RESEARCH PAPER SERIES, 2021–22   updated 23 March 2022

Stillbirth statistics in Australia

Grey Robertson

Statistics and Mapping

1 Executive summary

This research paper gives an overview of Australian statistics on stillbirths, including definitions, data collection methods, and the reasons for current approaches. It discusses current efforts being made by Australian Government agencies to improve reporting on stillbirths following the recommendations of the Senate inquiry into stillbirth research and education. It looks at how reporting by the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS) is contributing to efforts to reduce the number of preventable stillbirths in Australia and raise community awareness of stillbirth.

To improve reporting of stillbirths, the National Stillbirth Action and Implementation Plan (the Plan) tasks the Commonwealth to:

develop and implement a standardised approach to data collection on causes and contributing factors for perinatal deaths across maternity services. (p. 22)

ensure measures are in place to compare Australia’s performance in stillbirth prevention with other high-income countries and ensure that data quality on country of birth and Aboriginal and Torres Strait Islander status is sufficient to inform reporting on equity. (p. 23)

Preventing late gestation stillbirths is a focus of the National Stillbirth Action and Implementation Plan.¹ Recent data reported by the AIHW suggest the rate of preventable stillbirths may be falling.² The rate of late gestation stillbirths in Australia (those occurring after 28 weeks of gestation, or in the third trimester of pregnancy) has decreased from 3.5 per 1,000 births in 1999 to 2.2 per 1,000 births in 2018. Rates of early stillbirth are rising, although this may reflect more accurate reporting of stillbirths rather than an increase in the numbers of women experiencing stillbirth. Reported stillbirths in the second trimester have increased from 437.2 stillbirths per 1,000 births in 1999 to 535.6 stillbirths per 1,000 births in 2018.

Differences in the purpose and scope of the AIHW and the ABS data collections mean the data cannot be combined, but each source has strengths. AIHW data appear to be already contributing to better reporting on stillbirths across maternity services, while continuing improvements in ABS data can support better identification of the populations experiencing a disproportionate rate of stillbirths.

Contents

Executive summary

Abbreviations

Introduction

Current approach to data collection and reporting on stillbirths in Australia

AIHW data collection and reporting on stillbirths in Australia

ABS data collection and reporting on stillbirths in Australia

The National Stillbirth Action and Implementation Plan

Action area 11—Improving investigation and reporting of stillbirth

Improvements to AIHW reporting

Improvements to ABS reporting

Action area 12—Tracking progress to reduce inequity

Comparing Australia’s performance in stillbirth prevention with other high-income countries

Data quality and reporting on equity for tracking progress on inequity

Aboriginal and Torres Strait Islander Australians

Mother’s country of birth

Conclusion

National resources on stillbirth

Glossary

2 Abbreviations

CRVS

Civil registration and vital statistics

ICD-10

International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10)

MCCPD

Medical Certificate of Cause of Perinatal Death

NBEDS

Perinatal Mortality National Best Endeavours Data Set

NPDC

National Perinatal Data Collection

NPMDC

National Perinatal Mortality Data Collection

PSANZ

Perinatal Society of Australia and New Zealand Perinatal Mortality Classification System

PSANZ-PDC

PSANZ Perinatal Death Classification

3 

Introduction

This research paper gives an overview of Australian statistics on stillbirths, including definitions, data collection methods and the reasons for current approaches. It discusses current efforts being made by Australian Government agencies to improve reporting on stillbirths in line with actions under the National Stillbirth Action and Implementation Plan (the Plan). The Plan itself is an outcome of recommendation 15 of the Senate inquiry into stillbirth research and education.

In Australia, stillbirths are reported where the baby died before or during the birth and was at least 20 weeks gestation or weighed 400 grams or more. This definition is consistent with the legislated requirement for all state and territory Registrars of Births, Deaths and Marriages to register such deaths.

The two key sources of statistics in Australia: the Australian Bureau of Statistics (ABS) and the Australian Institute of Health and Welfare (AIHW), use the same definitions of stillbirth (which differ from international standards—see section on Action area 12). However, the numbers reported by the ABS and the AIHW differ due to differences in the sources and methods for collecting the data. The ABS notes differences in the scope of the data collections mean that users should be wary of using multiple sources for analysis. These differences in scope may mean that, depending on the statistics’ purpose, either AIHW data or ABS data might be the most suitable source.

Stillbirths are usually reported along with neonatal deaths, as perinatal deaths. This paper looks at stillbirth reporting only.

Stillbirth

A stillbirth is the death of a baby before birth, at a gestational age of 20 weeks or more, or of a birthweight of 400 grams or more. Technically described as a fetal death.

