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Maternal deaths in Australia

The maternal mortality rate in Australia in 2020 was 5.5 deaths per 100,000 women giving birth (16 maternal deaths).

In the decade from 2011 to 2020, there were 194 women reported to have died during pregnancy or within 42 days of the end of pregnancy and a maternal mortality rate of 6.4 deaths per 100,000 women giving birth. These deaths are reviewed in this article along with contextual information for maternal death in Australia since 2011.

In Australia, where childbirth is safe for most women, maternal death is rare. All maternal deaths are reviewed by health professionals to determine the likely cause and whether the pregnancy contributed to the death.

Maternal death is the death of a woman while pregnant or within 42 days of the end of pregnancy, irrespective of the duration and outcome of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

Maternal deaths are divided into two categories, direct and indirect. Direct maternal deaths are those resulting from obstetric complications of pregnancy or its management. Indirect maternal deaths are those resulting from diseases or conditions that were not due to a direct obstetric cause, but were aggravated by the physiologic effects of pregnancy. Deaths considered to be causally unrelated to pregnancy are classified as coincidental (see below for more information on these deaths).

Coincidental deaths are defined as those that are reported to have occurred during pregnancy or within 42 days of the end of pregnancy, but are considered to be causally unrelated to pregnancy. Unlike direct and indirect maternal deaths, coincidental deaths are excluded from analysis and Maternal Mortality Ratio (MMR) calculations.

There were 44 coincidental deaths in Australia from 2011–2020. The most common causes of these deaths were motor vehicle trauma and cancer. For more information visit data tables 1 and 2.

In 2020, there were 16 maternal deaths, or 5.5 deaths per 100,000 women giving birth.

Pie chart 1: Deaths indirectly related to the pregnancy - 44%25. Deaths directly related to the pregnancy - 56%25. Pie chart 2: Afterbirth - 62%25. During pregnancy - 31%25. During or within 24 hours of birth - 7.7%25. Causes of death (Bar chart - 7 items): Cardiovascular - 5. Thromboembolism - 4. Non-obstetric haemorrhage - 2. Substance use complications - 2. Substance use complications - 2. Amniotic fluid embolism - 1. Hypertensive disorders - 1. Sepsis: 1.

Source: AIHW analysis of the National Maternal Mortality Data Collection and the National Perinatal Data Collection.

Maternal mortality over time

The incidence of maternal death is expressed as the maternal mortality ratio (MMR). The MMR is calculated using direct, indirect and not classified maternal deaths (excluding coincidental deaths and deaths awaiting classification) and expressed as per 100,000 women giving birth. Between 2011 and 2020, the MMR in Australia was relatively stable, ranging from between 5.0 to 8.4 per 100,000 women giving birth. Fluctuations appear to reflect the normal variability that might be expected with rare events such as maternal deaths.

The data visualisation shows a stacked bar chart of the maternal mortality ratio for direct, indirect, and not classified deaths, by year, for the period 2011 to 2020. In 2020, the maternal mortality ratio was 5.5 per 100,000 women giving birth

For more information on maternal mortality ratio over time see National Maternal Mortality Data Collection annual update table 1.

Causes of maternal deaths

The most frequent causes of maternal death reported in Australia between 2011 and 2020 were:

  • For all maternal deaths:
    • cardiovascular disease (31 deaths or 16%)
    • thromboembolism (22 deaths or 11%)
    • suicide (20 deaths or 10%)
    • sepsis (20 deaths or 10%).
  • For direct maternal deaths:
    • thromboembolism (21 deaths)
    • amniotic fluid embolism (14 deaths)
    • obstetric haemorrhage (13 deaths).
  • For indirect maternal deaths:
    • complications of pre-existing cardiovascular disease (26 deaths)
    • non-obstetric haemorrhage (mostly haemorrhage within the brain and haemorrhage from a ruptured aneurysm of the splenic artery) (14 deaths)
    • suicide (13 deaths).

The data visualisation shows a stacked horizontal bar chart of the number of direct and indirect maternal deaths by cause of death for the period 2011 to 2020. During this period, cardiovascular disease was the leading cause of maternal death, with 31 deaths.

For more information on causes of maternal death see National Maternal Mortality Data Collection annual update table 2.

Timing of maternal deaths

Understanding the timing of maternal deaths is important for identifying periods of critical risk. Between 2011 and 2020 one third (34%) of maternal deaths occurred in women who were reported to be pregnant at the time of their death and, of these women, 2 in 5 (39%) died during the first trimester of pregnancy (less than 14 weeks of pregnancy).

In the same period, 1 in 5 (20%) maternal deaths were reported to have occurred during the birth process or within 24 hours of giving birth. Nearly half (47%) of all maternal deaths occurred after the woman gave birth, with 3 in 5 (61%) deaths after birth occurring within 1 to 13 days of giving birth. These proportions do not include maternal deaths following or due to miscarriage or termination of pregnancy as the timing of death was not adequately reported for these cases.

The data visualisation shows a bar chart of the number of direct and indirect maternal deaths by timing of death for the period 2011 to 2020. During this period, most deaths occurred after birth (75 deaths).

For more information on timing of maternal death see National Maternal Mortality Data Collection annual update table 3.

Characteristics of women who died

This section presents some demographic characteristics of the women who died from 2012–2020. It should be noted that not all demographic information was available for all women who died. Caution should be used when interpreting these data, due to the small number of maternal deaths in Australia, and even smaller numbers when these deaths are broken down by characteristics.

The data visualisation shows a stacked bar chart (direct and indirect) of the maternal mortality ratio for the maternal characteristics of age, Indigenous status, smoking status, parity and remoteness for the period 2012 to 2020. During this period, the maternal mortality ratio for women aged under 20 was 17.2 per 100,000 women giving birth.

Maternal age

Women aged under 20 had the highest MMR, followed by those aged 40 or more (17.2 and 11.8 per 100,000 women giving birth). The lowest MMR was for women in the 20 to 24 age group, followed by women in the 30 to 34 age group (1.8 and 4.7 per 100,000 women giving birth respectively).

Maternal Indigenous status

The MMR for Aboriginal and Torres Strait Islander women was 16.4 per 100,000 women giving birth. In the same period, the MMR for non-Indigenous women was 5.3 per 100,000 women giving birth.

Parity

Parity refers to a woman’s number of previous pregnancies, excluding the current pregnancy, carried to a viable gestational age (usually 20 weeks), resulting in a live birth or stillbirth. The rate of maternal death increased with parity, from an MMR of 4.8 and 4.3 per 100,000 women giving birth for women with a parity of none and 1 respectively, increasing up to 9.5 for women with a parity of 3 and 17.1 for women with a parity of 4 or more.

Smoking status

The rate of maternal deaths was higher in women who reported smoking during the first 20 weeks of pregnancy than in women who reported that they did not smoke during the first 20 weeks of pregnancy (15.6 compared to 3.5 per 100,000 women giving birth). As the number of maternal deaths with an unknown smoking status is relatively high (32% of data from included jurisdictions), caution should be used when interpreting these data.

Remoteness

Women who lived in Remote and very remote areas had the highest MMR, followed by women who lived in Inner regional areas (13.3 and 8.6 per 100,000 women giving birth). The lowest MMR was for women who lived in Major cities (5.3 per 100,000 women giving birth). The rate of maternal death in areas other than Major cities should be treated with caution due to the small numbers.

For more information on timing of characteristics women who died see National Maternal Mortality Data Collection annual update tables 4 to 8.

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