Updated 23 March 2022
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Grey
Robertson
Statistics and Mapping
Executive
summary
This research paper gives an overview of Australian
statistics on stillbirths, including definitions, data collection methods, and
the reasons for current approaches. It discusses current efforts being made by
Australian Government agencies to improve reporting on stillbirths following
the recommendations of the Senate inquiry into stillbirth research and
education. It looks at how reporting by the Australian Institute of Health and
Welfare (AIHW) and the Australian Bureau of Statistics (ABS) is contributing to
efforts to reduce the number of preventable stillbirths in Australia and raise
community awareness of stillbirth.
To improve reporting of stillbirths, the National
Stillbirth Action and Implementation Plan (the Plan) tasks the Commonwealth
to:
- develop and implement a standardised
approach to data collection on causes and contributing factors for perinatal
deaths across maternity services. (p. 22)
- ensure measures are in place to compare Australia’s performance
in stillbirth prevention with other high-income countries and ensure that data
quality on country of birth and Aboriginal and Torres Strait Islander status is
sufficient to inform reporting on equity. (p. 23)
Preventing late gestation stillbirths is a
focus of the National
Stillbirth Action and Implementation Plan.[1]
Recent data reported by the AIHW suggest the rate of preventable stillbirths
may be falling.[2]
The rate of late gestation stillbirths in Australia (those occurring after 28
weeks of gestation, or in the third trimester of pregnancy) has decreased from
3.5 per 1,000 births in 1999 to 2.2 per 1,000 births in 2018. Rates of early
stillbirth are rising, although this may reflect more accurate reporting of
stillbirths rather than an increase in the numbers of women experiencing
stillbirth. Reported stillbirths in the second trimester have increased from
437.2 stillbirths per 1,000 births in 1999 to 535.6 stillbirths per 1,000
births in 2018.
Differences in the
purpose and scope of the AIHW and the ABS data collections mean the data cannot
be combined, but each source has strengths. AIHW data appear to be already
contributing to better reporting on stillbirths across maternity services,
while continuing improvements in ABS data can support better identification of
the populations experiencing a disproportionate rate of stillbirths.
Contents
Executive summary
Abbreviations
Introduction
Current approach to data collection
and reporting on stillbirths in Australia
AIHW data collection and reporting on
stillbirths in Australia
ABS data collection and reporting on
stillbirths in Australia
The National Stillbirth Action and
Implementation Plan
Action area 11—Improving investigation
and reporting of stillbirth
Improvements to AIHW reporting
Improvements to ABS reporting
Action area 12—Tracking progress to
reduce inequity
Comparing Australia’s performance in
stillbirth prevention with other high-income countries
Data quality and reporting on equity
for tracking progress on inequity
Aboriginal and Torres Strait Islander
Australians
Mother’s country of birth
Conclusion
National resources on stillbirth
Glossary
Abbreviations
| CRVS |
Civil registration and
vital statistics |
| ICD-10 |
International Statistical
Classification of Diseases and Related Health Problems, Tenth Revision
(ICD-10) |
| MCCPD |
Medical Certificate of
Cause of Perinatal Death |
| NBEDS |
Perinatal Mortality
National Best Endeavours Data Set |
| NPDC |
National Perinatal Data
Collection |
| NPMDC |
National Perinatal
Mortality Data Collection |
| PSANZ |
Perinatal Society of
Australia and New Zealand Perinatal Mortality Classification System |
| PSANZ-PDC |
PSANZ Perinatal Death
Classification |
Introduction
This research paper gives
an overview of Australian statistics on stillbirths, including definitions,
data collection methods and the reasons for current approaches. It discusses
current efforts being made by Australian Government agencies to improve
reporting on stillbirths in line with actions under the National
Stillbirth Action and Implementation Plan (the
Plan). The Plan itself is an outcome of recommendation 15 of the Senate
inquiry into stillbirth research and education.
In Australia, stillbirths are reported where
the baby died before or during the birth and was at least 20 weeks gestation or
weighed 400 grams or more. This definition is consistent with the legislated
requirement for all state and territory Registrars of Births, Deaths and
Marriages to register such deaths.
The two key sources of statistics in
Australia: the Australian
Bureau of Statistics (ABS) and the Australian
Institute of Health and Welfare (AIHW), use the same definitions of
stillbirth (which differ from international standards—see section on Action
area 12). However, the numbers reported by the ABS and the AIHW differ due to
differences in the sources and methods for collecting the data. The ABS notes
differences in the scope of the data collections mean that users should be wary
of using multiple sources for analysis. These differences in scope may mean
that, depending on the statistics’ purpose, either AIHW data or ABS data might
be the most suitable source.
Stillbirths are usually reported along with
neonatal deaths, as perinatal deaths. This paper looks at stillbirth reporting
only.
|
Stillbirth
A stillbirth is the death of a baby before birth, at
a gestational age of 20 weeks or more, or of a birthweight of 400 grams or
more. Technically described as a fetal death.