The stillbirth rate and the perinatal mortality rate are calculated using all live births and stillbirths (fetal deaths) in the denominator.³

Definitions of key terms and their usages are in the glossary.

1 Current approach to data collection and reporting on stillbirths in Australia

In Australia both the ABS and the AIHW define a stillbirth as a death that occurs prior to or at the birth of a baby of 20 or more completed weeks of gestation or of 400 grams or more birthweight. The stillbirth rate is stillbirths as a proportion of all live births (at gestational age) plus stillbirths. That is the stillbirth rate = number of stillbirths / total number of births x 1,000.

Table 1 below shows the timeseries of available statistics for stillbirths as published by the AIHW and the ABS. Despite using consistent definitions, the reported number and rate of stillbirths is usually greater in the AIHW data than the ABS data.

Table 1: AIHW and ABS reported fetal deaths (stillbirths), Australia, 2010 to 2020

AIHW reported stillbirths

ABS reported stillbirths

Year

Number

Rate

Number

Rate

2020

…

7.4*

1,784

6.0

2019

2,183

7.2

1,686

5.5

2018

2,116

7.0

1,682

5.3

2017

2,174

7.1

1,760

5.7

2016

2,114

6.7

1,724

5.5

2015

2,149

7.0

1,718

5.6

2014

2,225

7.1

1,698

5.6

2013

2,194

7.1

1,781

5.7

2012

2,255

7.2

1,832

5.9

2011

2,230

7.4

1,748

5.8

2010

2,201

7.3

1,767

5.8

Source: AIHW analysis of the National Perinatal Mortality Data Collection and the National Perinatal Data Collection as published in AIHW Stillbirths and neonatal deaths in Australia 2017–2018 and Australia's mothers and babies web report December 2021; ABS 3303.0 Causes of Death, Australia, 2019 Table 15.1, Fetal, neonatal, and perinatal deaths, Australia, 2010-2019.

Notes: ABS data are sourced from state and territory registrars of Births, Deaths and Marriages, while AIHW data are sourced from state and territory health authority data from midwives and other staff who collect information from mothers and perinatal administrative and clinical record systems. AIHW stillbirth counts may include late termination of pregnancy in some states depending on State legislation.

* The AIHW 2020 figure are preliminary and do not include data for Victoria and South Australia. AIHW preliminary 2020 and final 2019 stillbirth data accessed 15 March 2022 (Preliminary Table 4.1: Fetal, neonatal, and perinatal deaths, by state and territory, 2020).

The scope of the ABS data differs from other Australian data sources on perinatal deaths. The ABS notes caution should be taken if using multiple sources for analysis.

AIHW data collection and reporting on stillbirths in Australia

The AIHW data comes from the National Perinatal Mortality Data Collection (NPMDC) and the National Perinatal Data Collection (NPDC).⁴ This data is obtained from midwives and other staff who collect the information from mothers and from perinatal administrative and clinical record systems. The numbers are published in the AIHW publications: Stillbirths and neonatal deaths in Australia 2017-18 and Australia’s mothers and babies 2018—in brief. Findings are usually published two years after the year the death has occurred, and the state or territory’s perinatal mortality review process is complete. The 2018 data was published in December 2020.

The AIHW data collections classify causes of death according to the Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Classification System which is used in Australia and New Zealand to classify the causes of stillbirths and neonatal deaths. It includes the PSANZ Perinatal Death Classification (PSANZ-PDC). The National Maternal and Perinatal Mortality Advisory Group have agreed that the PSANZ-PDC classifications are the most appropriate for national reviews. The clinical practice guidelines note:

The overarching objective of the PSANZ Clinical Practice Guideline for Care Around Stillbirth and Neonatal Death is to ensure best practice across Australia and New Zealand around the time of a perinatal death to improve maternity and newborn care for bereaved parents and families and to improve the quality of data on causes of stillbirth and neonatal deaths through appropriate investigation, audit and classification.⁵ [emphasis added]

More information on care guidelines and investigation pathways is available from the Centre of Research Excellence in Stillbirth (stillbirthcre.org.au) clinical practice guidelines.

The PSANZ-PDC system classifies all perinatal deaths by the single most important factor thought to be the cause of death. The cause is classified as part of each state and territory’s perinatal mortality review process after investigations are completed and at the end of a multi-disciplinary review of the perinatal death. The clinical practice guideline suggests:

Following application of the PSANZ SB&ND system, mapping to ICD-PM categories should be undertaken to enable high quality global reporting.⁶

As outlined in Table 2 below, in 2017 and 2018 the most common causes of stillbirths were:

congenital anomaly (30.3%)

unexplained antepartum death (22.0%)

maternal conditions (12.2%).

