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Healthy Communities: Child and maternal health in 2009–2012 - Report - Summary

Healthy Communities: Child and maternal health in 2009–2012

Summary

The numbers of infants and children who die prematurely has fallen rapidly in recent years on a population basis. Nevertheless, Australia has infant mortality rates three times higher than the best-performing countries.1 Even within Australia, there is a marked difference in infant and young child death rates between the areas where the rates are lowest, and areas where they are highest. Identifying these differences may help to inform improvements in access to or delivery of services that could in time lead to reductions in avoidable deaths among infants and young children.

This is the first report from the National Health Performance Authority (the Authority) that presents data at the local level for infant and young child mortality, low birthweight, smoking during pregnancy and access to antenatal care.

There is a strong relationship between antenatal care that commences within the first 13 weeks (first trimester) of pregnancy and positive child health outcomes.2 Accordingly, in 2011 the Council of Australian Governments (COAG) identified the number of women with at least one antenatal visit in the first trimester as an important indicator of access to care in communities.

COAG also agreed that infant and young child mortality rates, the proportion of babies born with low birthweight and prevalence of smoking are important population health outcome measures that provide context for the interpretation of local health system performance.

For example, low-birthweight babies are at greater risk of poor health outcomes including death and disability, particularly in the first year of life, and have an increased risk in adulthood of diabetes type 2, high blood pressure and cardiovascular disease.3

Measuring access to antenatal care and the health outcomes of children at the local level, including premature death, low birthweight and smoking during pregnancy, allows us to begin to identify the communities where programs such as antenatal services are needed or have achieved success. Other factors such as the quality of antenatal care provided and broader social determinants of health also impact on infant and child heath outcomes.

This report shows variation across local areas that is not seen when reporting at national or state and territory level. Data in the report cover all children and mothers and, where the data are available, Aboriginal and Torres Strait Islander mothers and their babies.

Data are presented for the period from January 2009 to December 2012, for 61 local areas across Australia called Medicare Local catchments. For measures regarding Aboriginal and Torres Strait Islander mothers and their babies, data are presented for the period from January 2007 to December 2011.

Key findings

Infant and young child mortality rate

In 2010–2012, the national rate of infant and young child mortality was 4.4 deaths per 1,000 live births (1,344 deaths).

Across local areas, the infant and young child mortality rate was more than three times higher in the catchment with the highest rate compared to the catchment with the lowest rate.

The infant and young child mortality rate ranged as follows:

Highest: Northern Territory – 9.2 deaths per 1,000 live births

Lowest: Bayside (Vic) – 2.6 deaths per 1,000 live births

(Figure 3 and Infant and young child mortality rate)

To allow fairer comparisons, the Authority compared local areas across Australia that have similar characteristics such as remoteness, socioeconomic status and distance to hospitals. These catchments are grouped into one of seven ‘peer groups’.

The report shows there are differences in infant and young child mortality rates across catchments in peer groups that have similar geographic characteristics.

Across the metropolitan catchments, the highest infant and young child mortality rate was more than double in the local area with the highest rate (6.1 deaths per 1,000 live births in Greater Metro South Brisbane) compared to the local area with the lowest rate (2.6 deaths per 1,000 live births in Bayside (Vic)).

There were also differences across similar local areas within the same peer group, even after accounting for geographic and socioeconomic characteristics.

  • Across lower-income metropolitan communities (Metro 2 peer group), the infant and young child mortality rate was more than double in Greater Metro South Brisbane (6.1 deaths per 1,000 live births) compared to South Western Melbourne (2.9 deaths per 1,000 live births)
  • Across middle-income regional communities (Regional 2 peer group), the infant and young child mortality rate was 86% higher in Country South SA (6.5 deaths per 1,000 live births) compared to Goulburn Valley (Vic) (3.5 deaths per 1,000 live births) (Table 1).

While this report shows higher rates in many regional and rural areas compared to metropolitan areas, and in lower-income compared to higher-income areas, there are some areas that do not follow this trend. These areas demonstrate what is possible to achieve for other similar areas.

For example, Nepean-Blue Mountains (NSW), Barwon (Vic) and Goulburn Valley (Vic) are middle-to lower-income regional areas that have infant and young child mortality rates similar to or better than many higher-income metropolitan communities (Figure 4).

Low-birthweight babies

The national percentage of all liveborn singleton babies that were of low birthweight was 4.8% for babies born to all women in 2009–2011 and 11.0% for babies born to Aboriginal and Torres Strait Islander women in 2007–2011.

Across local areas, the percentage of all live births that were of low birthweight was more than double in the catchment with the highest percentage compared to the catchment with the lowest percentage.

The percentage of low-birthweight babies ranged as follows:

Highest: Northern Territory – 7.7%

Lowest: Sydney North Shore & Beaches – 3.3%

(Figure 4 and Low-birthweight babies, all women).

Differences were found across similar local areas even after accounting for geographic and socioeconomic characteristics.