The stillbirth rate and the perinatal mortality
rate are calculated using all live births and stillbirths (fetal deaths) in
the denominator.[3]
Definitions of key terms and their usages are in the glossary.
|
Current approach to data collection
and reporting on stillbirths in Australia
In Australia both the ABS and the AIHW
define a stillbirth as a death that occurs prior to or at the birth of a baby
of 20 or more completed weeks of gestation or of 400 grams or more birthweight.
The stillbirth rate is stillbirths as a proportion of all live births (at
gestational age) plus stillbirths. That is the stillbirth rate = number of
stillbirths / total number of births x 1,000.
Table 1 below shows the timeseries of
available statistics for stillbirths as published by the AIHW and the ABS.
Despite using consistent definitions, the reported number and rate of
stillbirths is usually greater in the AIHW data than the ABS data.
Table 1:
AIHW and ABS reported fetal deaths (stillbirths), Australia, 2010 to 2020
|
|
AIHW reported
stillbirths |
ABS reported
stillbirths |
| Year |
Number |
Rate |
Number |
Rate |
| 2020 |
… |
7.4* |
1,784 |
6.0 |
| 2019 |
2,183 |
7.2 |
1,686 |
5.5 |
| 2018 |
2,116 |
7.0 |
1,682 |
5.3 |
| 2017 |
2,174 |
7.1 |
1,760 |
5.7 |
| 2016 |
2,114 |
6.7 |
1,724 |
5.5 |
| 2015 |
2,149 |
7.0 |
1,718 |
5.6 |
| 2014 |
2,225 |
7.1 |
1,698 |
5.6 |
| 2013 |
2,194 |
7.1 |
1,781 |
5.7 |
| 2012 |
2,255 |
7.2 |
1,832 |
5.9 |
| 2011 |
2,230 |
7.4 |
1,748 |
5.8 |
| 2010 |
2,201 |
7.3 |
1,767 |
5.8 |
Source: AIHW analysis of the National Perinatal Mortality Data
Collection and the National Perinatal Data Collection as published in AIHW Stillbirths
and neonatal deaths in Australia 2017–2018 and Australia's
mothers and babies web report December 2021;
ABS
3303.0 Causes of Death, Australia, 2019 Table 15.1,
Fetal, neonatal, and perinatal deaths, Australia, 2010-2019.
Notes: ABS data are sourced from state and territory registrars
of Births, Deaths and Marriages, while AIHW data are sourced from state and
territory health authority data from midwives and other staff who collect
information from mothers and perinatal administrative and clinical record
systems. AIHW stillbirth counts may include late termination of pregnancy in
some states depending on State legislation.
* The AIHW 2020 figure are preliminary and do not include data
for Victoria and South Australia. AIHW preliminary 2020 and final 2019
stillbirth data accessed 15 March 2022 (Preliminary Table 4.1: Fetal, neonatal,
and perinatal deaths, by state and territory, 2020).
The scope of the ABS data differs from other Australian data
sources on perinatal deaths. The ABS notes caution should be taken if using
multiple sources for analysis.
AIHW data
collection and reporting on stillbirths in Australia
The AIHW data comes from the National
Perinatal Mortality Data Collection (NPMDC) and the National Perinatal Data
Collection (NPDC).[4]
This data is obtained from midwives and other staff who collect the information
from mothers and from perinatal administrative and clinical record systems. The
numbers are published in the AIHW publications: Stillbirths
and neonatal deaths in Australia 2017-18 and Australia’s
mothers and babies 2018—in brief. Findings are usually published two
years after the year the death has occurred, and the state or territory’s
perinatal mortality review process is complete. The 2018 data was published in
December 2020.
The AIHW data collections classify causes of
death according to the Perinatal Society of Australia and New Zealand (PSANZ)
Perinatal Mortality Classification System which is used in Australia and New
Zealand to classify the causes of stillbirths and neonatal deaths. It includes
the PSANZ Perinatal Death Classification (PSANZ-PDC). The National Maternal and
Perinatal Mortality Advisory Group have agreed that the PSANZ-PDC
classifications are the most appropriate for national reviews. The clinical
practice guidelines note:
The overarching objective of the PSANZ Clinical Practice
Guideline for Care Around Stillbirth and Neonatal Death is to ensure best
practice across Australia and New Zealand around the time of a perinatal death
to improve maternity and newborn care for bereaved parents and families and to
improve the quality of data on causes of stillbirth and neonatal deaths through
appropriate investigation, audit and classification.[5]
[emphasis added]
More information on care guidelines and
investigation pathways is available from the Centre
of Research Excellence in Stillbirth (stillbirthcre.org.au) clinical
practice guidelines.
The PSANZ-PDC
system classifies all perinatal deaths by the single most important factor thought
to be the cause of death. The cause is classified as part of each state
and territory’s perinatal mortality review process after investigations are
completed and at the end of a multi-disciplinary review of the perinatal death.