Table 2: Stillbirths by cause of death (PSANZ-PDC) and gestational age group, 2017 and 2018

Stillbirths

Gestational age at birth (per cent)

Cause of death

Number

Total (%)

20–22 weeks

23–26 weeks

27–31 weeks

32–35 weeks

36+ weeks

Congenital anomaly

1,298

30.3

38.3

35.2

29.3

21.7

9.5

Unexplained antepartum death

942

22

15.2

15.9

25.8

29.9

39.3

Maternal conditions

523

12.2

14.0

16.1

5.6

8.2

9.1

Specific perinatal conditions

330

7.7

5.0

6.2

10.7

12.5

11.4

Spontaneous preterm

284

6.6

13.4

4.9

0.2

0.7

0.1

Fetal growth restriction

274

6.4

3.3

7.6

11.8

9.5

6.8

Antepartum haemorrhage

261

6.1

4.5

6.5

6.6

8.0

8.0

Perinatal infection

205

4.8

5.2

3.7

3.3

3.2

7.1

Hypertension

109

2.5

0.8

3.5

5.2

4.0

3.0

Hypoxic peripartum death

39

0.9

0.1

0.3

0.2

1.7

3.7

Not stated

25

0.6

0.1

0.2

1.2

0.5

2.0

Number of stillbirths

4,290

 ..

1,719

975

484

401

704

Source: AIHW analysis of the NPMDC and NPDC. AIHW (2021) Stillbirths and neonatal deaths in Australia 2017–2018, p. 18.

Notes: The category of unexplained antepartum death includes deaths of normally formed fetuses prior to the onset of labour where no identified predisposing factors are considered likely to have caused the death, and those deaths with insufficient information available to allow a more specific classification of the cause of death. Clinical groups refer to intervals of gestational ages identified as being of clinical significance by members of the National Maternal and Perinatal Mortality Advisory Group (NMPMAG).

ABS data collection and reporting on stillbirths in Australia

The ABS numbers come from each State and Territory Registry of Births, Deaths and Marriages (RBDM). Stillbirths are registered with each jurisdiction through the birth registration process. The data collection is based on the system of civil registration and vital statistics (CRVS). CRVS systems are a key data source for stillbirths internationally.

Registration of all births (live births and stillbirths) is based on information provided on the Birth Registration Form (completed by parents) which is matched to the birth notification supplied to the state or territory registry by the hospital or birth clinic. For stillbirths, details of the cause of death are sent to the registry by the certifying doctor at the hospital or birth clinic, or the attending midwife.

Australia uses the Medical Certificate of Cause of Perinatal Death (MCCPD) which requests information on the main condition in the baby and main condition in the mother. Some stillbirths may not be recorded in the ABS data if parents have not registered the birth with the State registry. The ABS reports the causes of perinatal deaths using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). The ICD-10 classification is based on the registered causes of death on the Medical Certificate of Cause of Perinatal Death, assigned by the treating medical practitioner shortly after death and (unlike PSANZ-PDC process) without access to any subsequent investigations.⁷

Stillbirth data is published in a supplementary perinatal data set in the ABS Causes of Death, Australia usually in the year after the registration is recorded. A delay in registration, particularly for stillbirths, can mean the original date of death was a year or more before the registration.⁸ In its Causes of Death, Australia, 2020, the ABS published fetal deaths by main condition in fetus (table 15.5) and in mother (table 15.6). The ABS data is generally used in international comparisons (table 15.21).

2 The National Stillbirth Action and Implementation Plan

The National Stillbirth Action and Implementation Plan (the Plan) was released in December 2020 in response to the recommendations of the Senate Select Committee on Stillbirth Research and Education. The Plan aims to:

reduce the number of stillbirths in Australia

reduce disparities in stillbirth rates between population groups

raise community awareness and understanding of stillbirth

ensure high quality bereavement care and support is available to families who experience stillbirth.⁹

Chapter 4 of the Senate report examines stillbirth reporting and data collection.

Under Action area 11 - Improving investigation and reporting of stillbirth, the Plan tasks the Commonwealth to:

Develop and implement a standardised approach to data collection on causes and contributing factors for perinatal deaths, across maternity services linked to perinatal mortality review committees to ensure timely review and reporting of stillbirth deaths.¹⁰

Ensuring a better quality of stillbirth data also underpins the goals under Action area 12 - Tracking progress to reduce inequity. The goals are to ensure:

Measures are in place to compare Australia’s performance in stillbirth prevention with other high-income countries, including a stillbirth rate equity target.

