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Age group 0 to 5 years

Positive antenatal environment

Health influences begin even before birth, with a mother’s own health and wellbeing playing an important role in the baby’s development in utero. A healthy start to life contributes to good health and wellbeing for a child over their lifetime.

This indicator considers three key influences on a baby’s development during pregnancy - a mother’s attendance at antenatal visits, maternal tobacco smoking and alcohol consumption during pregnancy. While these activities have a significant impact on a baby’s health, other factors are also influential including a mothers’ diet, parental stress, poverty and other socioeconomic and environmental factors.

Overview and areas of concern

Early and regular attendance at antenatal services to monitor and enhance the health of mother and baby during pregnancy provides important support to parents and ensures babies receive the best possible start to life. These services should also provide a supportive environment where mothers can be encouraged to discuss any lifestyle concerns and consider making changes.

Data overview

There has been a sustained increase in the reported number of mothers attending their first antenatal check in under 14 weeks (50.9% in 2011 compared to 62.8% in 2018).

Nine in ten pregnant women reported they do not smoke during pregnancy. There has been a steady decrease in the number of women smoking during their pregnancy in WA and across Australia over the last 10 years.

Source: Australian Institute of Health and Welfare, National Perinatal Data Collection 2016

There was a significant increase in the number of women who reported they drank no alcohol while pregnant in WA from 2007 to 2016 (38.4% compared to 65.3%).

Areas of concern

Aboriginal mothers are much less likely to have their first antenatal visit in the first trimester than non-Aboriginal mothers (for example, in the Perth North Metropolitan region, 32.0% of Aboriginal mothers attended in the first trimester compared to 56.8% of non-Aboriginal mothers).

Mothers living in regional and remote areas are more likely to smoke during pregnancy than mothers living in the metropolitan area (17.9% in regional and remote WA compared to 6.1% in the Perth North Metropolitan region and 9.2% in the Perth South Metropolitan region).

Other measures

Low birth weight is often considered a key measure of child wellbeing. Low birth weight has not been selected as a measure in the Indicators of wellbeing. This is not because it is not important, but because low birth weight is often the result of other antenatal factors such as smoking during pregnancy, maternal age and poor maternal health and wellbeing, which are being reported in the Indicators.

For information on low birth weight rates in WA refer to the AIHW Children’s Headline Indicators website which provides regular data on this measure by jurisdiction and other disaggregations.

Infant mortality rates are also often used as a population level measure of child wellbeing. It informs understandings of the factors that influence a child’s life and death chances at birth and provides insight into the effectiveness of the health system in antenatal and perinatal health.1

Infant mortality rates have not been included as a measure in the Indicators of wellbeing as the data is reported regularly in other sources. Furthermore, infant mortality rates are influenced by the measures being reported, such as smoking during pregnancy or lack of antenatal care.

For information on infant mortality rates in WA refer to the Mothers and Babies: Infant mortality rates website which is regularly updated, or for more comparative data across Australia refer to the AIHW Children’s Headline Indicators website.

Endnotes

  1. Australian Institute of Health and Welfare (AIHW) 2018, Children’s Headline Indicators – Infant Mortality, AIHW.
Measure: Antenatal visits

Antenatal visits between a pregnant woman and a midwife or doctor assess and monitor the health and wellbeing of the mother and baby throughout pregnancy. Antenatal visits provide an opportunity for regular clinical assessments, screening for a range of infections and abnormalities, and advice on healthy lifestyles.1

There is substantial evidence that regular antenatal care, particularly in the first trimester (less than 14 weeks’ gestational age) is associated with better maternal health in pregnancy and positive child health outcomes.2

Australian Pregnancy Care Guidelines recommend that the first antenatal visit occur within the first 10 weeks of pregnancy and that first-time mothers with an uncomplicated pregnancy attend 10 visits (seven visits for subsequent uncomplicated pregnancies).3

The National Perinatal Data Collection (NPDC) is a national collection of data on pregnancy and childbirth managed by the Australian Institute of Health and Welfare (AIHW).4

The data for WA may not be complete as data is generally only collected for women who attend their first antenatal visit at their birth hospital.

A lower proportion of WA mothers are reported as attending their first antenatal visit in the first trimester than Australian mothers overall (61.4% compared to 67.4%).