The clinical practice guideline suggests:
Following application of the PSANZ SB&ND system, mapping
to ICD-PM categories should be undertaken to enable high quality global
reporting.[6]
As outlined in Table 2 below, in 2017 and 2018
the most common causes of stillbirths were:
- congenital
anomaly (30.3%)
- unexplained
antepartum death (22.0%)
- maternal
conditions (12.2%).
Table 2: Stillbirths by
cause of death (PSANZ-PDC) and gestational age group, 2017 and 2018
| |
Stillbirths |
Gestational
age at birth (per cent) |
| Cause of death |
Number |
Total (%) |
20–22 weeks |
23–26 weeks |
27–31 weeks |
32–35 weeks |
36+ weeks |
| Congenital anomaly |
1,298 |
30.3 |
38.3 |
35.2 |
29.3 |
21.7 |
9.5 |
| Unexplained antepartum death |
942 |
22 |
15.2 |
15.9 |
25.8 |
29.9 |
39.3 |
| Maternal conditions |
523 |
12.2 |
14.0 |
16.1 |
5.6 |
8.2 |
9.1 |
| Specific perinatal conditions |
330 |
7.7 |
5.0 |
6.2 |
10.7 |
12.5 |
11.4 |
| Spontaneous preterm |
284 |
6.6 |
13.4 |
4.9 |
0.2 |
0.7 |
0.1 |
| Fetal growth restriction |
274 |
6.4 |
3.3 |
7.6 |
11.8 |
9.5 |
6.8 |
| Antepartum haemorrhage |
261 |
6.1 |
4.5 |
6.5 |
6.6 |
8.0 |
8.0 |
| Perinatal infection |
205 |
4.8 |
5.2 |
3.7 |
3.3 |
3.2 |
7.1 |
| Hypertension |
109 |
2.5 |
0.8 |
3.5 |
5.2 |
4.0 |
3.0 |
| Hypoxic peripartum death |
39 |
0.9 |
0.1 |
0.3 |
0.2 |
1.7 |
3.7 |
| Not stated |
25 |
0.6 |
0.1 |
0.2 |
1.2 |
0.5 |
2.0 |
| Number of stillbirths |
4,290 |
.. |
1,719 |
975 |
484 |
401 |
704 |
Source: AIHW analysis of the NPMDC and NPDC. AIHW (2021) Stillbirths
and neonatal deaths in Australia 2017–2018, p. 18.
Notes: The category of unexplained antepartum 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, and those deaths
with insufficient information available to allow a more specific classification
of the cause of death. Clinical groups refer to intervals of gestational ages
identified as being of clinical significance by members of the National
Maternal and Perinatal Mortality Advisory Group (NMPMAG).
ABS data
collection and reporting on stillbirths in Australia
The ABS numbers come from each State and
Territory Registry of Births, Deaths and Marriages (RBDM). Stillbirths are
registered with each jurisdiction through the birth registration process. The data
collection is based on the system of civil registration and vital statistics
(CRVS). CRVS systems are a key data source for stillbirths internationally.
Registration of all births (live births and
stillbirths) is based on information provided on the Birth Registration Form
(completed by parents) which is matched to the birth notification
supplied to the state or territory registry by the hospital or birth clinic. For
stillbirths, details of the cause of death are sent to the registry by the
certifying doctor at the hospital or birth clinic, or the attending midwife.
Australia uses the Medical Certificate of
Cause of Perinatal Death (MCCPD) which requests information on the main
condition in the baby and main condition in the mother. Some stillbirths may
not be recorded in the ABS data if parents have not registered the birth with
the State registry. The ABS reports the causes of perinatal deaths using the
International Statistical Classification of Diseases and Related Health
Problems, Tenth Revision (ICD-10). The ICD-10 classification is based on the
registered causes of death on the Medical Certificate of Cause of Perinatal
Death, assigned by the treating medical practitioner shortly after death and
(unlike PSANZ-PDC process) without access to
any subsequent investigations.[7]
Stillbirth data is published in a
supplementary perinatal data set in the ABS Causes of Death, Australia usually
in the year after the registration is recorded. A delay in registration,
particularly for stillbirths, can mean the original date of death was a year or
more before the registration.[8]
In its Causes
of Death, Australia, 2020, the
ABS published fetal deaths by main condition in fetus (table 15.5) and in
mother (table 15.6). The ABS data is generally used in international
comparisons (table 15.21).
The National
Stillbirth Action and Implementation Plan
The National
Stillbirth Action and Implementation Plan (the Plan) was released in
December 2020 in response to the recommendations of the Senate
Select Committee on Stillbirth Research and Education. The Plan aims to:
- reduce
the number of stillbirths in Australia
- reduce
disparities in stillbirth rates between population groups
- raise
community awareness and understanding of stillbirth
- ensure
high quality bereavement care and support is available to families who
experience stillbirth.[9]
Chapter
4 of the Senate report examines stillbirth reporting and data collection.