Data quality on country of birth and Aboriginal and Torres Strait Islander status is sufficient to inform reporting on equity.¹¹

3 Action area 11—Improving investigation and reporting of stillbirth

Improvements to AIHW reporting

As outlined in the Stillbirth Action and Implementation Plan, the Commonwealth has been tasked to ‘develop and implement a standardised approach to data collection on causes and contributing factors for perinatal deaths, across maternity services linked to perinatal mortality review committees to ensure timely review and reporting of stillbirth deaths’ (p. 22). The Plan includes funding to develop a Perinatal Mortality National Best Endeavours Data Set (NBEDS) which will be led by the Maternal and Perinatal Health Unit at the AIHW. The project is running from 2021 to 2024 and seeks to ensure a common standard for reporting:

• data items around timing and cause of death

• information on autopsy and type of post-mortem investigations performed

• the information on factors contributing to the death.¹²

These data items are currently provided on a voluntary, non-standard basis. Using a consistent standard across the country is expected to improve the availability and quality of data and lead to more consistent reporting and monitoring of the rates and causes of perinatal mortality over time.

Improvements to ABS reporting

Since the Senate inquiry, the ABS has worked to improve the consistency of information provided on stillbirths from states and territories. This includes:

• enabling coding of cause of death information for registered stillbirths in Tasmania and Northern Territory

• new methods of data collection for MCCPD from Victoria, resulting in a greater number of registrations.

The ABS is also working with states and territories whose birth registration figures more closely align with birth notifications to understand any differences in processing.¹³

4 Action area 12—Tracking progress to reduce inequity

Comparing Australia’s performance in stillbirth prevention with other high-income countries

The AIHW, quoting UNICEF, reports that the estimated worldwide stillbirth rate in 2019 was 13.9 stillbirths per 1,000 births, varying from 3.0 stillbirths per 1,000 births in combined high-income countries, including Australia and New Zealand, to 22.7 stillbirths per 1,000 in combined low-income countries.¹⁴

The age and weight of babies counted in the stillbirth data varies around the world. The OECD notes high-income countries including Australia and Canada include fetal deaths occurring at earlier gestation ages (commencing between 20 weeks to 24 weeks in different countries) in their definition of a stillbirth, while other countries’ register a stillbirth at or after 28 weeks’ gestation.¹⁵ Both the ABS and the AIHW publish tables allowing international comparisons. The ABS publish a table of fetal, neonatal, and perinatal deaths as at 22 weeks, or 500 grams, consistent with OECD reported data prior to 1978 showing fetal deaths at 500 grams at delivery or 22 weeks.¹⁶

For statistics collections, the World Health Organisation (WHO) recommends defining stillbirths as the death of a fetus that has reached a birth weight of 500 grams, or if birth weight is unavailable, gestational age of 22 weeks or crown-to-heel length of 25 cm. Within this it also recommends classifying late fetal deaths (greater than 1000 grams or after 28 weeks) and early fetal deaths (500–1000 grams or 22–28 weeks). The WHO recommends that all fetuses and infants weighing at least 500 grams at birth, whether alive or dead, should be included in the statistics.¹⁷

The AIHW reports that Australia compares well internationally on perinatal mortality, although the overall rate of stillbirths in Australia is not declining: ‘Australia is one of the safest places in the world for a baby to be born, yet … every day in Australia, 6 babies are stillborn and 2 die within 28 days of birth.’¹⁸ Using the Australian definitions, the rate of stillbirths in Australia has held steady, with 7.0 per 1,000 births in both 1999 and 2018, while the rate of neonatal deaths in Australia has decreased from 3.2 per 1,000 live births in 1999 to 2.2 per 1,000 live births in 2018.¹⁹

Preventing late gestation stillbirths—which evidence suggests is when most preventable deaths occur—is the focus of the National Stillbirth Action and Implementation Plan.²⁰ The rate of late gestation stillbirths in Australia (those occurring after 28 weeks of gestation, or in the third trimester of pregnancy) has decreased from 3.5 per 1,000 births in 1999 to 2.2 per 1,000 births in 2018.²¹

The AIHW notes the apparent lack of improvement in the overall incidence of stillbirth is due to an increase in stillbirths in the second trimester, from 437.2 stillbirths per 1,000 births in 1999 to 535.6 stillbirths per 1,000 births in 2018. This increase in early gestation stillbirths in the Australian data may reflect improvements in data quality, as well as improvements in detecting congenital anomalies that may result in earlier diagnosis and clearer indications for the offer of termination of pregnancy for this gestational period.²²

In its reporting on Causes of Death, the ABS provides data on fetal deaths by main condition in fetus (table 14.5) and in mother (table 14.6). The ABS data is generally used in international comparisons. The ABS reports the causes of perinatal deaths using the ICD-10 classification which is based on the registered causes of death on the Medical Certificate of Cause of Perinatal Death, assigned by the treating medical practitioner shortly after death and (unlike PSANZ-PDC process) without access to any subsequent investigations.

