Overview
This page provides information about Indigenous mothers and their babies, including discussions of Indigenous fertility rates, the health of Indigenous babies, perinatal mortality and Indigenous ante-natal health programs.
The two main sources of this information are state and territory perinatal collections and the records from the Registrars of Births, Deaths and Marriages in each jurisdiction.
On this page
Mothers
In 2003, Aboriginal and/or Torres Strait Islander women who gave birth made up 3.6% of all mothers in Australia. Aboriginal and Torres Strait Islander women, on average, have babies at a younger age than non-Indigenous women, with the data for 2003 showing that the average age of Aboriginal and Torres Strait Islander mothers was 24.8 years, 4.9 years younger than the average for other Australian mothers. In the period from 2000-02, 78% of Indigenous mothers were having babies before the age of 30. The comparable figure for non-Indigenous mothers was 49%.
While the peak age group for all Australian women to give birth is 30-34 years, with declining fertility following, the peak age group for Indigenous women to give birth is 20-24 years, with declining fertility immediately following. In 2003, the Indigenous teenage fertility rate was more than four times the teenage fertility rate of the total Australian population.
Based on birth registrations and population projections, Indigenous fertility for 2003 was estimated to be at least 2.15 babies per woman (based on 91% coverage), compared with 1.76 babies for all Australian women. It should be noted that because a considerable number of Indigenous babies are born to non-Indigenous women, measures of the fertility of Indigenous women inevitably underestimate the impact of births on the growth of the Indigenous population. Babies of Indigenous mothers were nearly twice as likely as babies of non-Indigenous mothers to be of low birthweight, a factor affecting health in childhood and, as some evidence suggests, throughout adult life also.
Babies of Indigenous mothers were twice as likely to die at birth and during the early post-natal phase. Local antenatal care programs, such as that run by the Nganampa Health Council in South Australia, are providing Indigenous mothers with support and care throughout the antenatal and postnatal periods, which should have a positive impact on the health of these mothers and their babies.
Babies
Babies born with a birthweight of less than 2,500 grams are classified as being of "low birthweight". Low birthweight may be a result of pre-term birth, foetal growth retardation, or a combination of the two (Alberman 1994). Factors influencing a baby's birthweight may include socioeconomic disadvantage, the size and age of the mother, the number of babies previously born, the mother's nutritional status, smoking and other risk behaviours, illness during pregnancy, and the duration of pregnancy. Low birthweight babies are more prone to ill health during childhood, and may be more vulnerable to illness in adulthood (Alberman 1994, Barker & Clark 1997).
In 2003, 14.1% of babies born to Aboriginal or Torres Strait Islander mothers were born preterm (before 37 weeks gestation), compared with 7.6% of babies of other mothers. Low birthweight babies (less than 2,500 grams at birth) were more common in babies born to Aboriginal or Torres Strait Islander mothers (13%), compared to babies born to other mothers (6%). Since 1991, there appears to have been little change in both the proportion of low birthweight babies born to Indigenous mothers and the mean birthweight of these babies.
In 1998-2000, in Queensland, the proportion of low birthweight babies born to Torres Strait Islander mothers (10%) was slightly lower than that recorded for babies born to Aboriginal mothers (13%), but higher than that recorded for babies born to non-Indigenous mothers (7%) (Perinatal Data Collection, Queensland Health). Coory (2000) has queried the use of birthweight as an appropriate measure of the health of babies born to Torres Strait Islander mothers. By using ten years of combined data on live births in Queensland, he found that even though the recorded birthweights of babies of both Torres Strait Islander and non-Indigenous mothers were similar, babies born to Torres Strait Islander mothers experienced higher rates of neonatal mortality than babies born to non-Indigenous mothers. The study suggests that this result may be related to the high prevalence of diabetes among Torres Strait Islander mothers. More research is needed to explore these findings.
Perinatal mortality
Over the period 1998-2002, the national perinatal mortality rate for babies born to Indigenous women was twice as high as that for babies born to non-Indigenous women. In the period 1998-2002, the perinatal mortality rates for Aboriginal and Torres Strait Islander infants in Queensland, South Australia, Western Australia and the Northern Territory were 20.1 per 1,000, 26.3 per 1,000, 21.2 per 1,000 and 22.9 per 1,000 respectively.
Perinatal deaths may be underestimated because the number of neonatal deaths may not be accurately ascertained, particularly deaths occurring among babies transferred, or readmitted to hospital, and those dying at home. This is a result of some states and territories having no linkage between registered perinatal deaths and the birth records of these babies in the perinatal data collections (Nassar et al. 2000). In recent years a number of states and territories have linked their perinatal data collections to the registered perinatal deaths of their respective Registries of Births, Deaths and Marriages, in an effort to improve the extent to which neonatal deaths are ascertained. This has led to improved information about perinatal deaths in those states and territories and apparent reporting of higher numbers of neonatal deaths. Valid comparisons between the neonatal data of states and territories are therefore not always possible in these circumstances. Improved standardisation and linkage of perinatal deaths by all states and territories will allow valid comparisons and interpretation of perinatal mortality in the future.
Nganampa Health Council antenatal care program
The Nganampa Health Council is an Ananga (Aboriginal) controlled community health organisation providing a range of health programs to all persons on Ananga Pitjanjatjara Lands in the far west of South Australia.
When Nganampa Health Council took over the provision of health services in 1985, it identified poor antenatal care as a major health problem in the region. Most women presented late in the second trimester of pregnancy and a few had regular antenatal visits or appropriate investigations or checkups. It was estimated that less than a third of all women were receiving reasonable antenatal care at that time.
In response, Nganampa Health Council developed a care record system for antenatal patients, to be used in all clients. The system is both a tool for health management and a source of antenatal care data for the population. It allows the health service to collate information and report annually on its success in moving towards agreed targets.
The initial antenatal care targets for pregnant women were:
- first presentation prior to 20 weeks
- more than five antenatal care visits for each pregnancy
- an ultrasound performed in all pregnancies
- an ultrasound performed at an appropriate time for estimating gestational age
- appropriate investigations performed and checked in all pregnancies
Data show a steady but marked improvement in antenatal care for women in the Ananga Pitjantjatjara Lands over this time, particularly when contrasted with the very poor antenatal status of women at the time the service commenced.
An independent study undertaken at Nganampa between 1984 and 1996 showed encouraging results. The authors noted that substantial, statistically significant improvements had been demonstrated, for example:
perinatal mortality rates decreased from 45.2 per 1000 to 8.6 per 1000, compared with a national average rate for non-Indigenous babies of 6.7 per 1000.
low birthweight decreased from 14.2% to 8.1%, compared with a national average rate for non-Indigenous babies of 6.2%.
mean birthweight increased from 3,080 grams to 3,183 grams, compared with a national mean of 3,365 grams for non-Indigenous babies.
Source: Department of Health and Aged Care ed. 2001 'Better Health Care: Studies in the Successful Delivery of Primary Health Care Services for Aboriginal and Torres Strait Islander Australians', cited in AIHW 2003 The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples, AIHW: Canberra.