Duration of pregnancy at first antenatal visit in weeks, number and per cent of mothers, WA and Australia, 2016

WA

Australia

No. of weeks

Number

%

Number

%

Less than 14

21,747

61.4

209,073

67.4

14-19

4,502

12.7

62,452

20.1

20 and over

6,598

18.6

33,113

10.7

Not applicable

59

0.2

338

0.1

Not stated

2,490

7.0

5,271

1.7

Total

35,396

100.0

310,247

100.0

Source: AIHW - National Perinatal Data Collection 2016 – Table 2.13: Duration of pregnancy at first antenatal visit by selected characteristics for women who gave birth in 2016

Note: For WA, gestational age at first visit is reported by birth hospital; therefore, data may not be available for women who attend their first antenatal visit outside the birth hospital. This particularly affects hospitals without antenatal care services onsite.

There is substantial variation across Australia in the proportion of mothers recorded as attending their first antenatal visit in the first 13 weeks.

Proportion of mothers attending their first antenatal visit in less than 14 weeks by jurisdiction, per cent, Australia, 2016

Proportion attending in
less than 14 weeks

NSW

67.5

Vic

57.9

Qld

77.3

WA (a)

61.4

SA

80.1

Tas

88.0

ACT (b)

53.9

NT

82.9

Australia

67.4

Source: AIHW - National Perinatal Data Collection 2016 – Table 2.13: Duration of pregnancy at first antenatal visit by selected characteristics for women who gave birth in 2016

Notes:

1. For WA, gestational age at first visit is reported by birth hospital; therefore, data may not be available for women who attend their first antenatal visit outside the birth hospital. This particularly affects hospitals without antenatal care services onsite.

2. For ACT, first antenatal visit is often the first hospital antenatal clinic visit. In many cases, earlier antenatal care provided by the woman's general practitioner is not reported. In 2016, 13.2% of women who gave birth in the ACT were non-ACT residents (proportion calculated after excluding records where state/territory of usual residence was 'Not stated'). Care must therefore be taken when comparing percentages across jurisdictions.

3. Proportion has been calculated including the visits that were reported as duration ‘Not stated’. WA had a high proportion of visits that were not categorised compared to other jurisdictions.

Data from the WA Department of Health shows that there has been an increase in the reported number of WA mothers attending their first antenatal visit in less than 14 weeks since 2011 (50.9% in 2011 compared to 62.8% in 2018). This is in part due to improvements in the data collection process resulting in a reduction in the ‘not reported’ category.

Duration of pregnancy at first antenatal visit in weeks, per cent of mothers, WA, 2011 to 2018

<14
weeks

14 - 27
weeks

≥28
weeks

Not reported

2011

50.9

30.5

6.6

11.9

2012

58.5

28.6

4.8

8.1

2013

62.1

26.6

4.7

6.6

2014

61.4

27.8

4.3

6.5

2015

64.9

25.5

4.5

5.1

2016

61.8

27.4

4.0

6.9

2017

62.9

27.8

3.6

5.7

2018

63.0

28.1

4.1

4.9

Source: WA Dept of Health - Western Australian Mothers and Babies Summary Information

Note: Data for most recent complete calendar year are incomplete and subject to change.

Duration of pregnancy at first antenatal visit in weeks, per cent of mothers, WA, 2011 to 2018

 

Source: WA Department of Health - Western Australian Mothers and Babies Summary Information

Mothers who are less likely to attend antenatal care in the first trimester include women living in lower socioeconomic status areas, those living in very remote areas, Aboriginal mothers and women born in non-English speaking countries.5

There is considerable variation in women’s use of antenatal services across WA.

Duration of pregnancy at first antenatal visit in weeks by region, per cent of mothers, WA, 2018

<14 weeks

14 - 19
weeks

≥20
weeks

Not determined

North Metropolitan

57.1

9.2

33.4

0.3

South Metropolitan

62.1

15.9

21.6

0.3

Goldfields

79.1

7.7

13.1

0.1

Great Southern

82.9

8.3

8.8

0.0

Kimberley

75.0

11.4

13.7

0.0

Mid West

77.7

9.5

12.7

0.1

Pilbara

73.5

6.6

19.8

0.1

South West

80.9

3.8

14.3

1.1

Wheatbelt

61.8

9.9

27.8

0.4

Source: Custom report provided to the Commissioner for Children and Young People WA by the WA Department of Health from the Midwives Notification System and Birth Notification Dataset [unpublished]

Note: Data for most recent complete calendar year are incomplete and subject to change.

Duration of pregnancy at first antenatal visit in weeks by region, per cent of mothers, WA, 2018

Source: Custom report provided to the Commissioner for Children and Young People WA by the WA Department of Health from the Midwives Notification System and Birth Notification Dataset [unpublished]

In 2018, the North Metropolitan area had the lowest proportion of women attending an antenatal visit in the first trimester (57.1%) and the highest proportion of women attending their first visit at over 20 weeks gestation (33.4%). The Great Southern region had the highest proportion of women attending their first antenatal visit in the first trimester (82.9%).