Data quality and reporting on equity for tracking progress on inequity

Aboriginal and Torres Strait Islander Australians

The AIHW note ‘the rate of stillbirth for babies born to Indigenous women has held relatively steady from 11.8 stillbirths per 1,000 births in 2005 to 11.5 stillbirths per 1,000 births in 2018’.²³

ABS data comparing stillbirths for Aboriginal and Torres Strait Islander Australians to Non-Indigenous Australians by state shows death rates are generally higher for Aboriginal and Torres Strait Islander babies, except for NSW and the Northern Territory (Table 3). However, processing and registration issues that have influenced the number of births registered in these two jurisdictions in recent years may have affected the figures.²⁴ The data for South Australia has also recently been revised to overcome an issue with the derivation of Indigenous status for fetal deaths registered in South Australia.

An ABS table which shows the top causes of death in New South Wales, Queensland, South Australia, West Australia, and the Northern Territory by Aboriginal and Torres Strait Islander status, 2015–2019, shows stillbirths and neonatal deaths due to disorders related to short gestation and low birth weight are a much higher proportion of the cause of death for Aboriginal and Torres Strait Islander babies, at a rate of 2.4, than for non-Indigenous babies, with a rate of 1.1.²⁵

The ABS also notes it is likely that Aboriginal and Torres Strait Islander status may not always be accurately identified in registering deaths, and as such, the Aboriginal and Torres Strait Islander mortality rate is likely to be underestimated in deaths data.²⁶

Table 3: Fetal deaths, by Aboriginal and Torres Strait Islander status, selected states and territories (NSW, Queensland, SA, WA, and NT), 2015–2019 (number, per cent and rate per 1,000 births)

Aboriginal and Torres Strait Islander

Non-Indigenous

Total

Rate ratio

Rate difference

Number

%

Rate

Number

%

Rate

Number

%

Rate

NSW

94

3.8

2.8

2,331

93.8

5.0

2,486

100.0

5.0

0.6

-2.2

Qld

210

10.7

6.9

1,756

89.3

6.3

1,966

100.0

6.3

1.1

0.6

SA

35

9.8

6.7

323

90.2

3.6

358

100.0

3.7

1.9

3.2

WA

121

10.8

8.6

959

85.5

6.2

1,121

100.0

6.5

1.4

2.4

NT

89

47.6

12.3

98

52.4

7.9

187

100.0

9.5

1.6

4.5

Total

549

9.0

6.1

5,467

89.4

5.4

6,118

100.0

5.6

1.1

0.7

Source: ABS 2020, Causes of Death Table 14.20 Perinatal deaths, by Aboriginal and Torres Strait Islander status, Selected states, and territories, 2015-2019.

Notes: In 2019 an issue was identified with the derivation of Indigenous status for fetal deaths registered in South Australia: namely, there has been an undercount of Aboriginal and Torres Strait Islander fetal deaths in South Australia in ABS outputs over a number of years. The ABS has worked with the SA RBDM to revise the Indigenous status of all fetal deaths for the years 2015 to 2019. Revised data are presented in this table. Care needs to be taken when interpreting perinatal death rates for New South Wales and the Northern Territory in recent years. In NSW, a policy change was introduced in 2016 which required additional ‘proof of identity’ documentation from parents registering a new birth. These changes resulted in an increase in the number of births that occurred in 2016 and 2017 that were registered in 2018. This may affect perinatal death rates, which are calculated using births data. In 2018, the Northern Territory Registry of Births, Deaths and Marriages identified a processing issue that led to delays in sending data on some registrations for births that occurred in previous years. Addressing this resulted in 355 additional births being included in 2018 data, the majority of which (339) were of Aboriginal and Torres Strait Islander children. As the number of births are used as the denominator for calculating perinatal death rates, rates should be interpreted with caution for NSW and NT for recent years.

In the ABS Perinatal deaths collection, the Indigenous status of a stillbirth is captured through the birth registration process and through information on the Medical Certificate of Cause of Perinatal Death (MCCPD). The ABS Birth Registrations collection records a person as being of Aboriginal and/or Torres Strait Islander origin where at least one parent reported themselves as being of Aboriginal and/or Torres Strait Islander origin on the birth registration form. If the Indigenous status reported through the birth registration process does not agree with that in the MCCPD, the preference is to identify the stillborn as Aboriginal and/or Torres Strait Islander rather than non-Indigenous or an ‘unknown’ status. It is recognised that not all Aboriginal and Torres Strait Islander stillbirths are identified through these processes, leading to under identification.

