In 2008, one of the 6 Closing the Gap targets agreed by the Council of Australian Governments (COAG) was to halve the gap in mortality rates for Indigenous children under 5 by 2018. This report looks at current patterns and trends in Indigenous child mortality and associated risk factors. It examines interventions aimed at reducing child mortality; the time frames between program implementation and expected reductions in risk factors; child health outcomes; and data availability to measure outcomes achieved.
Indigenous child mortality
Mortality rates for Indigenous children aged under 5 have declined over the past decade, largely driven by decreases in infant mortality. In particular, there were significant declines in deaths from sudden infant death syndrome and deaths from certain conditions originating in the perinatal period. These contributed 42% and 25% respectively to the fall in Indigenous infant mortality between 2001 and 2011.
Conditions originating in the perinatal period and congenital malformations have continued to dominate infant mortality rates in recent years, while external causes (injury and poisoning) still account for just over one half of all deaths of Indigenous children aged 1-4. Further declines in these three causes of death will likely have the greatest impact on achieving the COAG child mortality target.
Risk factors and interventions
A number of risk factors are associated with infant and child mortality, including low birthweight and pre-term births, maternal health and behaviours (smoking and alcohol use during pregnancy; STIs; breastfeeding) and access to health services (antenatal care and immunisation).
The literature suggests that one way to improve outcomes for Indigenous mothers and babies is through improved access to, and take up of, antenatal care services, as studies have shown an association between inadequate antenatal care and increased risk of stillbirths, perinatal deaths, fetal growth retardation, low birthweight and pre-term births (Taylor et al. 2013). Culturally secure and comprehensive antenatal care services also address a number of risk factors including maternal smoking and alcohol use during pregnancy.
Time frames from program implementation to improved health outcomes vary. For example, the impact of antenatal care, immunisation and health check initiatives can be seen fairly quickly after program implementation (for example, recent data show increases in immunisation rates and health checks for Indigenous children following the first year of funding of relevant COAG health initiatives). However, it may take several years to see the impact of population health initiatives on reductions in risk factors and child health outcomes. There is also a time lag between when improvements occur and when data are available to measure those changes.
Given these timing issues, 2014 is the earliest year that data are expected to be available to measure initial changes in Indigenous child mortality resulting from the COAG maternal and child health initiatives, and the full effect of these initiatives may not be evident for a number of years to come.