About this report
The National Health Performance Authority (the Authority) bases its performance reports on indicators agreed by the Council of Australian Governments (COAG). This report focuses on the following indicators:
- Infant and young child mortality rate
- Proportion of babies with low birthweight
- Prevalence of smoking
- Number of women with at least one antenatal visit in the first trimester.
The report provides information broken down by 61 Medicare Local catchments. The national network of Medicare Local organisations was established between 2011 and 2012 to improve the responsiveness, coordination and integration of local health services. These organisations are due to be replaced in 2015 with Primary Health Networks.
Data are presented for the period from January 2009 to December 2012. For some measures regarding Aboriginal and Torres Strait Islander mothers and their babies, data are presented for the period from January 2007 to December 2011.
Presentation of the findings in this report aims to help clinicians, health managers, administrators and the public see how rates of infant and child mortality, low birthweight, maternal smoking and antenatal care differ across local areas. They are also intended to provide Medicare Locals, Primary Health Networks and Local Health Networks with information they need to plan and deliver community and hospital care.
Why information on maternal and child health matters
Infant and child mortality is a broad measure of the overall health of a population. In Australia, infant mortality rates have declined by 33% from 2005 to 2012, from 4.9 deaths to 3.3 deaths per 1,000 live births.4 Australia is currently ranked 14 of 30 OECD countries for which infant mortality rates were reported for 2012. Australia had an infant mortality rate (3.3 deaths per 1,000 live births) three times higher than that of the best-performing country, Iceland (1.1 deaths per 1,000 live births), and twice that of Slovenia (1.6 deaths per 1,000 live births).1
|Classification||Perinatal death||Infant death||Infant and young child death||Measured in report|
|Fetal death (At least 20 weeks or 400 grams)||Yes||No|
|Neonatal death (0 to 27 days)||Yes||Yes||Yes||Measured|
|Post-neonatal death (28 days to < 1 year)||Yes||Yes||Measured|
|Young child deaths (1 year to < 5 years)||Yes||Measured|
Infant and young child mortality rates are reported as the number of deaths among children aged less than 5 years per 1,000 live births during the three calendar years from 1 January 2010 to 31 December 2012. The number of infant and young child deaths are reported as the average number of deaths per year during the same time period. The majority of these deaths (84%) occur in infancy (before 1 year of age).
In this report, infant mortality rates are reported as the number of deaths of liveborn infants aged less than 1 year per 1,000 live births during the three calendar years from 1 January 2010 to 31 December 2012. In 2010–2012, 70% of infant and young child deaths occurred before 28 days of life (neonatal death) (Figure 1).
Three years of data were combined to create stable estimates for reporting mortality rates at the local area level.
In 2011, there were 297,126 women who gave birth to 299,588 liveborn and 2,220 stillborn babies in Australia. Of these women, 11,729 were identified on the National Perinatal Data Collection (NPDC) as being Aboriginal and Torres Strait Islander women who gave birth to 11,737 liveborn and 158 stillborn babies.5
The leading causes of infant and young child mortality in Australia are shown below in Figure 2.
Low-birthweight babies are defined in this report as liveborn singleton babies who weigh less than 2,500 grams at birth. A baby’s birthweight is a key indicator of health status and may reflect the health of a mother during her pregnancy, including her smoking status and the quality of antenatal care received.3
In this report, the percentage of babies who were of low birthweight is the number of liveborn singleton babies who weighed less than 2,500 grams at birth, divided by the total number of live singleton babies born.
|Category||Rank||Cause of death||Percentage|
0 to < 1 year
|1||Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery||26.6%|
|2||Ill-defined and unknown causes of mortality (including SIDS)||11.1%|
|3||Congenital malformations of the circulatory system||6.7%|
|4||Disorders related to length of gestation and fetal growth (including low birthweight)||6.5%|
|5||Congenital malformations of the nervous system||4.7%|
1 to < 5 years
|1||Accidental drowning and submersion||10.5%|
|2||Pedestrian injured in transport accident||6.7%|
|3||Ill-defined and unknown causes of mortality||5.7%|
|4||Malignant neoplasms of eye, brain and other parts of central nervous system||4.4%|
|5||Car occupant injured in transport accident||4.3%|
Smoking during pregnancy is the most common preventable risk factor for complications in pregnancy and is associated with poorer outcomes for babies such as low birthweight and perinatal death5, including sudden infant death syndrome (SIDS).
In this report, the percentage of women who smoked during pregnancy is the number of women who self-reported having smoked at any time during pregnancy, divided by the total number of women who gave birth.
Antenatal visits within the first trimester of pregnancy are important for monitoring the health of mothers and babies and identifying pregnancy complications early so that appropriate treatment can be provided. Antenatal care within the first trimester is within the first 13 weeks of pregnancy and involves assessment, appropriate advice and treatment during pregnancy either in hospital, in primary health care or specialist practices, or in the home. An antenatal visit in the first trimester represents an opportunity for appropriate care to be provided early on in pregnancy.