Aboriginal mothers, on average, accessed services later in their pregnancy and had fewer visits than non-Aboriginal mothers.6

Women who gave birth, by duration of pregnancy at first antenatal visit by Aboriginal status, in per cent, WA and Australia, 2014

WA

Australia

Aboriginal

Non- Aboriginal

Aboriginal

Non-Aboriginal

Less than 14 weeks

48.4

64.8

53.2

60.2

14 to 19 weeks

16.3

14.5

21.4

23.7

20 or more weeks

33.3

20.5

24.4

16.1

No antenatal care

1.9

0.1

1.1

0.1

Source: AIHW, Aboriginal and Torres Strait Islander Health Performance Framework 2017, Table 3.01.10

Note: For WA, gestational age at first visit is reported by birth hospital; therefore, data may not be available for women who attend their first antenatal visit outside the birth hospital. This particularly affects hospitals without antenatal care services onsite.

The quality and accessibility of primary health care available to pregnant women and infants is directly correlated with the infant mortality rate.7 Aboriginal stillbirth rates in WA are higher than rates for all WA infants (11.7 per 1,000 and 6.7 per 1,000, respectively).8 The Aboriginal stillbirth rate has, however, declined from 14.4 per 1,000 babies in 2002–2004.9

WA Aboriginal mothers have increased attendance at antenatal visits in the first trimester over the last four years. However, a lower proportion of Aboriginal mothers attend in the first trimester than non-Aboriginal mothers (48.4% compared to 64.8% in 2014).

Proportion of Aboriginal mothers who had at least one antenatal visit in first trimester by Primary Health Network area, in per cent, WA, 3-year aggregates from 2012 to 2016

2012–2014

2013–2015

2014–2016

North Metropolitan

32.3

36.0

36.6

South Metropolitan

43.1

50.1

52.0

Country WA

53.1

56.7

58.1

Source: AIHW My Healthy Communities: Child and maternal health indicators - National Perinatal Data Collection, Table 13

Note: First antenatal visits that occur outside of the hospital may not be included.

Proportion of Aboriginal mothers who had at least one antenatal visit in first trimester by Primary Health Network area, in per cent, WA, 3-year aggregates from 2012 to 2016

Source: AIHW My Healthy Communities: Child and maternal health indicators - National Perinatal Data Collection, Table 13

For Aboriginal mothers there has been an improvement in attendance at an antenatal visit in the first trimester since 2012–2014. A consistently higher proportion of Aboriginal mothers in regional and remote WA attend at least one antenatal visit in the first trimester than in metropolitan Perth. There are, however, large differences in attendance across regions in WA.

Proportion of mothers attending first antenatal visit in 1 to 12 weeks gestational age by region and Aboriginal status, in per cent, WA, 2018

Aboriginal mothers

Non-Aboriginal mothers

North Metropolitan

34.1

56.1

South Metropolitan

47.7

59.7

Goldfields

47.1

83.0

Great Southern

65.8

81.9

Kimberley

63.9

84.6

Mid West

54.5

80.5

Pilbara

55.3

76.5

South West

77.6

79.9

Wheatbelt

51.6

60.6

Source: Custom report provided to Commissioner for Children and Young People WA from the Department of Health, Midwives Notification System and Birth Notification Dataset [unpublished]

Note: The majority of public homebirths are included in the Birth Notification database, but homebirths attended by private practising midwives are not. The 2018 data may be incomplete and subject to change.

Proportion of mothers attending first antenatal visit in 1 to 12 weeks gestational age by region and Aboriginal status of mothers, in per cent, WA, 2018

Source: Custom report provided to Commissioner for Children and Young People WA from the Department of Health, Midwives Notification System and Birth Notification Dataset [unpublished]

The South West and Kimberley regions had the highest proportion of Aboriginal mothers attending their first antenatal visit during the initial one to 12 weeks of pregnancy. The North Metropolitan and the Wheatbelt regions had the lowest proportion of Aboriginal and non-Aboriginal mothers attending in the first 12 weeks.

In all regions the proportion of Aboriginal mothers attending their first antenatal visit during weeks one to 12 was lower than non-Aboriginal mothers.