Under Action
area 11 - Improving investigation and reporting of stillbirth, the Plan tasks
the Commonwealth to:
Develop and implement a standardised
approach to data collection on causes and contributing factors for perinatal
deaths, across maternity services linked to perinatal mortality review
committees to ensure timely review and reporting of stillbirth deaths.[10]
Ensuring a better quality of stillbirth data
also underpins the goals under Action area 12 - Tracking progress to reduce
inequity. The goals are to ensure:
Measures are in place to compare Australia’s performance in
stillbirth prevention with other high-income countries, including a stillbirth
rate equity target.
Data quality on country of birth and Aboriginal and Torres
Strait Islander status is sufficient to inform reporting on equity.[11]
Action area
11—Improving investigation and reporting of stillbirth
Improvements
to AIHW reporting
As outlined in the Stillbirth Action and
Implementation Plan, the Commonwealth has been tasked to ‘develop and implement
a standardised approach to data collection on causes and contributing factors
for perinatal deaths, across maternity services linked to perinatal mortality
review committees to ensure timely review and reporting of stillbirth deaths’
(p. 22). The Plan includes funding to develop a Perinatal Mortality
National Best Endeavours Data Set (NBEDS) which will be led by the Maternal and
Perinatal Health Unit at the AIHW. The project is running from 2021 to 2024 and
seeks to ensure a common standard for reporting:
- data items
around timing and cause of death
-
information on
autopsy and type of post-mortem investigations performed
- the
information on factors contributing to the death.[12]
These data items are currently provided on a
voluntary, non-standard basis. Using a consistent standard across the country
is expected to improve the availability and quality of data and lead to more
consistent reporting and monitoring of the rates and causes of perinatal
mortality over time.
Improvements
to ABS reporting
Since the Senate inquiry, the ABS has worked
to improve the consistency of information provided on stillbirths from states
and territories. This includes:
- enabling
coding of cause of death information for registered stillbirths in Tasmania and
Northern Territory
- new methods of
data collection for MCCPD from Victoria, resulting in a greater number of
registrations.
The ABS is also working with states and
territories whose birth registration figures more closely align with birth
notifications to understand any differences in processing.[13]
Action area
12—Tracking progress to reduce inequity
Comparing
Australia’s performance in stillbirth prevention with other high-income countries
The AIHW, quoting UNICEF, reports that
the estimated worldwide stillbirth rate in 2019 was 13.9 stillbirths per 1,000
births, varying from 3.0 stillbirths per 1,000 births in combined high-income
countries, including Australia and New Zealand, to 22.7 stillbirths per 1,000
in combined low-income countries.[14]
The age and weight of babies counted in the
stillbirth data varies around the world. The OECD notes high-income countries
including Australia and Canada include fetal deaths occurring at earlier
gestation ages (commencing between 20 weeks to 24 weeks in different countries)
in their definition of a stillbirth, while other countries’ register a stillbirth
at or after 28 weeks’ gestation.[15] Both the ABS and the AIHW publish tables
allowing international comparisons. The ABS publish a table of fetal, neonatal,
and perinatal deaths as at 22 weeks, or 500 grams, consistent with OECD
reported data prior to 1978 showing fetal deaths at 500 grams at delivery or 22
weeks.[16]
For statistics collections, the World Health
Organisation (WHO) recommends defining stillbirths as the death of a fetus that
has reached a birth weight of 500 grams, or if birth weight is unavailable,
gestational age of 22 weeks or crown-to-heel length of 25 cm. Within this it
also recommends classifying late fetal deaths (greater than 1000 grams or after
28 weeks) and early fetal deaths (500–1000 grams or 22–28 weeks). The WHO
recommends that all fetuses and infants weighing at least 500 grams at birth,
whether alive or dead, should be included in the statistics.[17]
The AIHW reports that Australia compares
well internationally on perinatal mortality, although the overall rate of
stillbirths in Australia is not declining: ‘Australia is one of the safest
places in the world for a baby to be born, yet … every day in Australia, 6
babies are stillborn and 2 die within 28 days of birth.’[18]
Using the Australian definitions, the rate of stillbirths in Australia has held
steady, with 7.0 per 1,000 births in both 1999 and 2018, while the rate of
neonatal deaths in Australia has decreased from 3.2 per 1,000 live births in
1999 to 2.2 per 1,000 live births in 2018.[19]
Preventing late gestation stillbirths—which
evidence suggests is when most preventable deaths occur—is the focus of the National
Stillbirth Action and Implementation Plan.[20]
The rate of late gestation stillbirths in Australia (those occurring after 28
weeks of gestation, or in the third trimester of pregnancy) has decreased from
3.5 per 1,000 births in 1999 to 2.2 per 1,000 births in 2018.[21]
The AIHW notes the apparent lack of
improvement in the overall incidence of stillbirth is due to an increase in
stillbirths in the second trimester, from 437.2 stillbirths per 1,000 births in
1999 to 535.6 stillbirths per 1,000 births in 2018. This increase in early
gestation stillbirths in the Australian data may reflect improvements in data
quality, as well as improvements in detecting congenital anomalies that may
result in earlier diagnosis and clearer indications for the offer of
termination of pregnancy for this gestational period.[22]
In its reporting on Causes
of Death, the ABS provides data on fetal
deaths by main condition in fetus (table 14.5) and in mother (table 14.6). The
ABS data is generally used in international comparisons. The ABS reports the
causes of perinatal deaths using the ICD-10 classification which is based on
the registered causes of death on the Medical Certificate of Cause of Perinatal
Death, assigned by the treating medical practitioner shortly after death and
(unlike PSANZ-PDC process) without access to any subsequent investigations.
