection annual update 2021).
Figure 3: Perinatal mortality rates for babies born to First Nations mothers, by selected baby characteristic, 2020–2021
Rates of perinatal death in 2020-2021 for babies of First Nations mothers, by characteristics of the baby and pregnancy including birthweight and gestational age.
Timing of perinatal death
In babies born to First Nations women, over half (57%) of perinatal deaths occurred prior to the onset of labour (antepartum stillbirths; Figure 4).
Figure 4: Number of perinatal deaths among babies born to First Nations women, by timing of death, 2020–2021
Number of perinatal deaths in 2020-2021 among babies born to First Nations women, by timing of death. Antepartum deaths were most common, accounting for 272 perinatal deaths.
| Timing of perinatal death | Number of perinatal deaths |
|---|---|
| Antepartum | 272 |
| Intrapartum | 64 |
| Very early neonatal (less than 1 day) | 76 |
| Early neonatal (1–7 days) | 38 |
| Late neonatal (8–28 days) | 28 |
Source:
AIHW analysis of the National Perinatal Mortality Data Collection
|
Data source overview
Causes of death
Classifying cause of death
Causes of perinatal deaths are classified according to the Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Classification System, version 3.0, as part of each state or territory’s perinatal mortality review process. This system is a way of grouping the causes of perinatal death to better understand and prevent them in the future.
The PSANZ Perinatal Mortality Classification System has two different classifications. The first is the Perinatal Death Classification (PSANZ-PDC), which includes maternal and fetal causes and is applied to all perinatal deaths (stillbirths and neonatal deaths). The second is the Neonatal Death Classification (PSANZ-NDC), which includes neonatal causes and is applied to neonatal deaths only. It is used in addition to the Perinatal Death Classification.
Refer to Technical notes – Definitions for more information on cause of death classifications.
The most common causes of perinatal death among babies born to First Nations women in 2020–2021 were split almost evenly across three different causes. The most common cause was ‘spontaneous preterm labour’ (20%), followed by ‘congenital anomaly’ (19%) (Figure 5). The third most common cause of death was ‘maternal conditions’ (17%), which includes medical conditions (for example, diabetes), surgical conditions (for example, appendicitis) and injuries, as well as complications or treatment of that condition.
The most common causes of stillbirths and neonatal deaths were different. For stillbirths, the most common cause was ‘maternal conditions’ (21%), followed by ‘congenital anomaly’ (18%) and stillbirths where no cause could be found (‘unexplained antepartum fetal death’, 14%). For neonatal deaths, the most common cause was ‘spontaneous preterm labour’ (40%), followed by ‘congenital anomaly’ (22%) and bleeding from the area behind the placenta during pregnancy (‘antepartum haemorrhage’, 8.5%).
Figure 5: Number of perinatal deaths among babies born to First Nations mothers, by PSANZ Perinatal Death Classification, 2020–2021
Number of perinatal deaths in 2020-2021 among babies born to First Nations mothers, by PSANZ Perinatal Death Classification. Spontaneous preterm labour or rupture of membranes was the most commonly classified cause, with 105 deaths.
| PSANZ Perinatal Death Classification | Number of perinatal deaths |
|---|---|
| Spontaneous preterm labour | 105 |
| Congenital anomaly | 100 |
| Maternal conditions | 89 |
| Unexplained antepartum fetal death | 51 |
| Antepartum haemorrhage | 45 |
| Placental dysfunction | 38 |
| Perinatal infection | 23 |
| Hypertension | 16 |
| Specific perinatal conditions | 16 |
| Hypoxic peripartum death | 11 |
| Not stated | 10 |
| Complications of multiple pregnancy | 9 |
| Neonatal death without obstetric antecedent | 8 |
The category of unexplained antepartum fetal death includes deaths of normally-formed fetuses prior to the onset of labour where no identified predisposing factors are considered likely to have caused the death, as well as deaths where insufficient information was available to allow more specific classification of the cause of death.
