In 2020, in Australia, 3,004 babies died in the perinatal period. Three-quarters (2,273) were stillbirths and the remaining 731 were neonatal deaths. This web article provides information related to these deaths, including causes, maternal characteristics, timing and investigations.

The data presented in this article are from the National Perinatal Mortality Data Collection. Due to differences in reporting cycles, preliminary data on perinatal deaths are also available from the National Perinatal Data Collection and are available in the Preliminary perinatal deaths section of this web report.

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 (from 20 weeks of gestation to 28 days after birth) is not uncommon. Every day in Australia, 6 babies are stillborn and 2 die within 28 days of birth (neonatal death).

In 2020, there were:

  • 295,976 babies born to 291,712 women
  • 3,004 perinatal deaths (1% of babies born). Of these deaths, just over three-quarters (76%) were stillbirths (2,273) and 24% (731) were neonatal deaths
  • 10.1 perinatal deaths per 1,000 births (7.7 stillbirths per 1,000 births and 2.5 neonatal deaths per 1,000 live births).

How have perinatal mortality rates changed over time?

Although the rate of perinatal death continues to range between 9 and 11 deaths per 1,000 births, the rate has decreased slightly since 2003. Two categories have particularly decreased over this period:

  • neonatal deaths of babies born at 23 weeks’ gestation or more
  • stillbirths occurring at 28 weeks’ gestation or more.

The overall stillbirth rate has remained between 7 and 8 per 1,000 births between 2003 and 2020. The higher rate in 2020, compared with 2019, is similar to year-to-year fluctuations observed in the stillbirth rate since 2003. A higher stillbirth rate for 2020 was not seen among stillbirths occurring from 28 weeks' gestation (3rd trimester), where the rate has continued to decline. The 2020 data point occurred in the same year as events such as the severe bushfires in Australia and the first year of the COVID-19 pandemic. Further analysis will be conducted in the future as more data are available. 

Perinatal mortality rates in Australia 2003-2020

The chart includes 4 scatter plots showing the rate of perinatal death, stillbirth, neonatal death, and stillbirth from 28 weeks' gestation over time from 2003 to 2020.

Notes:

  1. The rate is the number of deaths per 1,000 births. Stillbirth and perinatal death rates were calculated using total births (live births and stillbirths). Neonatal death rates were calculated using live births.
  2. Data for 2001, 2002 and 2009 were excluded from the model as data are missing from some states and territories for these years.
  3. The stillbirth rate reported for stillbirths from 28 weeks’ gestation is similar to the rate reported using the WHO definition for international comparison. For more information see International comparison using the WHO definition.

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

International comparison using the WHO definition

The data visualisation below displays perinatal mortality rates in Australia using two different definitions – the Australian and the World Health Organization (WHO) definitions.

The standard definition used for stillbirths in Australia is a fetal death prior to birth of a baby born at 20 weeks gestation or more, and/or weighing 400 grams or more.

This differs from the international definition, where stillbirths are defined as those occurring in the third trimester – born at 28 weeks gestation or more, and/or weighing 1,000 grams or more (WHO 2018).

Neonatal deaths are all registered deaths occurring within 28 days of birth (WHO 2018). In Australia, registered deaths are those born at 20 weeks gestation or more, and/or weighing 400 grams or more. As a result, the reporting of neonatal deaths is the same for both the Australian and WHO definitions.

The WHO definition of stillbirth results in reporting of babies who are larger and more mature than the definition applied in Australia. This means Australian perinatal mortality rates reported using the WHO definitions are lower than those reported using Australian definitions.

The stacked continuous line graph shows that perinatal mortality rates in Australia, using the Australian definitions, was 10.2 perinatal deaths per 1,000 total births in 2003 and 10.1 perinatal deaths per 1,000 total births in 2020. The rate of stillbirths in Australia was 7.1 per 1,000 births in 2003 and 7.7 per 1,000 in 2020. The rate of neonatal deaths in Australia was 3.1 per 1,000 live births in 2003 and 2.5 per 1,000 live births in 2020.

