Maternal deaths in Australia 2021–2023

Deaths during pregnancy or in the postpartum period are rare in Australia, but do still occur. All these deaths are reviewed by health professionals to determine the likely cause and whether the pregnancy contributed to the death. This report focuses on the women who died during pregnancy or within 42 days of the end of pregnancy, regardless of duration, from any cause related to or aggravated by the pregnancy or its management. These are called ‘maternal deaths’. Maternal deaths do not include deaths by accident or other incidental causes.

It is important to understand how often and why maternal deaths happen. Data on maternal deaths can help policymakers and health care providers better understand what can be done to help ensure mothers stay healthy through pregnancy and beyond. As maternal deaths are rare in Australia, it can be difficult to interpret the trend in maternal mortality over time using single year rates. This report combines data over a 3-year period (1 January 2021 to 31 December 2023) to allow for more detailed and robust reporting and analysis of maternal characteristics, as well as presenting data for longer periods where possible. Care should be taken when interpreting these data due to the very small numbers.

The maternal mortality ratio has significantly declined since the 1970s

When compared internationally, Australia has a consistently low rate of maternal death. Between 2021 and 2023, more than 886,000 women gave birth and there were 81 deaths. Of these, 59 were considered maternal deaths (that is, related to the pregnancy), 21 were considered coincidental to the pregnancy, and one death has not yet been classified. This is a maternal mortality ratio (MMR) of 6.7 deaths per 100,000 women giving birth in 2021–2023.

The rate of maternal death has significantly decreased since comparable definitions were introduced in 1973–1975, when the rate was 12.7 per 100,000. Prior to this most recent period, the rate of maternal death had consistently decreased in each of the preceding four triennia, from 7.7 in 2009–2011 to 6.3 in 2018–2020.

However, this triennium (2021–2023) shows an increase in the MMR, to 6.7 per 100,000 women giving birth – see Trends in maternal deaths. The MMR will be monitored as more data are available.

Non-obstetric haemorrhage, cardiovascular conditions and sepsis were the leading causes of maternal death in 2021-2023

The most common causes of maternal deaths in 2021–2023 were non-obstetric haemorrhage (8 deaths, or 14%), cardiovascular conditions (7 deaths, or 12%), sepsis (7 deaths, or 12%) and amniotic fluid embolism (6 deaths, or 10%).

These were similar to the most common causes of maternal death when looking at the last decade of data (2014-2023): cardiovascular disease (19 deaths, or 14%), sepsis (24 deaths, or 12%), suicide (20 deaths, or 10%) and thromboembolism (obstruction of a blood vessel by a blood clot) (19 deaths, or 10%).

Some women are at greater risk

While the overall MMR in 2021–2023 remains low, at 6.7 per 100,000 women giving birth, the MMR is higher among some groups of women. These include women who:

• have given birth 4 or more times (MMR 25.6 per 100,000 women giving birth, or 7 deaths) 
• are aged under 20 (MMR 21.5, or 3 deaths) or aged 40 and over (MMR 20.9, or 9 deaths) 
• have a BMI of 40 or more (obese class III; MMR 22.0, or 7 deaths)
• lived in the most disadvantaged socioeconomic areas (MMR 10.4, or 17 deaths), or least disadvantaged socioeconomic areas (MMR 8.2, or 11 deaths).
• smoked in the first 20 weeks of their pregnancy (MMR 16.2, or 9 deaths)
• are identified as being of Aboriginal and Torres Strait Islander origin (First Nations) (MMR 15.0, or 7 deaths).

Where and when did the maternal deaths occur?

Of the 59 maternal deaths in 2021–2023, 40 mothers died within a hospital setting (68%), 14 died at home (24%) and 4 died elsewhere (6.8%). In terms of the timing of maternal deaths (based on a decade of data from 2014–2023), 37% occurred during pregnancy, 18% occurred during or within 24 hours of birth, and 45% occurred after the woman gave birth (with more than half of these deaths occurring within 1 to 13 days of giving birth).

Factors contributing to maternal death can be identified for some cases

In 25 of the 59 maternal deaths, factors contributing to the death were identified. The most common factors were grouped as professional care (such as inadequate staffing, failure or delay in emergency response, failure to offer or follow recommended best practice; 13 deaths) and factors relating to the individual, family or social circumstances (for example insufficient or no antenatal care, substance abuse and family violence; 11 deaths).  

Opportunities for improving the monitoring of maternal deaths in Australia

While maternal deaths are rare in Australia, it is important to continue to monitor and scrutinise all deaths, to identify contributory factors and potential opportunities for improvement in health care or community support.

AIHW and the National Maternal and Perinatal Mortality Clinical Expert Group (NMPMCEG) oversee Australia’s National Maternal and Perinatal Mortality Data Collections. Areas of interest to the group are varied but include autopsy rates and late maternal deaths:

• Autopsy findings can be crucial in accurately determining the cause of maternal death, and other factors that may have contributed to the death. In 2021–2023, the autopsy rate for maternal deaths was lower than preceding years (66%, compared with 75% in 2018–2020 and 70% in 2015–2017). NMPMCEG continues to advocate for autopsy in all cases of maternal death, as clinical appearances are not always confirmed by autopsy findings, with some jurisdictions pursuing legislative changes to ensure this.
• It is increasingly recognised that monitoring maternal deaths beyond the immediate post-partum period is important, particularly for psychosocial causes of death, such as suicide. Late maternal deaths (occurring between 6 weeks and 12 months after the end of pregnancy) are not consistently captured across jurisdictions. AIHW and NMPMCEG are exploring options to improve data quality to enable monitoring of these deaths in future reporting.