Maternal deaths high for Indigenous women
Article Outline
On the 2nd May 2008 the Indigenous Affairs Minister Jenny Macklin and Health Minister Nicola Roxon released a media statement titled ‘Maternal deaths high for Indigenous women’ noting: ‘the Australian Institute of Health and Welfare (AIHW) today released Maternal deaths in Australia 2003–2005, which showed that overall there was a considerable drop in the number of maternal deaths’ and highlighted ‘however the mortality rate among Aboriginal and Torres Strait Islander women is still unacceptably high and of great concern to the Australian Government’1.
The report shows that nationally, 65 deaths were reported, compared to 84 over the previous 3-year period (2000–2002)2. This equates to a maternal mortality ratio (MMR) of 8.4 down from 11.1 per 100,000 women giving birth. Aboriginal and Torres Strait Islander women had an MMR that was more than two and a half times as high as other Australian women in 2003–2005 (21.5) also down from 45.9 in 2000–2002 (when it was more than 5 times higher)2, 3. These figures should be reassuring as they suggest that the number of women dying in childbirth is decreasing. However we cannot be confident that this is the case. Unfortunately, in Australia we do not have a robust system for monitoring and reporting maternal mortality or morbidity.
The latest report does not provide the same details or analysis applied to the previous report, nor does it provide any assurances that the data are valid. According to the report there are several jurisdictions (Northern Territory and Queensland) that did not at that time, and still today, have multidisciplinary committees that analyse their own data and system performance before the data is provided to the national committee. Additionally, the report does not document the use of any ascertainment strategies that would reassure the reader that the number of maternal deaths is as correct as they possibly can be given limitations. In the previous triennium the data was validated by searching though the Australian Bureau of Statistics Mortality Database and National Hospital Morbidity Database. An extra 18 deaths that had not been reported to the National Committee were found. It does not appear that similar validation strategies were applied to the latest triennia data. If a similar number were underreported in the 2003–2005 report then the number of deaths would have been almost the same. Thus, the stated decline in national maternal deaths is unlikely. Additionally, not all deaths identify if the woman was of Aboriginal or Torres Strait Islander origin, so we can presume that this figure is also an underestimate.
The maternal mortality ratio is an internationally recognised indicator of the safety and quality of maternity services and most research suggests that for every maternal death there are many more women who suffer from severe morbidity. Importantly, many of these deaths could be prevented by improving the health system for example, with policy and guideline recommendations. The 2000–2002 report found almost 50% of the deaths had at least one contributing factor suggesting considerable room for health system improvement4. There is no comment on contributing factors in the later report.
The United Kingdom has recognised the importance of this area and has established the ‘gold standard’ of maternal death reporting through their Confidential Enquiries into Maternal Deaths5. They have established a thorough systematic process that results in a comprehensive report with recommendations, national guidelines and key issues needing to be addressed to improve the safety and quality of maternity care in that country. The report is now titled ‘Saving Mothers’ Lives’ rather than ‘Why Mothers Die’ reflecting a reorientation of the use of data that has resulted in a significant impact on maternity services5.
Ensuring that our monitoring systems are appropriately resourced to provide this information to the clinicians and administrators to continually improve maternity services is essential and is currently not occurring systematically across Australia. The Australian Commission for Safety and Quality in Health Care are the current funders of the report and it is clear that neither they, nor the National Perinatal Statistics Unit, a collaborating unit of the Australian Institute of Health and Welfare, are providing appropriate funding to monitor or report on maternal mortality in Australia. The report itself highlights that ‘the current data system lacks the quality and sufficiency of information on risk factors, clinical pathways and management to allow adequate analysis of the deaths in order to inform recommendations on policy and practice change’2. Surely this is unacceptable in Australia today. Maternity service providers need to individually and collectively influence policy makers and funding bodies both nationally and in their own States and Territories to improve the reporting and review of maternal deaths in Australia. Only then will we be able to learn from these tragedies and put in place the system wide changes necessary to ensure we see a real ‘drop’ in maternal mortality in Australia. The incoming Director of the International Confederation of Midwives, Bridget Lynch, has called on midwives to get political. What can you do, both individually and collectively, to change this situation in Australia?
References
- Macklin N, Roxan N. Media release: maternal deaths high for indigenous women. Canberra: Minister for Families, Housing, Community Services and Indigenous Affairs [Jenny Macklin and Minister for Health and Ageing: Nicola Roxon]; May 2, 2008.
- In: Sullivan EA, Hall B, King J editor. Maternal deaths in Australia 2003–2005. Sydney: AIHW National Perinatal Statistics Unit; 2008;
- Maternal mortality in Aboriginal and Torres Strait Islander women. In: King J, Sullivan E editor. Maternal deaths in Australia 2000–2002. Canberra: AIHW; 2006;p. 75–81
- . Epidemiology of maternal deaths. In: King J, Sullivan E editor. Maternal deaths in Australia 2000–2002. Canberra: AIHW; 2006;p. 8–31
- Lewis, G. editor. The confidential enquiry into maternal and child health (CEMACH). Saving mothers’ lives: reviewing maternal deaths to make motherhood safer—2003–2005. The seventh report on confidential enquiries into maternal deaths in the United Kingdom. London: CEMACH.
PII: S1871-5192(08)00052-8
doi:10.1016/j.wombi.2008.06.002
© 2008 Australian College of Midwives. Published by Elsevier Inc. All rights reserved.