The graph also allows you to use the WHO definitions of perinatal death. When these definitions are used, the graph shows that perinatal mortality rates were 6.4 perinatal deaths per 1,000 total births in 2003 and 5.1 perinatal deaths per 1,000 total births in 2020. The rate of stillbirths was 3.3 in 2003 and  2.6 per 1,000 births in 2020, while the rate of neonatal deaths was 3.1 in 2003 and  2.5 per 1,000 live births in 2020.

The underlying data for this data visualization are also available Tables 1 and 2 in the Excel spreadsheet located on the Data page.

Perinatal death data reported by the Australian Bureau of Statistics (ABS) are not directly comparable with the National Perinatal Mortality Data Collection (NPMDC) and National Perinatal Data Collection (NPDC) data.

ABS data are sourced from state and territory registrars of Births, Deaths and Marriages. NPMDC and NPDC data are sourced from midwives and other staff, who collect information from mothers and perinatal administrative and clinical record systems. For more information on the NPMDC and NPDC and definitions used for reporting perinatal deaths please refer to the Technical Notes—Definitions used in reporting.

Maternal characteristics

Key demographics

This section presents data on maternal and medical characteristics, as supplied to the National Perinatal Data Collection (NPDC), which have been commonly associated with stillbirth or neonatal death.

While these characteristics are more commonly found in women with pregnancies resulting in stillbirth and neonatal death, they are characteristics that are numerically associated with perinatal death and it is not implied that they are the cause of perinatal deaths.

In 2020, there were:

  • 10.1 perinatal deaths per 1,000 births (3,004 deaths)
  • 7.7 stillbirths per 1,000 births (2,273 deaths)
  • 2.5 neonatal deaths per 1,000 live births (731 deaths).

Perinatal mortality rates were higher among babies born to:

  • women who were aged under 20, 20-24 or 40 and over (19.0, 12.4, and 15.6 deaths per 1,000 births, respectively)
  • Aboriginal and Torres Strait Islander women (17.0 deaths per 1,000 births)
  • women who lived in Very remote areas (15.3 deaths per 1,000 births)
  • women living in the most disadvantaged areas of Australia (12.1 per 1,000 births for quintile 1)
  • women who smoked throughout pregnancy (17.2 deaths per 1,000 births)
  • women who have had several previous pregnancies (17.4 deaths per 1,000 birth among women who had a parity of 4 or more).

Detailed data can be found in Table 3 of the supplementary data tables.

The horizontal bar charts in this data visualisation display the rate of stillbirths and neonatal deaths by different maternal demographic characteristics. The first view shows the difference in rates by state or territory of birth. The rate of stillbirths ranged between 5.9 deaths per 1,000 births in Tasmania to 11.1 deaths per 1,000 births in the Northern Territory. The neonatal death rates ranged from 1.3 per 1,000 live births in South Australia to 7.1 per 1,000 live births in the Northern Territory.

The difference in rates by remoteness shows that stillbirth rates increase with increasing remoteness. The rate of stillbirths was 7.3 per 1,000 births in Major cities and 11.1 per 1,000 births in Very remote areas. The rate of neonatal deaths ranged from 2.3 deaths per 1,000 births in Major cities to 4.7 deaths per 1,000 births in Remote areas.

The difference in rates by mother’s country of birth shows that rates of stillbirth and neonatal death are similar for mothers born in Australia or born overseas. The rate of stillbirths was 7.6 deaths per 1,000 births for both mothers born in Australia and mothers born overseas. The rate of neonatal death was 2.4 deaths per 1,000 live births for mothers born in Australia and 2.6 deaths per 1,000 live births for mothers born overseas

The difference in rates by mother’s Indigenous status shows that rates of stillbirth and neonatal death are higher for Aboriginal and Torres Strait Islander mothers. The rate of stillbirths was 11.9 deaths per 1,000 births for Indigenous mothers and 7.4 deaths per 1,000 births for non-Indigenous mothers. The rate of neonatal deaths was 5.2 deaths per 1,000 live births for Indigenous mothers and 2.3 deaths per 1,000 live births for non-Indigenous mothers.