Mother’s country of birth

The ABS do not currently publish stillbirth statistics by mother’s country of birth. In the AIHW report there was little overall difference in perinatal mortality rates for babies of women born in Australia compared to babies of women born overseas. The highest rates of perinatal death (stillbirth + neonatal deaths) were among babies of mothers whose country of birth was in Melanesia (including Papua New Guinea), Central and West Africa and Southern Europe.²⁷

Table 4: Selected characteristics of mothers and stillbirths per 1,000 births, 2017-18 (AIHW)

Mother’s Indigenous status

Aboriginal and Torres Strait Islander Mothers

11.1

Non-Indigenous Mothers

6.8

Mother’s country of birth

Australia

6.9

Other

7.3

Source: AIHW 2021. Stillbirths and neonatal deaths in Australia 2017 and 2018 Figure 3.1: Perinatal deaths by select demographics of the mother, 2017 and 2018 p. 10

Note: Stillbirth rates are calculated using all births (live births and fetal deaths).

5 Conclusion

Both the AIHW and the ABS have been seeking to improve the quality and timeliness of their still births data in line with the recommendations of the Select Committee on Stillbirth Research and Education inquiry into the future of stillbirth research and education in Australia.

Although the differences in scope and focus of the two major Australian data sources mean they cannot be combined, each source has strengths for informing policies to improve stillbirth outcomes.

The AIHW, with its expertise in maternal and baby health data, is well suited to improving data collection on causes and contributing factors for perinatal deaths and supporting better clinical practice in line with the goals of the national Plan, particularly in relation to action area 11. It also allows better reporting on equity within the clinical care environment.

The ABS can provide evidence to support policy initiatives designed to improve equity of health outcomes outside of clinical care. The ABS sources and classification system already align with international reporting standards, enabling international comparisons. The work of State and Territory registrars to improve registrations data also improves our ability to measure equity in outcomes across populations within Australia.

6 National resources on stillbirth

• Maternity Services and Stillbirth Prevention

This webpage provides information on Australian Government initiatives to support Australia’s maternity services. It includes national maternal and perinatal data, the Pregnancy Birth and Baby service, and the Government’s stillbirth prevention and support initiatives.

• Pregnancy, Birth and Baby

This is an Australian Government service providing support and information for expecting parents and parents of children, from birth to 5 years of age. The site provides information on pregnancy loss, including stillbirth risks and warning signs. It contains links to a range of information and support services on the stillbirth page.

• Senate Select Committee on Stillbirth Research and Education and report, ‘Stillbirth Research and Education’

The Select Committee on Stillbirth Research and Education inquiry into the future of stillbirth research and education in Australia received 269 submissions and took evidence over six days of public hearings. Submissions are available on the Committee website.

• National Stillbirth Action and Implementation Plan

Developed in response to the Senate Committee’s recommendations, the Plan aims to inform the development and implementation of interventions and programs that raise stillbirth awareness and support a reduction in the rate of stillbirth in Australia. The focus of the Plan is on stillbirth after 28 weeks, as most preventive interventions are specific to the third trimester.

• Centre for Research Excellence in Stillbirth

The Centre of Research Excellence in Stillbirth (The Stillbirth CRE) is a national collaboration addressing stillbirth. The Stillbirth CRE aims to reduce the rate of stillbirth and improve care for parents and families whose baby is stillborn.

The CRE is hosted by the Mater Research Institute, within The University of Queensland Faculty of Medicine, and is funded by the National Health and Medical Research Council (NHMRC) of Australia.

The site includes links to stillbirth statistical reports.

• Australian Institute of Health and Welfare (AIHW)

Stillbirths and neonatal deaths in Australia Web report, last updated: 14 Dec 2020.

The latest in-depth report was released on 10 June 2021: Stillbirths and neonatal deaths in Australia 2017–2018, Summary - Australian Institute of Health and Welfare (aihw.gov.au).

Previous releases: Stillbirths and neonatal deaths in Australia 2015 and 2016 (04 Jul 2019); Perinatal deaths in Australia 2013–2014 (29 May 2018); Perinatal deaths in Australia 1993–2012 (12 Oct 2016).

Australia’s mothers and babies 2018—in brief: presents key statistics and trends on pregnancy and childbirth of mothers, and the characteristics and outcomes of their babies.

Stillbirths in Australia 1991–2009: the first national report on the epidemiology of stillbirth in Australia. The report makes use of the extensive data about pregnancy and birth that have been collected in all states and territories since 1991. For the period 1991–2009, the stillbirth rate ranged from 6.4–7.8 per 1,000 births.