During an antenatal visit, a GP, midwife or other health professional provides care to monitor the health of the mother and fetus. This care may include taking a medical history, assessing the woman’s specific health needs, screening tests, providing advice on pregnancy and delivery, and referral to a medical specialist if necessary.5,6
Australian clinical guidelines recommend that the first antenatal visit is arranged at the first contact with a woman during pregnancy. This visit requires a long appointment and should occur within the first 10 weeks. Guidelines recommend for a woman’s first pregnancy without complications, a schedule of 10 visits and seven visits for subsequent uncomplicated pregnancies.6
In this report, the percentage of women who had at least one antenatal visit within the first trimester is the number of women who self-reported or who had a medical record that showed an antenatal visit occurred within the first trimester, divided by the total number of women who gave birth.
About the data
Infant and young child mortality rates were calculated using data from the Australian Bureau of Statistics (ABS) Death Registrations Collection and the ABS Birth Registrations Collection for the calendar years 2010, 2011 and 2012.
ABS births and deaths data contain administrative information supplied by the births, deaths and marriages registries in each state and territory. Deaths are attributed to the catchment in which a baby usually resided, irrespective of where they died. Live births are attributed to the catchment in which the mother usually resided, irrespective of where the birth occurred.
Information on low birthweight, smoking during pregnancy and antenatal visits are from the Australian Institute of Health and Welfare’s (AIHW) National Perinatal Data Collection (NPDC).
The NPDC is a national population-based crosssectional data collection of pregnancy and childbirth. Information is collected from the mother and the hospital, as well as records taken by a midwife or other health professional at the time of birth. The data are based on births reported to the perinatal data collection in each state and territory and are compiled and reported on annually by the AIHW’s National Perinatal Epidemiology and Statistics Unit.
For the measures presented in this report, the NPDC data are attributed to the local area where the mother usually resided, rather than the place where the birth occurred and exclude Australian non-residents, residents of external territories and women who could not be allocated to a Medicare Local catchment because their Statistical Local Area of usual residence was not stated or was not valid.
Results for smoking during pregnancy exclude women whose smoking status during pregnancy was not stated.
Results for antenatal visits in the first trimester exclude women whose gestation at the first antenatal visit was not stated.
State and territory differences in definitions and methods used for collection of data related to smoking during pregnancy and antenatal visits in the first trimester affect the comparability of these data across state and territory jurisdictions and lower levels of geography within these jurisdictions. In particular, as data on smoking during pregnancy are not available for women who gave birth in Victoria in 2007 or 2008, the percentage of Aboriginal and Torres Strait Islander women who gave birth and smoked during pregnancy during the five calendar years from 1 January 2007 to 31 December 2011 does not include Aboriginal and Torres Strait Islander women who usually resided and gave birth in Victoria in 2007 or 2008. In WA and ACT, first antenatal visits that occur outside of the hospital may not be included.
To enable fairer comparisons, the Authority has allocated each Medicare Local catchment to one of seven peer groups, based on socioeconomic status, remoteness, and distance to hospitals: three in metropolitan areas, two in regional areas, and two in rural areas (About the peer groups).
For further information, see the Technical Supplement.
The data presented on Aboriginal and Torres Strait Islander mothers and their babies are influenced by the quality and completeness of Aboriginal and Torres Strait Islander identification, which may vary across local areas.
Results for each measure in this report are presented on maps in the Health status and outcomes page.
1. Organisation for Economic Co-operation Development (OECD) Indicators [Internet]. OECDiLibrary. 2014 Jun [cited 2014 Jul 10]. Available from: http://www.oecd-ilibrary.org/social-issues-migration-health/infant-mortality_20758480-table9
3. Australian Institute of Health and Welfare. Headline Indicators for children’s health, development and wellbeing 2011 [Internet]. Cat. no. PHE 144. Canberra: AIHW. 2011 [cited 2014 Jun 26]. Available from: http://www.aihw.gov.au/reports/children-youth/headline-indicators-for-children-s-health-develop/External link, opens in a new window.
4. Australian Bureau of Statistics. Deaths, Australia, 2012 [Internet]. 2013 Nov 11 [cited 2014 May 26]; ABS cat. no. 3302.0. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3302.0Explanatory%20Notes12012?OpenDocumentExternal link, opens in a new window.
5. Li Z, Zeki R, Hilder L & Sullivan EA. Australia’s mothers and babies 2011. National Perinatal Epidemiology and Statistics Unit. Perinatal statistics series no. 28. Cat. no. PER 59. Canberra: AIHW; 2013.
6. Australian Health Ministers’ Advisory Council 2012, Clinical Practice Guidelines: Antenatal Care – Module 1 [Internet]. Canberra: Australian Government Department of Health and Ageing. Updated 2014 Jan [cited 2014 Jun 26]. Available from: http://www.health.gov.au/antenatal