The difference in rates by socioeconomic area of mother’s usual residence shows that rates of stillbirth and neonatal death increase with increasing disadvantage. The rate of stillbirths increased from 6.6 deaths per 1,000 births in the least disadvantaged areas of Australia to 8.9 deaths per 1,000 births in the most disadvantaged areas. The rate of neonatal death increased from 1.8 per 1,000 live births in the least disadvantaged areas of Australia to 3.2 per 1,000 live births in the most disadvantaged areas.

The difference in rates by maternal age group shows that rates of stillbirth and neonatal death are highest for the youngest and oldest mothers. The rate of stillbirths was highest for mothers under 20, 15.2 per 1,000 births, followed by mothers aged 40 or over, 11.9 stillbirths per 1,000 births. The rate of neonatal death was highest for mothers under 20, 3.9 per 1,000 live births, followed by mothers aged 40 or over, 3.7 per 1,000 live births.

The difference in rates by state or territory of mother’s usual residence show that the rate of stillbirth ranged between 5.8 deaths per 1,000 births for mothers from Tasmania to 10.3 deaths per 1,000 births for mothers from the Northern Territory. Neonatal death rates ranged from 1.1 per 1,000 livebirths for mothers from the Australian Capital Territory to 6.8 per 1,000 live births for mothers from the Northern Territory.

The underlying data for this data visualization are also available in the Table 3 of the Excel spreadsheet located on the Data page.

Country of birth

There was little overall difference in perinatal mortality rates for babies of women born in Australia (10.0 perinatal deaths per 1,000 births) compared to babies of women born overseas (10.2 perinatal deaths per 1,000 births). The highest rates of perinatal death were among babies of women whose country of birth was in:

  • Central and West Africa (19.4 perinatal deaths per 1,000 births)
  • Polynesia (excludes Hawaii) (18.5 perinatal deaths per 1,000 births)
  • Melanesia (15.7 perinatal deaths per 1,000 births).

Detailed country of birth data can be found in Table 3 of the supplementary data tables.

Baby characteristics

Birthweight and gestational age are interrelated and birthweight is generally expressed in relation to gestational age using population percentiles (refer to the Technical notes—Methods for more information on percentiles).

Gestational age and birthweight

A baby may be small due to being pre-term (born early), or due to being small for gestational age (either because it is small due to genetic factors, or because it is the subject of a growth restriction within the uterus). Poor fetal growth is associated with increased risk of perinatal death and with fetal distress during labour, and these babies are more likely to develop long-term health conditions later in life.

Adjusting birthweight for gestational age allows for differences in a baby’s growth status and maturity to be taken into account when examining their health outcomes at birth.

Babies are defined as being small for gestational age if their birthweight is below the 10th percentile for their gestational age and sex, as determined by national percentiles. Babies are defined as large for gestational age if their birthweight is above the 90th percentile for their gestational age and sex.

In 2020:

  • 2 in 5 perinatal deaths (41%) occurred among babies born before 23 completed weeks’ gestation.
  • Rates of perinatal death decreased rapidly from 28 weeks’ gestation (3rd trimester) and were lowest among babies born at or near term (from 36 weeks' gestation).

Detailed data can be found in Table 4 of the supplementary data tables.

The highest rates of perinatal death were among:

  • babies born at less than 23 weeks’ gestation (997.6 deaths per 1,000 births)
  • babies born with a birthweight less than 2,500 grams (117.0 deaths per 1,000 births)
  • babies who were small for gestational age (birthweight below the 10th percentile for their age and sex; 25.9 deaths per 1,000 births)
  • multiple births (29.4, and 40.9 deaths per 1,000 births, for twin and triplet or higher plurality respectively).

Detailed data can be found in Table 4 of the supplementary data tables.