Proportion of Aboriginal mothers attending first antenatal visit in 1 to 12 weeks gestational age by region, in per cent, WA, 2014 to 2018

2014

2015

2016

2017

2018

North Metropolitan

32.0

35.7

31.5

28.2

34.1

South Metropolitan

45.9

47.8

46.1

50.0

47.7

Goldfields

28.8

34.1

44.7

51.2

47.1

Great Southern

48.8

59.5

65.9

57.8

65.8

Kimberley

60.0

68.8

61.0

62.5

63.9

Mid West

54.5

55.6

61.9

56.2

54.5

Pilbara

26.7

50.8

49.0

54.5

55.3

South West

64.3

64.5

75.0

77.5

77.6

Wheatbelt

38.5

36.8

46.6

40.0

51.6

Source: Custom report provided to Commissioner for Children and Young People WA from the Department of Health, Midwives Notification System and Birth Notification Dataset [unpublished]

Proportion of non-Aboriginal mothers attending first antenatal visit in 1 to 12 weeks gestational age by region, in per cent, WA, 2014 to 2018

2014

2015

2016

2017

2018

North Metropolitan

56.8

58.9

55.7

54.8

56.1

South Metropolitan

61.6

65.6

60.4

62.0

59.7

Goldfields

58.2

65.4

69.1

77.3

83.0

Great Southern

78.6

84.7

84.8

82.1

81.9

Kimberley

79.3

86.3

87.2

89.6

84.6

Mid West

66.0

69.5

73.4

74.4

80.5

Pilbara

35.7

58.7

62.8

72.3

76.5

South West

70.7

72.0

72.4

78.4

79.9

Wheatbelt

56.9

54.8

52.9

55.1

60.6

Source: Custom report provided to Commissioner for Children and Young People WA from the Department of Health, Midwives Notification System and Birth Notification Dataset [unpublished]

Note: The majority of public homebirths are included in the Birth Notification database, but homebirths attended by private practising midwives are not. The 2018 data may be incomplete and subject to change.

In remote and regional WA, the proportion of Aboriginal and non-Aboriginal mothers attending their first antenatal visit in the first trimester has generally increased over the last five years.

In the metropolitan area there has been no significant increase in attendance in the first trimester of Aboriginal or non-Aboriginal mothers over the last five years.

Endnotes

  1. Australian Institute of Health and Welfare 2018, Australia’s mothers and babies 2016 - in brief, Perinatal statistics series no 34, Cat No Per 97, AIHW.
  2. Molloy C et al 2018, Restacking the Odds: Antenatal care: An evidence-based review of the relevant measures to assess quality, quantity and participation, Melbourne Children’s Research Institute, p. 5.
  3. Department of Health, Clinical Practice Guidelines – Pregnancy Care: 2018 Edition, Australian Government, p. 10.
  4. Australian Institute of Health and Welfare 2018, National Perinatal Data Collection, 2016: Quality Statement [website].
  5. Australian Institute of Health and Welfare 2018, Australia’s mothers and babies 2016 - in brief, Perinatal statistics series no 34, Cat No Per 97, AIHW, p 7.
  6. Department of Prime Minister and Cabinet 2018, Aboriginal and Torres Strait Islander Health Performance Framework 2017 Report [website], viewed 9 November 2018.
  7. Australian Research Alliance for Children and Youth (ARACY) 2008, Technical Report: The Wellbeing of Young Australians, ARACY, p. 49.
  8. WA Department of Health, Western Australia’s mothers and babies summary - Infant mortality rates. Note: Data from 2016 are incomplete and subject to change.
  9. WA Department of Health, Western Australia’s mothers and babies summary – Aboriginal infant mortality rates. Note: Data from 2016 are incomplete and subject to change.
Measure: Smoking during pregnancy

Smoking during pregnancy is one of the leading preventable causes of a wide range of adverse outcomes for babies. There is strong evidence that smoking in pregnancy is associated with low birth weight and increased risks of a child being born prematurely. There is also evidence of association with sudden infant death syndrome (SIDS).1

The effects of maternal smoking during pregnancy can also persist throughout a child’s life. These effects include increased likelihood of asthma, lower cognitive function and behavioural issues.2

There has been a steady increase in the number of women not smoking during their pregnancy in WA and across Australia over the last 10 years.

Proportion of women who did not smoke during pregnancy, in per cent, WA and Australia, 2006 to 2016

WA*

Australia

2006

82.5

82.5

2007

83.5

83.3

2008

84.6

83.7

2009

85.5

85.4

2010

87.4

86.3

2011

87.9

86.8

2012

88.4

87.5

2013

89.2

88.3

2014

89.7

89.0

2015

90.3

89.6

2016

90.9

90.1

Source: Australian Institute of Health and Welfare, National Perinatal Data Collection 2016

* For WA, ‘smoked’ includes occasional smoking and ‘did not smoke’ includes ‘not determined’.