Source:
AIHW analysis of the National Perinatal Mortality Data Collection
|
Data source overview
For neonatal deaths there is also a second classification used to identify the single most significant condition present in the neonatal period that caused the baby’s death. In 2020–2021, the most common causes of death for babies of First Nations women were extreme prematurity (typically babies born before 24 weeks’ gestation and classified as ‘periviable infants’; 44%), followed by congenital anomaly (16%) (Figure 6).
Figure 6: Number of neonatal deaths among babies born to First Nations mothers, by PSANZ Neonatal Death Classification, 2020–2021
Number of neonatal deaths in 2020-2021 among babies born to First Nations mothers, by PSANZ Neonatal Death Classification. Periviable infants (infants deemed too immature for resuscitation or continued life support, typically less than 24 weeks' gestation) was the most commonly classified cause, with 62 neonatal deaths.
| PSANZ Neonatal Death Classification | Number of neonatal deaths |
|---|---|
| Periviable infants | 62 |
| Congenital anomaly | 23 |
| Cardio-respiratory disorders | 14 |
| Other | 14 |
| Neurological | 13 |
| Neonatal infection | 9 |
| Gastrointestinal | 4 |
| Not stated | 3 |
Source:
AIHW analysis of the National Perinatal Mortality Data Collection
|
Data source overview
Data on the timing and causes of perinatal deaths for babies of First Nations mothers in 2020–2021 is presented in Table 14 of the supplementary data tables (Data tables: National Perinatal Mortality Data Collection annual update 2021).
Autopsy following perinatal death
This section presents data on autopsy, identified by PSANZ as a core investigation (test) to be undertaken following all perinatal deaths (Flenady et al. 2020).
The purpose of an autopsy is to accurately identify the cause(s) of death. Autopsy results contribute to clinical audit and assist with identification of factors contributing to the death and may be critical when clinicians consider providing parents with advice regarding the risk of a future perinatal death (RCOG 2010). Perinatal autopsy examinations require written consent from the parent(s) following informed discussion.
Whether an autopsy was performed was reported for 93% of the 521 perinatal deaths among babies born to First Nations women in 2020–2021, with the remainder not stated. Of deaths where autopsy status was known, an autopsy was performed in 36% of cases. This was slightly lower than the prevalence of autopsy across all babies who died in 2020–2021 (39%).
An autopsy was most commonly performed for perinatal deaths of babies born to First Nations women where the cause of death wasn’t provided (100%), for neonatal deaths which could not be explained by a problem in the pregnancy (‘neonatal death without obstetric antecedent’, 86%), for deaths caused by a specific health condition in the mother and/or baby other than a congenital anomaly (‘specific perinatal conditions’, 67%), and deaths where the placenta wasn’t functioning well (‘placental dysfunction or causative placental pathology’, 64%). Autopsy is an important part of finding the underlying causes of death in these babies.
Autopsy was least commonly performed where the cause of death was maternal conditions (9.1%). Detailed data on the investigation of perinatal deaths for babies of First Nations mothers in 2020–2021 can be explored in the interactive data visualisation below (Figure 7), with data also presented in Table 14 of the supplementary data tables (Data tables: National Perinatal Mortality Data Collection annual update 2021).
Figure 7: Proportion of perinatal deaths among babies born to First Nations women where autopsy was performed, 2020–2021
Proportions of stillbirths and neonatal deaths among babies born to First Nations mothers in 2020–2021 for which an autopsy was performed. In the majority of cases autopsies were not performed.
References
Flenady V, Oats J, Gardener G, Masson V, McCowan L, Kent A et al. for the PSANZ Care around the time of stillbirth and neonatal death guidelines group 2020. Clinical Practice Guideline for Care Around Stillbirth and Neonatal Death. Version 3. NHMRC Centre of Research Excellence in Stillbirth.
RCOG (Royal College of Obstetricians and Gynaecologists) (2010) Late Intrauterine Fetal Death and Stillbirth: Green top guideline No.55, RCOG, accessed 15 September 2022.