The horizontal bar charts in this data visualisation show the rates of both stillbirth and neonatal death by different baby characteristics. The first view shows the difference in rates by gestational age group (clinical groups). Rates of stillbirth and neonatal death decrease as a baby’s gestational age increases. The rate of neonatal death decreased from 996.4 deaths per 1,000 births at 20-22 weeks’ gestation to 0.6 deaths per 1,000 births at 36 weeks or more gestation. The rate of stillbirth decreased from 771.0 per 1,000 live births at 20-22 weeks’ gestation to 1.1 per 1,000 live births at 36 weeks or more gestation.

Rates of perinatal death were highest in babies born small for gestational age, or those with a birthweight below the 10th percentile for their gestational age and sex. The highest rates were in babies whose birthweight for gestational age was below the 3rd percentile for their gestational age and sex. The stillbirth rate for this category was 53.6 deaths per 1,000 total births, and the neonatal death rate was 9.4 deaths per 1,000 live births.

The difference in rates by birthweight groups shows that rates of stillbirth and neonatal death are highest for low birthweight babies, weighing less than 2,500 grams. The rate of stillbirths for low birthweight babies was 91.3 per 1,000 births, compared to 1.0 for normal weight babies weighing between 2,500 and 4,499 grams. The rate of neonatal death for low birthweight babies was 28.3 per 1,000 live births, compared to 0.5 for normal weight babies weighing between 2,500 and 4,499 grams.

The difference in rates by plurality shows that rates of stillbirth increase as the number of babies in a pregnancy increases. The rate of stillbirths decreased from 35.1 deaths per 1,000 births for pregnancies with three or more babies to 7.4 deaths per 1,000 births for pregnancies with a single baby. The rate of neonatal deaths ranged from 2.2 deaths per 1,000 live births for pregnancies with a single baby to 12.1 per 1,000 live births for twin pregnancies.

The difference in rates by trimester of pregnancy shows that rates of stillbirth and neonatal death are higher in the second trimester (20-27 weeks’ gestation). The rate of stillbirths was 559.4 deaths per 1,000 births in the second trimester (20-27 weeks’ gestation) and 2.4 per 1,000 births in the third trimester (28 weeks’ gestation or more). The rate of neonatal deaths was 380.1 deaths per 1,000 live births in the second trimester (20-27 weeks’ gestation) and 0.9 per 1,000 live births in the third trimester (28 weeks’ gestation or more).

The underlying data for this data visualization are also available in Table 4 of the Excel spreadsheet located on the Data page.

Gestational age trend

While perinatal mortality rates have been holding relatively steady for babies born before 28 weeks’ gestation, they have been gradually decreasing among babies born after 28 weeks’ gestation.

Stillbirths occurring after 28 weeks' gestation, or in the third trimester of pregnancy, are known as late gestation stillbirths. Evidence indicates that these stillbirths are the ones most likely to be preventable (Flenady et al. 2016). The rate of late gestation stillbirths in Australia has decreased from 3.3 per 1,000 births in 2003 to 2.4 per 1,000 births in 2020.

Neonatal deaths in both the second and third trimesters of pregnancy have decreased over this period, with deaths in the third trimester (28 weeks’ gestation or more) decreasing from 1.1 per 1,000 births in 2003 to 0.9 per 1,000 births in 2020.

The stacked continuous line graphs in this data visualisation show the changes in perinatal deaths rates by two different measures of gestational age, trimester of pregnancy and clinical gestational age groups.

The continuous line graph for trimester of pregnancy shows that the perinatal mortality rate has held steady for babies born in the second trimester of pregnancy, or from 20-27 weeks in this data collection, from 694.7 deaths per 1,000 births in 2003 to 726.6 deaths per 1,000 births in 2020. The second trimester category in the NPDC is limited to births occurring from 20 weeks of gestation and may also include babies born at less than 20 weeks weighing 400g or more. Mortality rates for babies born in the third trimester, or from 28 weeks’ gestation, has decreased from 4.4 deaths per 1,000 births in 2003 to 3.3 deaths per 1,000 births in 2020.