Note: Mother's tobacco smoking status during pregnancy is self-reported.

Proportion of women who did not smoke during pregnancy, in per cent, WA and Australia, 2006 to 2016

Source: Australian Institute of Health and Welfare, National Perinatal Data Collection 2016

Significantly more women who live in regional or remote WA smoke during pregnancy. However, since 2012 there has been a steady decrease in the proportion of women smoking during pregnancy across WA.

Proportion of women who gave birth and smoked during pregnancy, by WA Primary Health Network area, in per cent, WA and Australia, in 3-year aggregates from 2012 to 2016

2012–2014

2013–2015

2014–2016

North Metropolitan

6.9

6.4

6.1

South Metropolitan

10.5

9.7

9.2

Country WA

18.9

18.5

17.9

Australia

11.7

11.0

10.4

Source: AIHW My Healthy Communities: Child and maternal health indicators - National Perinatal Data Collection

Proportion of women who gave birth and smoked during pregnancy, by Primary Health Network area, in per cent, WA, in 3-year aggregates from 2012 to 2016

Source: AIHW My Healthy Communities: Child and maternal health indicators - National Perinatal Data Collection

In 2016, 34 per cent of Australian mothers living in very remote locations smoked in the first 20 weeks of pregnancy, compared to 7.1 per cent of mothers in major cities. In the same year, almost one fifth (17.4%) of Australian mothers living in the lowest socioeconomic areas smoked in the first 20 weeks of pregnancy, compared to 3.1 per cent in the highest socioeconomic areas.3

Aboriginal women are much more likely to smoke during pregnancy than non-Aboriginal women. The following table shows there is considerable variation across different geographic regions of WA and between Aboriginal and non-Aboriginal women.

Rate of not smoking tobacco during pregnancy by region and Aboriginal status, in per cent, WA, 2017

Aboriginal

Non-Aboriginal

North Metropolitan

53.4

95.6

South Metropolitan

62.3

92.8

East Metropolitan

58.8

93.4

Kimberley

45.8

92.7

Pilbara

57.3

94.0

Mid West

44.3

89.3

Wheatbelt

48.0

88.8

Goldfields

50.4

86.4

Great Southern

62.2

86.9

South West

61.3

89.2

Total

53.3

93.1

Source: Custom report provided to the Commissioner for Children and Young People WA by WA Department of Health from the Purchasing and System Performance, Data Collections Directorate [unpublished]

Aboriginal women in the Mid West region of WA (includes Geraldton and Meekatharra) had the lowest rate of not smoking during pregnancy (44.3%) and Aboriginal women in South Metropolitan Perth had the highest rate of not smoking during pregnancy (62.3%). In contrast, non-Aboriginal women in North Metropolitan Perth had the highest rate of not smoking during pregnancy (95.5%) while non-Aboriginal women in the Goldfields had the lowest rate of not smoking (86.4%).

There has, however, been a steady increase in the proportion of Aboriginal women (and non-Aboriginal women) not smoking during pregnancy over the last decade.

Rate of not smoking tobacco during pregnancy by Aboriginal Status, in per cent, WA, 2007 to 2017

Aboriginal

Non-Aboriginal

2007

47.0

85.9

2008

48.7

86.8

2009

48.7

87.7

2010

55.1

89.9

2011

54.9

89.8

2012

51.8

90.3

2013

51.3

91.3

2014

51.5

91.8

2015

51.4

92.3

2016

53.9

92.9

2017

53.3

93.1

Source: Custom report provided to the Commissioner for Children and Young People WA by WA Department of Health from the Purchasing and System Performance, Data Collections Directorate [unpublished]

Rate of not smoking tobacco during pregnancy by Aboriginal Status, in per cent, WA, 2007 to 2017

Source: Custom report provided to the Commissioner for Children and Young People WA by WA Department of Health from the Purchasing and System Performance, Data Collections Directorate [unpublished]

While many Aboriginal mothers have healthy pregnancies, poor health and social disadvantage contributes to a higher proportion of Aboriginal mothers and their babies experiencing adverse outcomes.

Aboriginal mothers are seven times more likely to be teenagers,4 14 times more likely to live in remote and very remote areas, and 2.4 times as likely to live in disadvantaged areas than non-Aboriginal mothers.5 Each of these characteristics increase the likelihood of a mother smoking during pregnancy.