• Australian Bureau of Statistics

Causes of Death 2020: (data download) Perinatal deaths (Australia)

The scope of the perinatal death statistics includes all registered fetal deaths (at least 20 weeks gestation or at least 400 grams birth weight) and all registered neonatal deaths (all live born babies who die within 28 completed days of birth, regardless of gestation or birth weight). The ABS scope rules for fetal deaths are consistent with the legislated requirement for all state and territory Registrars of Births, Deaths and Marriages to register all fetal deaths which meet the above-mentioned gestation and birth weight criteria.

• Australian Longitudinal Study on Women’s Health (ALSWH)

Unlike the studies above based on administrative data and clinical research, the ALSWH survey captures the miscarriage and stillbirth experiences of a cohort of Australian women. The study is a longitudinal population-based survey of over 57,000 Australian women in four cohorts.

Respondents to the Study from 5,806 women who were aged 31–36 years in 2009 and who had self-reported an outcome for one or more pregnancy reported:

- 10,247 live births

- 2,544 miscarriages

- 113 stillbirths.

The reported stillbirths and miscarriages in the study may not match clinical definitions of stillbirth as published by the ABS (2020) and AIHW (2021). The analysis notes the value of this data as a reference but that this estimate of risk should only be applied to women who are 36 years or younger.²⁸ Findings are reported in these articles:

• Miscarriage, preterm delivery, and stillbirth: large variations in rates within a cohort of Australian women.

• Pregnancy Losses in Young Australian Women: findings from the Australian Longitudinal Study on Women's Health.

7 Glossary

Unless noted otherwise all definitions come from the AIHW Mothers and babies Glossary.

antepartum fetal death

Fetal death occurring before the onset of labour.

birth

An event in which a baby comes out of the uterus after a pregnancy of at least 20 weeks gestation or weighing 400 grams or more. A term birth is a birth at 37–41 completed weeks of gestation.

birthweight 

The first weight of the baby (stillborn or live born) obtained after birth (usually measured to the nearest 5 grams and obtained within 1 hour of birth).

fetal death (stillbirth)

Death, before the complete expulsion or extraction from its mother, of a product of conception of 20 or more completed weeks of gestation or of 400 grams or more birthweight (or at least 22 weeks' gestation or 500 grams' birth weight when using the World Health Organization definition of a fetal death).²⁹ Death is indicated by the fact that, after such separation, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles. The fetal death (stillbirth) rate is the number of fetal deaths per 1,000 total births (fetal deaths plus live births).

gestational age

Duration of pregnancy in completed weeks, calculated from the date of the first day of a woman’s last menstrual period and her baby’s date of birth; or via ultrasound; or derived from clinical assessment during pregnancy or from examination of the baby after birth.

intrapartum fetal death

a fetal death occurring during labour.

labour

The physiological process by which a vaginal birth occurs that commences at the onset of regular uterine contractions that act to produce progressive cervical dilatation and is distinct from spurious labour or pre-labour rupture of membranes.

late gestation stillbirths

AIHW in its publication Stillbirths and neonatal deaths in Australia 2017 and 2018 (p.4) describes stillbirths occurring after 28 weeks of gestation, or in the third trimester of pregnancy as late gestation stillbirths.

live birth

The complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered live born (WHO definition).

neonatal death

The death of a live born baby within 28 days of birth. The neonatal mortality rate is the number of neonatal deaths per 1,000 live births.

perinatal

Pertaining to or occurring in the period shortly before or after birth (usually up to 28 days after).

perinatal death

A fetal or neonatal death of at least 20 weeks gestation or at least 400 grams birthweight. The perinatal mortality rate is the number of perinatal deaths per 1,000 total births (fetal deaths plus live births).

Perinatal mortality review committees (PMRCs)

State and territory-based multidisciplinary committees that review perinatal deaths to ascertain the underlying and contributory cause/s of death.

stillbirth

The death of a baby before birth, at a gestational age of 20 weeks or more, or of a birthweight of 400 grams or more. Technically described as a fetal death.

The stillbirth rate and the perinatal mortality rate are calculated using all live births and stillbirths (fetal deaths) in the denominator.³⁰

World Health Organization (WHO) definitions

To allow for international comparisons, the WHO definitions regarding perinatal mortality indicators have been used (WHO 2015).³¹ These definitions are:

Stillbirth: a fetal death prior to birth of a baby in the third trimester of pregnancy of 28 or more completed weeks of gestation or of 1,000 grams or more birthweight.

Neonatal death: the death of a baby in the first 28 days of life, measured through registered deaths. In Australia, registered deaths are those occurring at 20 or more completed weeks of gestation or of 400 grams or more birthweight.