The continuous line graph for gestational age group shows that the perinatal mortality rate has held relatively steady for babies born at 20-22 weeks gestation (from 993.9 deaths per 1,000 births in 2003 to 997.6 deaths per 1,000 births in 2020), 23-26 weeks (from 585 to 577.7 deaths per 1,000 births over the same period), and for babies born at 27-31 weeks (from 119.9 to 130.5 deaths per 1,000 births). Over the same period, mortality rates have decreased for babies born at 32-35 weeks, from 30.6 to 24.5 deaths per 1,000 births, and for babies born at 36 or more weeks, from 2.6 to 1.7 deaths per 1,000 births.

The underlying data for this data visualization are also available in Table 5 of the Excel spreadsheet located on the Data page.

Timing, causes and investigation of perinatal deaths

Timing of perinatal deaths

In 2020, where the timing of perinatal deaths was stated:

  • 3 in 5 (60%) perinatal deaths and the majority (83%) of stillbirths occurred before the onset of labour (antepartum death).
  • Nearly 3 in 5 (58%) neonatal deaths occurred within the first 24 hours following birth (very early neonatal death) and were more common with earlier gestational age.
  • Early neonatal deaths (1–7 days) were more common among babies born 23-26 weeks (35%) and from 36 weeks' gestation (34%).
  • Late neonatal deaths (8–28 days) were more common among babies born from 36 weeks’ gestation (55%).

Percentages are calculated after excluding records with 'not stated' values. Care must be taken when interpreting percentages.

Detailed data can be found in Table 6 of the supplementary data tables.

The first view shows a horizontal bar chart of the timing of perinatal deaths. The majority, 61%, were antepartum stillbirths. This was followed by deaths in the very early neonatal period (less than 24 hours), and intrapartum stillbirths, 16% and 12% respectively. Early and late neonatal deaths accounted for 7% and 5% of deaths respectively.

The next view shows a stacked horizontal bar chart of the timing of perinatal deaths by gestational age group. Antepartum stillbirth was the most common time of death for all gestational age groups, with more than half of antepartum stillbirths being babies born at less than 27 weeks’ gestation. Most intrapartum stillbirths and very early neonatal deaths were for babies born at 20-22 weeks’ gestation, while most early neonatal deaths were babies born at 23-26 weeks’ gestation or 36 weeks’ gestation or more, and late neonatal deaths were babies born at 36 weeks’ gestation or more.

The underlying data for this data visualization are also available in Table 6 of the Excel spreadsheet located on the Data page.

Causes of perinatal death

Causes of perinatal deaths are classified according to the Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Classification System, version 3.2, as part of each state or territory’s perinatal mortality review process.

The PSANZ Perinatal Mortality Classification System incorporates a Perinatal Death Classification (PSANZ-PDC) and an additional Neonatal Death Classification (PSANZ-NDC).

The PSANZ-PDC system classifies all perinatal deaths (stillbirths and neonatal deaths) by the single most important factor which led to the chain of events that resulted in the death (refer to Technical notes—Definitions used in reporting for cause of death classifications).

In 2020:

  • the most commonly classified causes for all perinatal deaths were:
    • congenital anomaly (33%)
    • spontaneous preterm labour or rupture of membranes (<37 weeks' gestation) (13%)
    • maternal conditions (11%).
  • the most commonly classified causes of stillbirths were:
    • congenital anomaly (32%)
    • maternal conditions (14%)
    • unexplained antepartum death (13%).
  • the most commonly classified causes of neonatal deaths were:
    • congenital anomaly (36%)
    • spontaneous preterm labour or rupture of membranes (<37 weeks' gestation) (31%)
    • perinatal infection (6.3%).

A horizontal bar chart shows the number of deaths by eleven PSANZ Perinatal Death Classifications and by death status. Congenital anomaly was the most common cause of death and was the classification for 977 deaths (33% of 3,004 perinatal deaths). For perinatal deaths, the cause of death was classified as ‘Spontaneous preterm labour or rupture of membranes’ for 396 deaths, as ‘Maternal conditions’ for 329 and ‘Unexplained fetal death’ for 288 deaths. The least frequently classified causes of perinatal death were ‘Neonatal death without obstetric antecedent’ (20 perinatal deaths), ‘Hypoxic peripartum death’ (72 perinatal deaths) and ‘Hypertension’ (73 perinatal deaths).