There are also social factors that increase the likelihood of Aboriginal mothers smoking during pregnancy, including the normalisation of smoking in many Aboriginal communities and higher level of stressors including domestic violence and deaths in the family.6

Endnotes

  1. Mendelsohn C et al 2014, Management of smoking in pregnant women, Australian Family Physician, Vol 43, No 1–2.
  2. Ibid, p. 47.
  3. Australian Institute of Health and Welfare 2018, Australia’s mothers and babies 2016 - in brief, Perinatal statistics series no 34, Cat No Per 97, AIHW, p 10.
  4. Refer to the Healthy behaviours Indicator in age group 12 to 17 years.
  5. Australian Institute of Health and Welfare 2018, Australia’s mothers and babies 2016 - in brief, Perinatal statistics series no 34, Cat No Per 97, AIHW, p 42.
  6. Department of Health 2018, Clinical Practice Guidelines – Pregnancy Care: 2018 Edition, Australian Government, p. 31, 84, 87.
Measure: Drinking during pregnancy

Drinking alcohol is linked to a range of conditions including low birth weight, alcohol-related birth defects, alcohol-related neurodevelopmental disorders and a number of conditions that are broadly classified as Fetal Alcohol Spectrum Disorder (FASD).

Fetal Alcohol Syndrome (FAS) is a severe condition in children that can result from drinking alcohol during pregnancy, and is one of the conditions which falls under the classification of FASD. FAS is the most common preventable cause of intellectual disability in children. The prevalence of FASD (and FAS) in Australia and WA is currently unknown as children are not routinely screened.1

There is no conclusive evidence on whether there is a safe low level of drinking while pregnant.2 While it is well accepted that heavy alcohol consumption during pregnancy is a risk factor for FASD and other negative birth outcomes, the evidence of the impact of lower levels of drinking is limited.3,4 The National Health and Medical Research Council’s Australian Guidelines to Reduce Health Risks from Drinking Alcohol advise women who are pregnant or planning a pregnancy that not drinking is the safest option as maternal alcohol consumption may adversely affect the developing foetus.

There is less data on alcohol consumption during pregnancy than smoking during pregnancy. Unlike smoking during pregnancy, drinking alcohol during pregnancy is not included in the Perinatal National Minimum Data Set. Since 2010, the Australian Institute of Health and Welfare (AIHW) in partnership with the National Perinatal Data Development Committee has been progressing work to develop a nationally agreed, uniform method for measuring and recording alcohol use in pregnancy. This is still in progress.5

The following data has been provided by the AIHW to the Commissioner for Children and Young People WA from the National Drug Strategy Household Survey (NDSHS).

The NDSHS is a nationally representative survey that collects self-reported information on tobacco, alcohol and illicit drug use and attitudes from persons aged 12 years and over.

Proportion of women aged 14 to 49 years who drank no alcohol while pregnant, in per cent, by state and territory, 2001 to 2016

WA

NSW

VIC

QLD

SA

TAS

ACT

NT

Total

2001

36.1

39.5

37.5

32.1

32.7

n.p.

n.p.

n.p.

36.2

2004

32.1

38.7

42.0

31.8

42.3

n.p.

n.p.

n.p.

37.5

2007

38.4

43.0

39.2

33.9

45.1

n.p.

n.p.

n.p.

39.7

2010

50.1

48.7

51.5

50.0

39.0

n.p.

n.p.

n.p.

48.7

2013

45.8

49.0

52.7

58.6

68.8

30.6*

45.1

50.6

52.7

2016

65.3#

49.4

56.8

54.9

57.1

48.4

65.1

60.6

55.6

Source: AIHW analysis of NDSHS data – custom report provided to the Commissioner for Children and Young People WA [unpublished]

# Statistically significant change between 2013 and 2016.

* Estimate has a relative standard error between 25 per cent and 50 per cent and should be used with caution.

n.p. Not published because of small numbers, confidentiality or other concerns about the quality of the data.

Note: Base includes women who were pregnant including those who were pregnant and breastfeeding at the same time.

Proportion of women aged 14 to 49 years who drank no alcohol while pregnant, in per cent, WA and Australia, 2001 to 2016

Source: AIHW analysis of NDSHS data – custom report provided to the Commissioner for Children and Young People WA [unpublished]

There was a statistically significant increase from 2013 to 2016 in the proportion of mothers in WA not drinking alcohol during pregnancy. This was offset by a decrease in the proportion of mothers drinking less alcohol during pregnancy.

Proportion of women aged 14 to 49 years who drank more, less or the same amount of alcohol while pregnant, in per cent, WA, 2001 to 2016

2001

2004

2007

2010

2013

2016

More or same

6.6*

4.5**

2.8**

1.0**

3.6**

n.p.