Data quality
and reporting on equity for tracking progress on inequity
Aboriginal
and Torres Strait Islander Australians
The AIHW note ‘the rate of stillbirth for
babies born to Indigenous women has held relatively steady from 11.8
stillbirths per 1,000 births in 2005 to 11.5 stillbirths per 1,000 births in
2018’.[23]
ABS data comparing stillbirths for
Aboriginal and Torres Strait Islander Australians to Non-Indigenous Australians
by state shows death rates are generally higher for Aboriginal and Torres
Strait Islander babies, except for NSW and the Northern Territory (Table 3).
However, processing and registration issues that have influenced the number of
births registered in these two jurisdictions in recent years may have affected the
figures.[24] The data for South Australia has also
recently been revised to overcome an issue with the derivation of Indigenous
status for fetal deaths registered in South Australia.
An ABS table which shows the top causes of
death in New South Wales, Queensland, South Australia, West Australia, and the
Northern Territory by Aboriginal and Torres Strait Islander status, 2015–2019, shows
stillbirths and neonatal deaths due to disorders related to short gestation and
low birth weight are a much higher proportion of the cause of death for
Aboriginal and Torres Strait Islander babies, at a rate of 2.4, than for
non-Indigenous babies, with a rate of 1.1.[25]
The ABS also notes it is likely that
Aboriginal and Torres Strait Islander status may not always be accurately identified
in registering deaths, and as such, the Aboriginal and Torres Strait Islander
mortality rate is likely to be underestimated in deaths data.[26]
Table 3: Fetal
deaths, by Aboriginal and Torres Strait Islander status, selected states and
territories (NSW, Queensland, SA, WA, and NT), 2015–2019 (number, per cent and
rate per 1,000 births)
| |
Aboriginal and Torres
Strait Islander |
Non-Indigenous |
Total |
Rate ratio |
Rate difference |
| |
Number |
% |
Rate |
Number |
% |
Rate |
Number |
% |
Rate |
| NSW |
94 |
3.8 |
2.8 |
2,331 |
93.8 |
5.0 |
2,486 |
100.0 |
5.0 |
0.6 |
-2.2 |
| Qld |
210 |
10.7 |
6.9 |
1,756 |
89.3 |
6.3 |
1,966 |
100.0 |
6.3 |
1.1 |
0.6 |
| SA |
35 |
9.8 |
6.7 |
323 |
90.2 |
3.6 |
358 |
100.0 |
3.7 |
1.9 |
3.2 |
| WA |
121 |
10.8 |
8.6 |
959 |
85.5 |
6.2 |
1,121 |
100.0 |
6.5 |
1.4 |
2.4 |
| NT |
89 |
47.6 |
12.3 |
98 |
52.4 |
7.9 |
187 |
100.0 |
9.5 |
1.6 |
4.5 |
| Total |
549 |
9.0 |
6.1 |
5,467 |
89.4 |
5.4 |
6,118 |
100.0 |
5.6 |
1.1 |
0.7 |
Source: ABS 2020, Causes
of Death Table 14.20 Perinatal deaths, by Aboriginal and Torres Strait
Islander status, Selected states, and territories, 2015-2019.
Notes: In 2019 an issue was identified with the derivation of
Indigenous status for fetal deaths registered in South Australia: namely, there
has been an undercount of Aboriginal and Torres Strait Islander fetal deaths in
South Australia in ABS outputs over a number of years. The ABS has worked with
the SA RBDM to revise the Indigenous status of all fetal deaths for the years
2015 to 2019. Revised data are presented in this table. Care needs to be taken
when interpreting perinatal death rates for New South Wales and the Northern Territory
in recent years. In NSW, a policy change was introduced in 2016 which required
additional ‘proof of identity’ documentation from parents registering a new
birth. These changes resulted in an increase in the number of births that
occurred in 2016 and 2017 that were registered in 2018. This may affect
perinatal death rates, which are calculated using births data. In 2018, the
Northern Territory Registry of Births, Deaths and Marriages identified a processing
issue that led to delays in sending data on some registrations for births that
occurred in previous years. Addressing this resulted in 355 additional births
being included in 2018 data, the majority of which (339) were of Aboriginal and
Torres Strait Islander children. As the number of births are used as the
denominator for calculating perinatal death rates, rates should be interpreted
with caution for NSW and NT for recent years.
