Australia's mothers and babies

Overview of perinatal deaths

Australia is one of the safest places in the world for a baby to be born, yet death occurring within the perinatal period is not uncommon. On an average day in Australia, more than 6 babies are stillborn (around 4 in the second trimester of pregnancy, and 2 in the third trimester), and 2 die within 28 days of birth (neonatal death).

In 2022, there were:

• 297,725 babies born to 293,435 women
• 3,076 perinatal deaths (1% of babies born). Of these deaths, just over three-quarters (77%) were stillbirths (2,380) and 23% (696) were neonatal deaths
• 10.3 perinatal deaths per 1,000 births (8.0 stillbirths per 1,000 births and 2.4 neonatal deaths per 1,000 live births).

Key findings 2022

Stillbirth rates increased in Australia in 2022, neonatal death rates remained stable

Stillbirths

The rate of stillbirth increased from 7.2 per 1000 births in 2021 to 8.0 per 1000 births in 2022 – the highest in the twenty-year period from 2003 (Figure 1). There has been no consistent trend over the period from 2003. Between 2010 and 2015 the stillbirth rate appeared to decline. Since 2015 it has fluctuated, with an unusually low rate in 2016 of 6.7 per 1,000 births and then unusually high rates in 2020 and in 2022 (7.7 and 8.0 per 1,000 births respectively).

Due to the small number of stillbirths that occur in a year, small variations in the number of stillbirths can lead to large fluctuations in the stillbirth rate. Some of the fluctuation since 2015 has coincided with key events, such as the commencement of the COVID-19 pandemic, the 2019–20 bushfires, and fluctuations in the underlying birth rate. This may have been associated with changing characteristics of women giving birth in Australia. Some of the increase in 2022 is related to improved capture and inclusion of cases in some areas. As a result, care should be taken when interpreting this trend data.

The AIHW is working with jurisdictions to investigate these trends and clarify the drivers for these changes. These trends in perinatal mortality rates will be explored in future reporting of Stillbirth and neonatal deaths. In light of the increase in 2022, an audit was conducted in Queensland to identify potential drivers of the increased perinatal mortality rate in the state. See Review of selected 2022 Perinatal Deaths Report for more details. 

Neonatal deaths

The rate of neonatal death in 2022 was 2.4 deaths per 1,000 live births. In contrast to stillbirths, rates of neonatal mortality have remained stable in recent years, with the rate in 2022 remaining unchanged from 2021. The rate of neonatal death has ranged between 2.2 and 3.2 deaths per 1,000 live births over the period from 2003 to 2022. 

International comparison 

When international comparisons are made, the definition of stillbirth is that used by the World Health Organisation (WHO) – fetal death occurring in the third trimester (born at 28 weeks’ gestation or more), and/or weighing 1,000 grams or more (WHO 2018). This definition differs from the standard definition used for stillbirth in Australia (and this report) – fetal death prior to birth of a baby born at 20 weeks’ gestation or more, and/or weighing 400 grams or more.

Using the WHO definition of stillbirth excludes the smaller and less mature babies who are included when the standard definition applied in Australia is used. Australian perinatal mortality rates reported using the WHO definitions are therefore lower than those reported using the Australian definitions.

Reporting of neonatal deaths is the same for both the Australian and WHO definitions. Neonatal deaths are all deaths occurring within 28 days of birth (WHO 2018). In the NPMDC, neonatal deaths are those born at 20 weeks’ gestation or more, and/or weighing 400 grams or more. Refer to the Technical notes for more information on WHO definitions of perinatal mortality.

There was wide variation in perinatal death rates across Australia

Rates of perinatal death in 2022 varied across Australia. Rates were highest for babies born in the Northern Territory, with 20.0 deaths per 1,000 births, and ranged between 8.6 and 12.3 deaths per 1,000 births for all other states and territories. Among states and territories, rates have been highest in the Northern Territory for each of the 6 years from 2017 to 2022.

Trend data on perinatal mortality rates by selected geographic area can be explored in the interactive data visualisation below (Figure 3), with data also presented in Table 3 of the supplementary data tables (Data tables: National Perinatal Mortality Data Collection annual update 2022).

Adjusted perinatal mortality rates (excluding terminations) in Australia remained stable

In addition to the standard perinatal mortality rate, for the first time, this release includes an adjusted perinatal mortality rate for most of Australia (excluding Western Australia and Tasmania). This adjusted rate excludes terminations of pregnancy, providing important context for interpreting perinatal mortality rates in Australia and facilitating international comparison.

The adjusted rate of perinatal mortality remained relatively stable between 2019 and 2022 (ranging between 6.1 and 6.4 deaths per 1,000 births). In contrast, the unadjusted rate has fluctuated over this time (Figure 4). The difference between these rates suggests that the fluctuation in the unadjusted mortality rate was related to variation in the number of terminations of pregnancy reported to the NPMDC.

In 2022, 41% of perinatal deaths in Australia (excluding Western Australia and Tasmania) were following a termination of pregnancy.

It is important to note that some pregnancies that ended by termination would have resulted in a perinatal death had the pregnancy continued without medical intervention. The perinatal deaths following a termination of pregnancy that were excluded to calculate the adjusted perinatal mortality rate may have involved one or more of:

• diagnosis of a fetal congenital anomaly,
• risk to the woman’s life due to infection or other problems arising from complications of the pregnancy, such as chorioamnionitis or severe pregnancy-induced hypertension (pre-eclampsia and/or eclampsia),
• the presence of a pregnancy complication such as preterm rupture of membranes, inconsistent with long-term fetal survival, or
• decision by the parent(s) or family not to continue the pregnancy.

