Australian Births, Maternal and Infant Health to 2023. Rising Still Births (includes Abortions). Rising Obesity, Diabetes and Hypertension with large variations based on Maternal Country of Birth.

Maternal age is rising. 2023 has the lowest recorded birthrate of 52/1000 women. If maternal and infant health are a barometer of overall population health, Australia's health situation is failing!

I was forwarded a copy of an excel file labelled “AIHW-PER-101- National-Perinatal-Data-Collection-Annual 2023” by a reader and asked to evaluate infant and maternal outcomes over time. The file comes from the Australian Institute of Health and Welfare; site links below. I have prepared visual presentation of data that may be of interest to my readers.

Please note that the Maternal-Infant data is only up to 2023, 2024 data is not yet released. Please also note that different data sources may have slightly different totals (I have noted differences between ABS and AIHW birth totals), therefore, please focus on trending.

Births, Birth Rates, and Population Growth

Births, deaths, and estimated resident population are shown. Slowly rising deaths until the 2021/2022 inflection, fairly stable births over time, and a growing population fueled primarily by migration.

The following figure, generated from ABS data, shows the components of change in Australia’s population to 2024; births, deaths, migration, and Estimated Resident Population. Between 2000 and 2024, Australia had a natural population growth of 3.4 million (7.2 million births less 3.8 million deaths) and a Net Migration of 5.2 million to give a total population increase of some 8.3 million.

Births and birth rates did not track with the increasing population. Birth rates have declined from a peak of 65.8 annual births/1000 women in 2007 to 51.7 births /1000 women in 2023, a 21% drop.

Migration has kept birth counts relatively stable over time, thus camouflaging the true state of Australian fertility. The rise in births / birth rate in 2021, was a natural consequence of stay-at-home orders. However, it was followed by a big drop in 2022 and an even bigger drop in 2023; the number of babies born is falling rapidly, despite migration.

Births by State

Births vary by state, with New South Wales, Victoria and Queensland being the most populous states and having the lion’s share of new babies.

Births by Maternal Age

Average maternal age has risen over time from 28.9 in 1998 to 31.3 in 2023. Fecundity decreases with age and delayed childbearing may certainly affect the number of infants birthed.

Births by Country of Birth of Mother

Australia is a land of many immigrants. Mother-baby data is broken down by maternal country of birth, with key immigrant countries shown. The number of babies born to Australian-born mothers has been steadily declining over time.

Births by maternal country of birth are shown for leading migrant-source countries with India and China leading the foreign-born mothers. Births from New Zealand, United Kingdom, China, and Vietnam-born mothers are declining over time, while those from India, Philippines, Pakistan, and Nepal are increasing/ stable; perhaps representing the current dominant mixes of new, generally young, migrants.

Infant Birth-Weight, Gestational Age Trending, Birth Interventions

Low Birth-weight Rates and Pre-term Birth Rates are showing slight rising trend over time, and the average gestational age is dropping.

The dropping gestational age may well be linked with rising CS and induction rates. Induction rates increased from 25.6% in 2005 to 32.7% in 2023, while CS rates increased from 30.3% to 40.6% in the same period. Does this represent real medical need, or increased medicalization and intervention in pregnancy and childbirth? It is hard to believe that every 2/5 women need a cesarian section, that nearly 1/3 of women need induction to birth their babies. NIH source states that an acceptable cesarian rate is 10 - 15%; even that I find high. WHO refers to a 7% historical rate. Such interventions, bypassing the exquisite symphony of hormonal and physical changes that lead to a natural birth, triggered by both infant and maternal factors, increase maternal and infant risks when not clearly medically indicated.

Still Births, Perinatal and Neonatal Deaths / 1000 births

Australian definitions for still birth, neonatal and perinatal deaths are shown. Still births and perinatal deaths also include some pregnancy terminations at least 20 weeks’ gestation and/or 400g birth weight.

Still-birth and perinatal death rates showed a distinct and progressive rises in 2022 and 2023.

AIHW has the following comments for the rising still births. Any impact of the Covid-19 countermeasures is not considered.

Neonatal and Perinatal death rates, and Still birth rates vary dramatically between states. 2020 is marked in red. Northern territory has far higher rates of deaths than other states, perhaps reflecting more disadvantaged conditions and less access to medical assistance; the lower population in NT naturally gives rise to more year-on-year variability.

South Australia and ACT’s very high still birth rates in 2023 warrant investigation. The overall high rates in NT are also of grave concern.

Maternal BMI - Rising Over Time

2016 is the turning point after which the % of underweight and normal weight mothers declined steadily while overweight and obese increased. This trajectory shows that women (and assume by default the entire population) is steadily and progressively getting heavier! Most concerningly, less than 50% of mothers have normal BMI.

Since 2020 the numbers of mothers who are overweight or obese have outnumbered the numbers of women who have normal weight.

Maternal % of underweight, normal weight, overweight and obese, varies very considerably by maternal country of birth. Highest numbers of underweight are in mothers of Chinese and Vietnamese birth. Underweight across all maternal country of birth categories has declined since 2016. Maternal normal weight also varies considerably between countries, with Chinese and Vietnamese-born mothers having highest % of normal weight.

Rising overweight is observed particularly among Nepali, Filipino and Indian-born mothers. The steepest rises in obesity are among New Zealand born, Australian born, and UK-born mothers. These bode poorly for population health and could point towards rising rates of pregnancy complications and poorer infant outcomes.

Diabetes and Hypertension - Preexisting and Gestational

Overweight is associated with health conditions such as diabetes and hypertension. Data on pre-existing and gestational diabetes and hypertension was provided. There is considerable variation by maternal country of birth for these conditions. These variations by ethnicity should drive vigilance by public health and health care providers. Population education is certainly required.

Less than 2% of women had pre-existing diabetes, but some groups had close to 40% rates of gestational diabetes. Such high rates must reflect underlying poor metabolic health.

Maternal and infant health outcomes are a critical population parameter, the barometer for overall population health. By all measures positive outcomes are declining. Alarm should be raised.

Interventions should certainly be based on lifestyle and education, including ensuring of robust support networks for mothers, infants, families and communities.

A timely post on the medicalization of birth, which I just happened to notice in my inbox this morning.

The Intervention Cascade: How Modern Medicine Creates the Birth Emergencies It Claims to Prevent