In the ABS
Perinatal deaths collection, the Indigenous status of a stillbirth is captured
through the birth registration process and through information on the Medical
Certificate of Cause of Perinatal Death (MCCPD). The ABS Birth Registrations
collection records a person as being of Aboriginal and/or Torres Strait
Islander origin where at least one parent reported themselves as being of
Aboriginal and/or Torres Strait Islander origin on the birth registration
form. If the Indigenous status reported through the birth registration process
does not agree with that in the MCCPD, the preference is to identify the
stillborn as Aboriginal and/or Torres Strait Islander rather than
non-Indigenous or an ‘unknown’ status. It is recognised that not all Aboriginal
and Torres Strait Islander stillbirths are identified through these processes,
leading to under identification.
Mother’s
country of birth
The ABS do not currently publish stillbirth
statistics by mother’s country of birth. In the AIHW report there was little
overall difference in perinatal mortality rates for babies of women born in
Australia compared to babies of women born overseas. The highest rates of
perinatal death (stillbirth + neonatal deaths) were among babies of mothers
whose country of birth was in Melanesia (including Papua New Guinea), Central
and West Africa and Southern Europe.[27]
Table 4: Selected characteristics of mothers and stillbirths
per 1,000 births, 2017-18 (AIHW)
| Mother’s Indigenous status |
|
| Aboriginal and Torres Strait Islander
Mothers |
11.1 |
| Non-Indigenous Mothers |
6.8 |
| Mother’s country of birth |
|
| Australia |
6.9 |
| Other |
7.3 |
Source: AIHW 2021.
Stillbirths and neonatal deaths in Australia 2017 and 2018 Figure 3.1:
Perinatal deaths by select demographics of the mother, 2017 and 2018 p. 10
Note: Stillbirth rates are calculated using all births (live
births and fetal deaths).
Conclusion
Both the AIHW and the ABS have been seeking
to improve the quality and timeliness of their still births data in line with
the recommendations of the Select Committee on Stillbirth Research and
Education inquiry into the future of stillbirth research and education in
Australia.
Although the differences in scope and focus of
the two major Australian data sources mean they cannot be combined, each source
has strengths for informing policies to improve stillbirth outcomes.
The AIHW, with its expertise in maternal and
baby health data, is well suited to improving data collection on causes and
contributing factors for perinatal deaths and supporting better clinical
practice in line with the goals of the national Plan, particularly in relation
to action area 11. It also allows better reporting on equity within the
clinical care environment.
The ABS can provide evidence to support
policy initiatives designed to improve equity of health outcomes outside of
clinical care. The ABS sources and classification system already align with
international reporting standards, enabling international comparisons. The work
of State and Territory registrars to improve registrations data also improves
our ability to measure equity in outcomes across populations within Australia.
National
resources on stillbirth
This webpage provides information
on Australian Government initiatives to support Australia’s maternity services.
It includes national maternal and perinatal data, the Pregnancy Birth and Baby
service, and the Government’s stillbirth prevention and support initiatives.
This is an Australian Government
service providing support and information for expecting parents and parents of
children, from birth to 5 years of age. The site provides information on pregnancy loss, including stillbirth risks and warning signs. It contains
links to a range of information and support services on the stillbirth
page.
The Select Committee on
Stillbirth Research and Education inquiry into the future of stillbirth
research and education in Australia received 269 submissions and took evidence
over six days of public hearings. Submissions are available on the Committee
website.
Developed in response to the
Senate Committee’s recommendations, the Plan aims to inform the development and
implementation of interventions and programs that raise stillbirth awareness
and support a reduction in the rate of stillbirth in Australia. The focus of
the Plan is on stillbirth after 28 weeks, as most preventive interventions are
specific to the third trimester.
The Centre of Research Excellence
in Stillbirth (The Stillbirth CRE) is a national collaboration addressing
stillbirth. The Stillbirth CRE aims to reduce the rate of stillbirth and
improve care for parents and families whose baby is stillborn.
The CRE is hosted by the Mater
Research Institute, within The University of Queensland Faculty of Medicine,
and is funded by the National Health and Medical Research Council (NHMRC) of
Australia.
The site includes links to stillbirth
statistical reports.
- Australian Institute of Health and Welfare (AIHW)
Stillbirths
and neonatal deaths in Australia Web report, last updated: 14 Dec 2020.
The latest in-depth report was released
on 10 June 2021: Stillbirths
and neonatal deaths in Australia 2017–2018, Summary - Australian Institute
of Health and Welfare (aihw.gov.au).
Previous releases: Stillbirths
and neonatal deaths in Australia 2015 and 2016 (04 Jul 2019); Perinatal deaths
in Australia 2013–2014 (29 May 2018); Perinatal deaths in Australia 1993–2012
(12 Oct 2016).