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Notes

[←1]

. The Plan supports a sustainable reduction in rates of preventable stillbirth after 28 weeks, with a primary

goal of 20% or more reduction over five years. (p. 5)

[←2]

. AIHW (2021) Stillbirths and neonatal deaths in Australia 2017 and 2018, Perinatal statistics series no. 38. Canberra. p.4.

[←3]

3. AIHW (2021) Australia's mothers and babies Preliminary perinatal deaths accessed 17 March 2022

[←4]

.    More information on the National Perinatal Data Collection (NPDC) is available from AIHW.

[←5]

.   Clinical Practice Guideline for Care Around Stillbirth and Neonatal Death, pp.3-4.

[←6]

.   Ibid, p. 20.

[←7]

.    MCCPD must be lodged within 48 hours for doctor certified deaths. The ABS does not have access to investigations finalised after this except for coroner referred deaths, but these are rare for stillbirths.

[←8]

.   ABS 2019, Causes of Death, Australia methodology, Perinatal deaths and technical notes.

[←9]

.   Australian Government 2020 National Stillbirth Action and Implementation Plan, p. 5.

[←10]

.   Ibid, p. 22.

[←11]

10.   Ibid, p. 23.

[←12]

.   Personal correspondence with subject matter experts at AIHW.

[←13]

.   Personal correspondence with subject matter experts at the ABS.

[←14]

.   For the purposes of international comparison, stillbirths are defined as those occurring in the third trimester, born at 28 weeks of gestation or more, and/or weighing 1,000 grams or more (WHO 2015). This differs from the standard definition used for stillbirths in Australia: born at 20 weeks of gestation or more, and/or weighing 400 grams or more (AIHW (2021) Stillbirths and neonatal deaths in Australia 2017 and 2018, (p.4 and p.44)

[←15]

12.   OECD Health Statistics, 2021, Definitions, Sources and Methods.

[←16]

.   ABS (2020), Causes of Death, Australia, 2019: Fetal, neonatal and perinatal deaths, Australia data cube.

[←17]

.   Stillbirth: Case definition and guidelines for data collection, analysis, and presentation of maternal immunization safety data. quoting WHO 2006 Neonatal and Perinatal Mortality Country, Regional and Global Estimates. For more information see p. 18 of Making Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths, 2016.

[←18]

.   AIHW (2020), Stillbirths and neonatal deaths in Australia , Overview of perinatal deaths - Australian Institute of Health and Welfare (aihw.gov.au).

[←19]

. AIHW (2021) Stillbirths and neonatal deaths in Australia 2017 and 2018, p.4.

[←20]

. AIHW (2020), Stillbirths and neonatal deaths in Australia, Overview of perinatal deaths - Australian Institute of Health and Welfare (aihw.gov.au).

[←21]

. AIHW (2021) Stillbirths and neonatal deaths in Australia 2017 and 2018, p. 4.

[←22]

. Stillbirths resulting from a termination of pregnancy are included in these rates published by the AIHW.

[←23]

. AIHW (2021) Stillbirths and neonatal deaths in Australia 2017 and 2018, p. 35.

[←24]

.   Registered births are used in the calculation of fetal death rates. See ‘Mortality rate denominators: Live births’ in the Data quality section of the Methodology of Causes of Death, Australia, 2019 for further details.

[←25]

.   ABS 2020, Causes of Death, Australia, 2019, Table 14.19, Perinatal deaths by Aboriginal and Torres Strait Islander top causes of death, NSW, Qld, SA, WA, NT, by Aboriginal and Torres Strait Islander status, 2015–2019.

[←26]

.   For further information see the Deaths of Aboriginal and Torres Strait Islander people section in the Causes of Death, Australia, 2019, methodology.

[←27]

. AIHW 2021. Stillbirths and neonatal deaths in Australia 2017 and 2018 p.9.

[←28]

.   Hure A J, Powers J R, Mishra G D, Herbert D L, Byles J E, et al (2012), ‘Miscarriage, Preterm Delivery, and Stillbirth: Large Variations in Rates within a Cohort of Australian Women’. PLoS ONE 7(5): e37109. doi:10.1371/journal.pone.0037109 Miscarriage, preterm delivery, and stillbirth: large variations in rates within a cohort of Australian women - PubMed (nih.gov).

[←29]

. ABS (2021) Causes of Death, Australia methodology, Glossary

[←30]

. AIHW (2021) Stillbirths and neonatal deaths in Australia 2017 and 2018, Perinatal statistics series no. 38. Canberra. p.4

[←31]

. Ibid p.44