The MMR for Aboriginal and Torres Strait Islander women remains three times higher than the MMR for non-Indigenous women.
We need first to ask, how good are the data? There is a concern about under-ascertainment. As distinct from a stillbirth or a neonatal death, there is no mandatory notification of maternal mortality, although some States and Territories have a ‘tick box’ for notification that the deceased has been pregnant within the preceding 12 months. It is generally held that in the absence of coordinated efforts to maximise ascertainment, maternal deaths are underestimated by as much as 30 per cent. Some States undertake such efforts, but as is so often the case in public health surveys in Australia, there is variation between States and Territories in the approach to ascertainment. Failure to notify might be more likely for deaths in early pregnancy and when the death occurs remotely in time and/or place from the birth or termination of the pregnancy.
There is also variation and inconsistency in the way in which maternal mortality committees function in Australia, with respect to consideration, classification and reporting of maternal deaths. For example, in the compilation of the most recent report on maternal deaths in Australia, it appeared that there was no functioning maternal mortality committee in Queensland, which was the State with the highest MMR in Australia (over the previous twelve years).Only some States consider and report on preventability. Other States refrain because of privacy or other concerns. There are also variations in referrals of these deaths for coronial investigation. From 2003 to 2005, only 47 of 65 deaths were reported to the coroner, and only 19 of the 29 direct deaths were referred to the coroner.
There are also concerns about the quality of data indicating Indigenous status. In the 2003 to 2005 report, data on Indigenous status was missing in eight per cent of maternal deaths. This deficiency is of special importance because the MMR for Indigenous women was 21.5, compared with 7.9 per 100,000 for non-Indigenous women, reflecting their health disadvantage, in pregnancy and childbirth, as it is in all areas of health of Indigenous
It is estimated that for every maternal death, there are approximately 80 instances of severe maternal morbidity, in which the woman experiences a life-threatening complication from which she survives (completely, or sometimes with residual injury).
A concerning aspect of maternal mortality monitoring in Australia is the lack of recurrent funding or a permanent auspicing agency. The last national maternal mortality report carried a foreword signed by the Director of the Australian Institute of Health and Welfare (AIHW), which auspiced and authorised the report that contained this statement:
‘..the (Australian) Commission (on Safety and Quality in Health Care)
is not able to provide ongoing funding (for regular reporting of
maternal deaths in Australia) and it is concerning that no resources
have been identified to sustain and improve this reporting in the future.’
An options paper to obtain a firm footing for the national maternal mortality survey has been prepared by the AIHW and submitted to the Commission on Safety and Quality in Health Care, but no response had been received at the time of preparing this article.