The data on terminations of pregnancy in this report are not, however, inclusive of all terminations of pregnancy occurring in Australia. The NPMDC only includes information on perinatal deaths, including terminations of pregnancy, occurring from at least 20 weeks’ gestation or of at least 400 grams birthweight. Therefore, data provided here do not include terminations of pregnancy prior to 20 weeks’ gestation except where the birthweight was 400 grams or more.

Data on termination of pregnancy are subject to differences in definitions across states and territories. States and territories also have different laws on termination of pregnancy (or abortion). For more information see: healthdirect’s Health topics: Abortion page

Stillbirth and neonatal death rates remain considerably lower in the third trimester

The rate of stillbirth in the second trimester has increased over the past two decades, from 461 per 1,000 births in 2003 to 558 per 1,000 births in 2022. Over this period, the rate of neonatal death in the second trimester has decreased, from 434 to 353 per 1,000 live births.

The rates of stillbirth and neonatal death in the third trimester are much lower than the rates in the second trimester and have generally decreased over the past two decades. The rate of stillbirth in the third trimester has decreased from 3.3 per 1,000 births in 2003 to 2.7 per 1,000 births in 2022. Over this period, the rate of neonatal death in the third trimester has also decreased, from 1.1 to 0.9 per 1,000 live births.

Perinatal mortality rates remain highest in the most disadvantaged areas

The rate of perinatal mortality has been consistently higher in Australia’s most disadvantaged areas over the past six years. The rate of perinatal deaths has been consistently lowest in the least disadvantaged areas of Australia. This is the case for both stillbirths and neonatal deaths.

In 2022, the rate of stillbirth was 9.6 per 1,000 births in the most disadvantaged quintile, compared with 6.0 per 1,000 births in the least disadvantaged quintile. In 2022, the rate of neonatal death was 3.0 per 1,000 live births compared with 1.9 per 1,000 live births in the least disadvantaged quintile. These rates are calculated based on the area of the mother’s usual residence, which may differ from the area in which she gave birth.

The proportion of stillbirths that occurred before the onset of labour continued to increase in 2022

The proportion of perinatal deaths that occurred before the onset of labour (antepartum stillbirths) increased from 55% in 2017 to 64% in 2022 (Figure 9).

Intrapartum stillbirth (fetal death occurring during labour and birth) and neonatal death within the first 24 hours after birth are often considered together as, in many cases, the factors contributing to the death could result in the death occurring before or after the birth.

In 2022, where the timing of perinatal deaths was stated:

• the majority of stillbirths (86%) occurred before the onset of labour (antepartum). This accounted for 3 in 5 (64%) of all perinatal deaths.
• over a quarter (26%) of perinatal deaths occurred during labour and/or birth (intrapartum death) or within the first 24 hours following birth (very early neonatal death).

Percentages are calculated after excluding records with ‘not stated’ values (342, or 11% of records). Care must therefore be taken when interpreting percentages.

Detailed data on the timing of perinatal deaths in 2022 are presented in Table 8 of the supplementary data tables (Data tables: National Perinatal Mortality Data Collection annual update 2022).

Leading causes of stillbirth and neonatal death remain unchanged

In 2022:

• the most common causes of perinatal death were:
  1. 'congenital anomaly' (30%)
  2. 'spontaneous preterm labour or rupture of membranes (<37 weeks’ gestation)' (14%)
  3. 'maternal conditions', which includes medical and surgical conditions (for example, diabetes and sepsis) and injuries, as well as complications or treatment of that condition or injury (13%)
• the most common causes of stillbirth were:
  1. 'congenital anomaly' (30%)
  2. 'maternal conditions' (16%)
  3. stillbirths where no cause could be found ('unexplained antepartum fetal death') (14%)
• the most common causes of neonatal death were:
  1. 'spontaneous preterm labour or rupture of membranes (<37 weeks’ gestation)' (34%)
  2. 'congenital anomaly' (28%)
  3. 'antepartum haemorrhage' (8%).

Detailed data on the causes of perinatal death in 2022 are presented in Table 9 of the supplementary data tables (Data tables: National Perinatal Mortality Data Collection annual update 2022).

Less than half of perinatal deaths had an autopsy performed

In 2022, 2 in 5 perinatal deaths had an autopsy performed, a rate that has remained steady over the six-year period from 2019. 

The purpose of an autopsy is to accurately identify the cause(s) of death. Autopsy results contribute to clinical audit and assist with identification of factors contributing to the death, and may be critical when clinicians consider providing parents with advice regarding the risk of a future perinatal death (RCOG 2010). Perinatal autopsy examinations require written consent from the parent(s) following informed discussion.

For the purposes of this report, deaths where any type of autopsy (full autopsy, limited autopsy or external examination) has been performed are collectively treated as deaths where an ‘autopsy’ has been performed.

Of deaths where autopsy status was known (98% in 2022), an autopsy was performed for:

• 39% of perinatal deaths (1,192)
• 42% of stillbirths (985)
• 30% of neonatal deaths (207).

The frequency of autopsy varies depending on the cause of death. Autopsy was most commonly performed in stillbirths where the cause was ‘Placental dysfunction or causative placental pathology’ (69%) and in neonatal deaths where the cause of death was classified as ‘Neonatal death without obstetric antecedent’ (72%), and performed least commonly when cause of death was ‘maternal conditions’ (11%). 

The frequency of autopsy also varied by timing of perinatal death, being most common among antepartum stillbirths (45%) and least common among early neonatal deaths (where the death occurred in 1–7 days; 27%).

See data tables for more information about autopsy rates by timing and cause of death.

Data on autopsies for perinatal deaths in 2022 are displayed in the data visualisation below (Figure 12), with data also presented in Table 11 of the supplementary data tables (Data tables: National Perinatal Mortality Data Collection annual update 2022).