It seems unbelievable that in the modern world, Australia could fall so far behind other developed nations, but this is the criticism being levelled at us from an eminent researcher in regards to stillbirths.
Associate Professor Vicki Flenady, the lead author of a global study focused on stillbirths in high-income countries, found that the Australian health system was not doing enough to investigate the stillbirths.
Her study, published recently in the Lancet, an international medical journal, uncovered that women from disadvantaged areas of Australia are at twice the risk of having a stillborn baby compared to women from wealthier areas.
At the moment, Australia is ranked 114th in the world when it comes to the percentage of stillbirths in the population, with around 2.7 stillbirths occurring for every 1,000 births.
However, if we were on par with other high-income countries, that number would be closer to two stillbirths per 1,000 births, saving around 210 lives every year. Iceland leads the way on the list, with just 1.3 stillbirths per 1,000 births, followed by Denmark, Finland and the Netherlands.
Flenady said that in her research, when she was able to compare Australia’s stillbirth rates to other countries with similar economies, we fell far behind in more ways than one. Even the improvement rate for stillbirths in the country, 1.4% each year, remains much slower than the improvements made by other developed countries. This is despite the fact that many of the stillbirths that occur in Australia every year are preventable.
“For disadvantaged Australian women, there is a higher prevalence of all those factors we know determine health outcomes for babies, so things like overweight and smoking, and health conditions associated with that like hypertension and diabetes,” Flenady said.
She went on to describe how the health service in Australia was letting women down, particularly Indigenous women by not making antenatal care available for them in a way that is culturally sensitive and easy to access. Flenady said this antenatal care was absolutely essential as it was when complications were detected and dealt with. However, the reality is that for many women in disadvantaged areas, which are often rural or remote, these services simply weren’t available.
Of course, these aren’t the only reasons that stillbirths occur. Indeed, there are many cases in which stillbirths happen to entirely healthy women in the last weeks or days of their pregnancies. But as Flenady pointed out there is no national reporting system or database for stillbirths, so it is incredibly difficult for medical researchers to figure out why the stillbirths are happening.
“What we could be doing better is investigating every case of stillbirth more throughly than we are now to identify factors that may have gone wrong,” she said.
“That’s where we fall down in Australia, we need to implement a national program where every case is investigated and an autopsy carried out. Countries like the Netherlands and New Zealand have such a national audit program and have seen significant reductions in stillbirth rates.”
One of the biggest barriers to postmortem examinations on stillborn babies is carrying out autopsies. According in Flenady autopsies are carried out as little as 30% of the time in some areas of Australia. She believes that the idea of an autopsy is difficult for many doctors to discuss with grieving parents, which means the conversations often never happen. This is such a shame as it is so necessary to have that data. Although inadequate care is behind 20-30% of stillbirths, there’s still so much we don’t know.
“Stillbirth is a devastating time for families, but we know more often than not that parents who do not have an autopsy often regret that,” Flenady said. “Being able to have these conversations openly is important.”
With the data collected from stillborn autopsies, as well as a more open investigations of the factors behind the stillbirths, Australia would have a better idea of how to tackle the higher rate for the future. Being overweight, smoking, or being an older mother all increase the risk of having a stillbirth, but being from a disadvantaged area should not put your child at higher risk. There is clearly a need for more quality and equity in women’s healthcare in Australia, and more steps to be taken to ensure that experiencing a stillbirth happens as rarely as possible.