Less

57.3

63.4

58.8

48.8

50.6

33.5#

Did not drink alcohol

36.1

32.1

38.4

50.1

45.8

65.3#

Source: AIHW analysis of NDSHS data – custom report provided to the Commissioner for Children and Young People WA [unpublished]

# Statistically significant change between 2013 and 2016.

* Estimate has a relative standard error between 25 per cent and 50 per cent and should be used with caution.

** Estimate has a high level of sampling error (relative standard error of 51% to 90%), meaning that it is unsuitable for most uses.

n.p. Not published because of small numbers, confidentiality or other concerns about the quality of the data.

Note: Base includes women who were pregnant including those who were pregnant and breastfeeding at the same time.

During antenatal visits, health professionals ask mothers about their alcohol consumption during pregnancy. Data on mother’s responses has been collected and recorded in the Midwives Notification System since July 2017. The initial results from this administrative data collection differ considerably from the NDSHS suggesting that over 90 per cent of mothers seen during that period are not drinking during pregnancy.6

This data shows that there is a greater incidence of drinking during pregnancy in some regional and remote areas than in metropolitan areas.

Rate of not drinking alcohol during pregnancy by region and Aboriginal status of mother, in per cent, WA, July to December 2017

Aboriginal

Non-Aboriginal

North Metropolitan

91.7

98.2

South Metropolitan

91.2

97.8

East Metropolitan

93.5

97.5

Kimberley

81.1

93.5

Pilbara

91.6

94.9

Mid West

86.5

97.1

Wheatbelt

94.3

96.0

Goldfields

88.5

98.1

Great Southern

95.8

93.3

South West

91.4

96.7

Total

89.2

97.5

Source: WA Department of Health, Purchasing and System Performance, Data Collections Directorate – custom report provided to the Commissioner for Children and Young People WA [unpublished]

Note: Alcohol consumption during pregnancy has only been collected since 1 July 2017, so only six months data is reported (6% of Aboriginal Births and 2.6% of non-Aboriginal births had unknown alcohol consumption and were excluded from the calculations).

The lowest proportion of Aboriginal mothers not consuming alcohol during pregnancy in the six months from July to December 2017 is in the Kimberley (81.1%), the Mid West (86.5%) and the Goldfields (88.5%). The lowest proportion of non-Aboriginal mothers not consuming alcohol during pregnancy is also in the Kimberley (93.5%), the Pilbara (94.9%) and Great Southern (93.3%).

Analysis from the National Aboriginal and Torres Strait Islander Social Survey 2014–15 found that the majority (81.1%) of WA mothers of Aboriginal children did not consume alcohol during pregnancy in 2014–15, although compared to other states and territories across Australia this was the lowest proportion.

Mothers of Aboriginal children aged 0 to 3 years who did not consume alcohol in pregnancy, in per cent, states and territories, 2014-15

WA

NSW

VIC

QLD

SA

TAS

ACT

NT

Australia

Percentage

81.1

92.4

92.2

86.2

86.9

89.9

90.9

90.4

90.9

Source: AIHW 2017, Aboriginal and Torres Strait Islander Health Performance Framework 2017, measure 2.21 Health behaviours during pregnancy

Note: Information on some aspects of maternal health could not be obtained from all respondents. Proportions for use of alcohol, tobacco and illicit substances during pregnancy have therefore been calculated on the responding population.

Endnotes

  1. Australian Institute of Family Studies 2018, Fetal alcohol spectrum disorders: Current issues in awareness, prevention and intervention, CFCA Paper No. 29 – December 2014 [website].
  2. National Health and Medical Research Council 2009, Australian Guidelines to Reduce Health Risks from Drinking Alcohol, Commonwealth of Australia.
  3. O’Leary CM et al 2006, A review of policies on alcohol use during pregnancy in Australia and other English-speaking countries, The Medical Journal of Australia, Vol 186, No 9.
  4. McCarthy FP et al 2013, Association between maternal alcohol consumption in early pregnancy and pregnancy outcomes, Obstetrics & Gynecology, Vol 122, No 4.
  5. Australian Institute of Health and Welfare 2018, Mothers and babies – Data sources: National data collection on alcohol in pregnancy: a qualitative study [website].
  6. Custom report from WA Department of Health, Purchasing and System Performance provided to the Commissioner for Children and Young People WA [unpublished].
Children in care

Not applicable

Children with disability

Not applicable

Policy implications

Antenatal care is associated with positive maternal and child health outcomes. Good antenatal care incorporates appropriate health checks and also discussions regarding any recommended lifestyle changes, such as a cessation of smoking or drinking during pregnancy. The likelihood of receiving effective health interventions is increased by attending antenatal visits.