Stacked horizontal bar charts show the cause of death classifications by maternal and baby characteristics and by death status. For perinatal deaths, ‘Congenital anomaly’ was the most commonly classified cause of death for all gestational age, timing of perinatal death, and birthweight percentile groups. For maternal age groupings, maternal conditions was the most common cause for mothers under 20 years. For plurality groupings, 'Complications of multiple pregnancy’ was the most common cause of death for multiple births.

The underlying data for this data visualization are also available in Table 7 of the Excel spreadsheet located on the Data page.

In 2020, congenital anomaly was the most commonly classified cause of perinatal death (33% of perinatal deaths). This remained true across almost all groups of perinatal deaths, regardless of maternal or gestational age, plurality, baby’s birthweight percentile or the timing of death.

Some exceptions to this were for:

  • Near or at term stillbirths. Unexplained antepartum death was the most commonly classified cause of death for stillbirths occurring from 36+ weeks’ gestation (18%), followed by placental dysfunction or causative placental pathology (17%).
  • Early gestation neonatal deaths. Spontaneous preterm birth was the most commonly classified cause for neonatal deaths occurring at 20-22 and 23-26 weeks’ gestation (45% and 50%, respectively).
  • Babies born to mothers aged under 20. Maternal conditions were the most commonly classified cause of perinatal death for babies born to mothers aged under 20 (31%). Maternal conditions refers to deaths where a medical condition (e.g. diabetes) or a surgical condition (e.g. appendicitis) or an injury in the mother (including complications or treatment of that condition) is the cause.
  • Multiple births. Complications of multiple pregnancy was the most commonly classified cause for multiples (44%), followed by spontaneous preterm labour or rupture of membranes (27%).
  • Neonatal deaths in babies considered appropriate for gestational age (AGA). Spontaneous preterm labour or rupture of membranes was the main classified cause of neonatal deaths for babies considered appropriate birthweight for their gestational age (35%).

Causes of neonatal deaths

The PSANZ-NDC is an additional classification system applied only to neonatal deaths to identify the single most significant condition present in the neonatal period that caused the baby’s death.

In 2020, the most commonly classified conditions causing neonatal deaths were:

  • periviable infants (infants deemed too immature for resuscitation or continued life support; 34%)
  • congenital anomaly (31%)
  • neurological conditions (13%).

The horizontal bar chart in this data visualisation shows that periviable infants (typically <24 weeks) was the most commonly classified condition causing neonatal death, followed by congenital anomaly and neurological conditions. Together, they accounted for 77.1% of all neonatal causes of death. The remaining deaths were caused by cardio-respiratory disorders (8.3%), other conditions (4.9%), neonatal infection (4.8%), and gastrointestinal conditions (2.3%).

Investigation following perinatal death

Autopsy

The National Perinatal Mortality Data Collection collects data on whether or not an autopsy was performed and, where applicable, the type of autopsy performed (a full autopsy, limited autopsy or external examination). For the purposes of this report, deaths where any of these autopsy types have been performed will be collectively treated as deaths where an ‘autopsy’ has been performed.

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.

In 2020, there were 3,004 perinatal deaths, 2,801 (93%) of which had a stated autopsy status (2,136 stillbirths and 665 neonatal deaths).

Of deaths where autopsy status was stated, an autopsy was performed for:

  • 1,043 (37%) perinatal deaths
  • 867 (41%) stillbirths, and
  • 176 (27%) neonatal deaths. 

Percentages are calculated after excluding records with ‘not stated’ values. Care must be taken when interpreting percentages.

The horizontal bar chart in this data visualisation shows that of perinatal deaths with a stated autopsy status, 59% of stillbirths and 74% of neonatal deaths did not have an autopsy performed. A higher proportion of stillbirths were reported as having an autopsy performed than neonatal deaths, 41% vs 27% respectively.