Australia’s
mothers and babies 2018—in brief: presents key statistics and
trends on pregnancy and childbirth of mothers, and the characteristics and
outcomes of their babies.
Stillbirths
in Australia 1991–2009: the first national report on the epidemiology of
stillbirth in Australia. The report makes use of the extensive data about
pregnancy and birth that have been collected in all states and territories since
1991. For the period 1991–2009, the stillbirth rate ranged from 6.4–7.8 per
1,000 births.
- Australian Bureau of Statistics
Causes
of Death 2020: (data download) Perinatal deaths (Australia)
The scope of the perinatal death
statistics includes all registered fetal deaths (at least 20 weeks gestation or
at least 400 grams birth weight) and all registered neonatal deaths (all live
born babies who die within 28 completed days of birth, regardless of gestation
or birth weight). The ABS scope rules for fetal deaths are consistent with the
legislated requirement for all state and territory Registrars of Births, Deaths
and Marriages to register all fetal deaths which meet the above-mentioned
gestation and birth weight criteria.
Unlike the studies above based on
administrative data and clinical research, the ALSWH survey captures the
miscarriage and stillbirth experiences of a cohort of Australian women. The
study is a longitudinal population-based survey of over 57,000 Australian women
in four cohorts.
Respondents to the Study from 5,806
women who were aged 31–36 years in 2009 and who had self-reported an outcome
for one or more pregnancy reported:
- 10,247 live births
- 2,544 miscarriages
- 113 stillbirths.
The reported stillbirths and
miscarriages in the study may not match clinical definitions of stillbirth as
published by the ABS (2020) and AIHW
(2021). The analysis notes the value of this data as a reference but that this
estimate of risk should only be applied to women who are 36 years or younger.[28]
Findings are reported in these articles:
Glossary
Unless noted otherwise all definitions come
from the AIHW Mothers
and babies Glossary.
antepartum fetal death
Fetal death occurring before the onset of
labour.
birth
An event in which a baby comes out of the
uterus after a pregnancy of at least 20 weeks gestation or weighing 400 grams
or more. A term birth is a birth at 37–41 completed weeks of gestation.
birthweight
The first weight of the baby (stillborn or
live born) obtained after birth (usually measured to the nearest 5 grams and
obtained within 1 hour of birth).
fetal death (stillbirth)
Death, before the complete expulsion or
extraction from its mother, of a product of conception of 20 or more completed
weeks of gestation or of 400 grams or more birthweight (or at least 22 weeks'
gestation or 500 grams' birth weight when using the World Health Organization
definition of a fetal death).[29]
Death is indicated by the fact that, after such separation, the fetus
does not breathe or show any other evidence of life, such as beating of the
heart, pulsation of the umbilical cord or definite movement of voluntary
muscles. The fetal death (stillbirth) rate is the number of fetal deaths
per 1,000 total births (fetal deaths plus live births).
gestational age
Duration of pregnancy in completed weeks,
calculated from the date of the first day of a woman’s last menstrual period
and her baby’s date of birth; or via ultrasound; or derived from clinical
assessment during pregnancy or from examination of the baby after birth.
intrapartum fetal death
a fetal death occurring during labour.
labour
The physiological process by which a vaginal
birth occurs that commences at the onset of regular uterine contractions that
act to produce progressive cervical dilatation and is distinct from spurious
labour or pre-labour rupture of membranes.
late gestation stillbirths
AIHW in its publication Stillbirths
and neonatal deaths in Australia 2017 and 2018 (p.4) describes stillbirths occurring
after 28 weeks of gestation, or in the third trimester of pregnancy as late
gestation stillbirths.
live birth
The complete expulsion or extraction from
its mother of a product of conception, irrespective of the duration of the
pregnancy, which, after such separation, breathes or shows any other evidence
of life, such as beating of the heart, pulsation of the umbilical cord or
definite movement of voluntary muscles, whether or not the umbilical cord has
been cut or the placenta is attached; each product of such a birth is
considered live born (WHO definition).
neonatal
death
The death of a live born baby within 28 days
of birth. The neonatal mortality rate is the number of neonatal deaths
per 1,000 live births.
perinatal
Pertaining to or occurring in the period shortly before or
after birth (usually up to 28 days after).
perinatal
death
A fetal or neonatal death of at least 20
weeks gestation or at least 400 grams birthweight. The perinatal mortality
rate is the number of perinatal deaths per 1,000 total births (fetal deaths
plus live births).
Perinatal mortality review committees
(PMRCs)
State and territory-based multidisciplinary
committees that review perinatal deaths to ascertain the underlying and
contributory cause/s of death.
stillbirth
The death of a baby before birth, at a
gestational age of 20 weeks or more, or of a birthweight of 400 grams or more. Technically
described as a fetal death.