Across middle-income metropolitan communities in the Metro 2 peer group, the percentage of low-birthweight babies was 41% higher in South Western Melbourne (5.2%) compared to Fremantle (WA) (3.7%).

The report also found that among Aboriginal and Torres Strait Islander mothers there was a greater proportion of low-birthweight babies compared with other mothers in Australia.

Across local areas, the percentage of low-birthweight babies to Aboriginal and Torres Strait Islander women ranged from 17.5% in Gippsland (Vic) to 6.7% in Frankston-Mornington Peninsula (Vic) (Figure 5 and Low-birthweight babies, Aboriginal and Torres Strait Islander women).

Smoking during pregnancy

The national percentage of women who smoked during pregnancy was 13.9% for all women for 2009–2011 and 51.7% for Aboriginal and Torres Strait Islander women for 2007–2011.

Across local areas, the percentage of women who smoked during pregnancy was 18 times higher in the catchment with the highest percentage compared to the catchment with the lowest percentage.

The percentage of women who smoked during pregnancy ranged as follows:

Highest: Far West NSW – 33.1%

Lowest: Sydney North Shore & Beaches – 1.8%

(Figure 4 and Smoking during pregnancy, all women).

There were differences found across similar local areas even after accounting for geographic and socioeconomic characteristics.

Across high-income metropolitan communities (Metro 1 peer group), the percentage of women who smoked during pregnancy was more than five times higher in Australian Capital Territory (10.2%) compared to Sydney North Shore & Beaches (1.8%).

The percentage of Aboriginal and Torres Strait Islander women who smoked during pregnancy ranged from 66.4% in Goulburn Valley (Vic) to 29.4% in Macedon Ranges & North Western Melbourne (Figure 5 and Smoking during pregnancy, Aboriginal and Torres Strait Islander women).

Antenatal visits in the first trimester

In 2010–2011, the national percentage of women who had at least one antenatal visit in the first trimester of pregnancy was 67.2% for all women and 50.3% for Aboriginal and Torres Strait Islander women.

Across local areas, the percentage of women who had at least one antenatal visit in the first trimester was more than double in the catchment with the highest percentage compared to the catchment with the lowest percentage.

The percentage of women who had at least one antenatal visit in the first trimester ranged as follows:

Highest: Western Sydney – 87.7%

Lowest: Grampians (Vic) – 36.6%

(Figure 4 and Antenatal visits in the first trimester, all women).

Differences were found across similar local areas even after accounting for geographic and socioeconomic characteristics.

Across higher-income regional communities (Regional 1 peer group), the percentage of women who had at least one antenatal visit in the first trimester of pregnancy was double in Nepean-Blue Mountains (NSW) (85.5%) compared to Frankston-Mornington Peninsula (Vic) (41.7%).

While this report shows higher rates in many regional and rural areas compared to metropolitan areas, and in lower-income compared to higher-income areas, there are some that do not follow this trend. These areas demonstrate what is possible to achieve for other similar areas.

For example, Western Sydney is a lower-income metropolitan area that has a lower rate of smoking during pregnancy than most higher-income metropolitan communities, and has the highest rate of antenatal visits in the first trimester than all other metropolitan communities for all women, and the second-highest rate for Aboriginal and Torres Strait Islander women.

The percentage of Aboriginal and Torres Strait Islander women who had at least one antenatal visit in the first trimester ranged from 80.5% in Nepean-Blue Mountains (NSW) to 21.8% in Grampians (Vic).

State and territory differences in definitions and methods used for data collection affect the comparability of data relating to smoking during pregnancy, low-birthweight babies and antenatal visits in the first trimester across state and territory jurisdictions and lower levels of geography within these jurisdictions.

Next steps

This is the first report from the Authority that presents data at the local level for infant and child mortality rates, low birthweight, smoking during pregnancy and access to antenatal care across Australia.

Future reports will allow trends to be monitored across local communities and may explore other factors that contribute to poorer health outcomes for infants and young children.

About the peer groups

To enable fairer comparisons, the Authority allocated each Medicare Local catchment to one of seven peer groups, based on socioeconomic status, remoteness and distance to hospitals.

  • Metro 1: High urban density, higher socioeconomic status
  • Metro 2: Medium urban density, medium socioeconomic status
  • Metro 3: Low urban density, lower socioeconomic status
  • Regional 1: Outer urban areas, middle socioeconomic status
  • Regional 2: Mostly non-metro urban and regional areas, middle socioeconomic status
  • Rural 1: Distant from metro cities, with diverse socioeconomic status
  • Rural 2: Mostly large remote areas, middle or lower socioeconomic status.

To find more information about peer groups, see the Technical Supplement.

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

2. World Health Organization (WHO). Chapter 1.6. Provision of effective antenatal care in standards for maternal and neonatal care [Internet]. Geneva. [cited 2014 Jun 26]. Available from: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/effective_antenatal_care.pdfExternal link, opens in a new window.

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.