Maternal mortality in Australia, 1973-1996

Aims: Maternal mortality has declined dramatically over the past 30 years in developed countries. This retrospective study aims to provide an epidemiological overview of maternal deaths in Australia between 1973 and 1996. Methods: Data were abstracted from national maternal mortality data collection and triennial reports for the period 1973-1996 for women who died from pregnancy-related causes while pregnant or within 42 days of a pregnancy being delivered or terminated. Deaths were restricted to those classified as direct or indirect maternal deaths. Maternal mortality age-specific mortality ratios were calculated. The leading causes of death were examined. Results: Of the 584 deaths, 363 were direct and 221 indirect. The leading causes of direct death were pulmonary embolism (18.4%) and hypertensive disorders (16.3%). Cardiovascular disease accounted for 41% of indirect deaths. The maternal mortality ratio declined from 12.7 deaths per 100 000 confinements in 1973-1975 to 6.2 in 1991-1993, and was 10.0 for the entire 24-year period. For women aged 40-44 years the ratio declined from 165.1 to 14.2 between 1973 and 1996. The ratio for Indigenous mothers was three times higher than for non-Indigenous mothers, being 34.8 in the most recent triennium 1994-1996. Conclusions: Although maternal deaths are rare in Australia, apparent health inequality persists with Indigenous mothers continuing to have a higher risk of maternal death. While mortality in traditionally higher risk women aged > 40 years has declined, women with morbid cardiovascular disease continue to be over-represented in the deaths. The comparatively high rate of deaths from pulmonary embolism needs to be addressed.