The stillbirth rate and the perinatal
mortality rate are calculated using all live births and stillbirths (fetal
deaths) in the denominator.[30]
World Health Organization (WHO) definitions
To allow for international comparisons, the WHO definitions
regarding perinatal mortality indicators have been used (WHO 2015).[31] These
definitions are:
Stillbirth: a fetal death
prior to birth of a baby in the third trimester of pregnancy of 28 or more
completed weeks of gestation or of 1,000 grams or more birthweight.
Neonatal death: the death
of a baby in the first 28 days of life, measured through registered deaths. In
Australia, registered deaths are those occurring at 20 or more completed weeks
of gestation or of 400 grams or more birthweight.
[1]. The Plan supports
a sustainable reduction in rates of preventable stillbirth after 28 weeks, with
a primary
goal of 20% or more reduction over five years. (p. 5)
[2]. AIHW (2021) Stillbirths
and neonatal deaths in Australia 2017 and 2018, Perinatal statistics series
no. 38. Canberra. p.4.
3. AIHW (2021) Australia's mothers and
babies Preliminary perinatal deaths accessed 17 March 2022
[4]. More
information on the National Perinatal Data Collection (NPDC) is available from AIHW.
[5]. Clinical
Practice Guideline for Care Around Stillbirth and Neonatal Death, pp.3-4.
[6]. Ibid, p. 20.
[7]. MCCPD must be lodged within 48 hours for
doctor certified deaths. The ABS does not have access to investigations
finalised after this except for coroner referred deaths, but these are rare for
stillbirths.
[8]. ABS 2019, Causes
of Death, Australia methodology, Perinatal
deaths and technical notes.
[9]. Australian
Government 2020 National
Stillbirth Action and Implementation Plan, p. 5.
[10]. Ibid, p. 22.
10. Ibid,
p. 23.
[12]. Personal
correspondence with subject matter experts at AIHW.
[13]. Personal
correspondence with subject matter experts at the ABS.
[14]. For the purposes
of international comparison, stillbirths are defined as those occurring in the
third trimester, born at 28 weeks of gestation or more, and/or weighing 1,000
grams or more (WHO 2015). This differs from the standard definition used for
stillbirths in Australia: born at 20 weeks of gestation or more, and/or
weighing 400 grams or more (AIHW (2021) Stillbirths
and neonatal deaths in Australia 2017 and 2018, (p.4 and p.44)
12. OECD
Health Statistics, 2021, Definitions,
Sources and Methods.
[16]. ABS (2020), Causes
of Death, Australia, 2019: Fetal, neonatal and perinatal deaths, Australia
data cube.
[17]. Stillbirth: Case definition and guidelines for
data collection, analysis, and presentation of maternal immunization safety
data. quoting WHO 2006 Neonatal and Perinatal Mortality Country, Regional and
Global Estimates. For more information see p. 18 of Making
Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths,
2016.
[18]. AIHW (2020), Stillbirths and neonatal deaths in
Australia , Overview of perinatal deaths - Australian Institute of Health and
Welfare (aihw.gov.au).
[19]. AIHW (2021) Stillbirths and neonatal deaths in
Australia 2017 and 2018, p.4.
[20]. AIHW (2020), Stillbirths and neonatal deaths in
Australia, Overview of perinatal deaths - Australian Institute of Health and
Welfare (aihw.gov.au).
[21]. AIHW (2021) Stillbirths and neonatal deaths in
Australia 2017 and 2018, p. 4.
[22]. Stillbirths resulting from a
termination of pregnancy are included in these rates published by the AIHW.
[23]. AIHW (2021) Stillbirths and neonatal deaths in
Australia 2017 and 2018, p. 35.
[24]. Registered births are used in the
calculation of fetal death rates. See ‘Mortality rate denominators: Live
births’ in the Data quality section of the Methodology of Causes of Death,
Australia, 2019 for
further details.
[25]. ABS 2020, Causes of Death, Australia, 2019, Table
14.19, Perinatal deaths by Aboriginal and Torres Strait Islander top causes of
death, NSW, Qld, SA, WA, NT, by Aboriginal and Torres Strait Islander status,
2015–2019.
[26]. For further information see the Deaths of Aboriginal
and Torres Strait Islander people section in the Causes of Death, Australia,
2019, methodology.
[27]. AIHW 2021.
Stillbirths and neonatal deaths in Australia 2017 and 2018 p.9.
[28]. Hure A J, Powers
J R, Mishra G D, Herbert D L, Byles J E, et al (2012), ‘Miscarriage, Preterm
Delivery, and Stillbirth: Large Variations in Rates within a Cohort of
Australian Women’. PLoS ONE 7(5): e37109. doi:10.1371/journal.pone.0037109 Miscarriage, preterm delivery,
and stillbirth: large variations in rates within a cohort of Australian women -
PubMed (nih.gov).
[29]. ABS (2021) Causes
of Death, Australia methodology,
Glossary
[30]. AIHW (2021) Stillbirths and neonatal deaths in Australia 2017 and
2018, Perinatal statistics series no.
38. Canberra. p.4
[31]. Ibid p.44
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