While there has been gradual improvement over recent years, a large proportion of WA mothers (37.2% in 2018) still do not attend an antenatal appointment in the first trimester of their pregnancy. WA has a very low attendance rate compared to the Australian average. In particular WA mothers in the metropolitan area are much less likely to attend an antenatal appointment in the first trimester. Policy and practice should be focused towards increasing antenatal care attendance of these mothers, particularly those at risk of adverse birth outcomes.

While overall, WA has low infant mortality rates (3.1 infant deaths - less than one year of age - per 1,000 live births),1 adverse pregnancy outcomes, including infant death, are more likely for some mothers. Perinatal deaths are 65 per cent more likely for mothers who live in remote or very remote regions, and 25 per cent more likely for mothers who live in areas of socioeconomic disadvantage.2

Women and families in low socioeconomic areas and remote and regional WA need to have access to high quality antenatal care including appropriate medical care if complications arise.3 Services and programs should be designed to encourage families to access them during pregnancy and ensure ongoing contact with health services and professionals after childbirth. Research shows that women who have continuity of care have better outcomes as they are more likely to attend antenatal appointments, more likely to discuss their pregnancy and lifestyle concerns and to feel well-prepared.4

Lifestyle changes such as reducing or quitting smoking or drinking during pregnancy can be difficult, particularly for women experiencing socioeconomic disadvantage, mental illness or family violence and for some women from Aboriginal communities.5,6 Services and health professionals should provide women with a safe space where they can be encouraged to discuss their lifestyle concerns and consider making changes through behavioural counselling.7 Throughout pregnancy, women should have the opportunity to make informed decisions about their care and treatment in consultation with their healthcare professionals.8 Good communication is essential.

A recent evaluation of the right@home nurse home visiting program, which offered pregnant women experiencing adversity in Victoria and Tasmania 25 nurse visits at home until the child was aged two years, found that the program improved parenting and home environment determinants of children’s health and development. Programs of this nature should be considered for mothers deemed at risk.9

Aboriginal mothers in WA are much less likely to attend an antenatal appointment in the first trimester than non-Aboriginal mothers. It is therefore critical that antenatal services are culturally appropriate and accessible, particularly considering the needs of Aboriginal mothers and families. The factors that appear to improve Aboriginal women’s engagement with antenatal care are:10

  • creating an effective relationship between the woman and the health provider
  • supporting the woman’s individual decision-making
  • culturally competent carers and models of care
  • maintaining a holistic approach to health which incorporates Aboriginal understandings of health including social, emotional, spiritual, and cultural wellbeing.11

Provision of universal services for all families linked to specific targeted services for families with additional needs will result in improved maternal and infant health.

Data gaps

The data on antenatal visits is not complete as first antenatal visits that occur outside of hospital may not be included. The method of data collection should be reviewed and improved to ensure accurate reporting on low attendance rates to focus policy and practice changes in the right area.

There is limited trend data on alcohol consumption during pregnancy disaggregated by region and Aboriginal status. This should be improved over time with the data collection which commenced in July 2017 by the WA Department of Health.

Endnotes

  1. Australian Institute of Health and Welfare 2018, Children’s Headline Indicators – Infant Mortality, AIHW [website].
  2. Australian Institute of Health and Welfare 2018, Perinatal deaths in Australia: 2013–2014, Cat No PER 94, AIHW p. 34.
  3. Reibel T and Morrison L 2014, Young Aboriginal Women’s Voices on Pregnancy Care, Telethon Kids Institute and the University of WA, WA Department of Health, p. 12.
  4. McLean K, Goldfeld S, Molloy C and Wake M 2014, Screening and surveillance in early childhood health: Rapid review of evidence for effectiveness and efficiency of models; Murdoch Children Research Institute, p. 6.
  5. Mendelsohn CP et al 2014, Management of smoking in pregnant women, Australian Family Physician, Vol 43, No 1–2.
  6. France KE et al 2010, Health professionals addressing alcohol use with pregnant women in Western Australia: Barriers and strategies for communication, Substance Use and Misuse, Vol 45 No 10.
  7. Mendelsohn CP et al 2014, Management of smoking in pregnant women, Australian Family Physician, Vol 43, No 1–2.
  8. National Collaborating Centre for Women's and Children's Health (UK) 2008, Chapter 3 Women-centred care and informed decision making in Antenatal Care: Routine Care for the Healthy Pregnant Woman - NICE Clinical Guidelines, No. 62, Royal College of Obstetricians and Gynaecologists Press, [website], viewed 8 November 2018.
  9. Goldfeld S et al 2019, Nurse Home Visiting for Families Experiencing Adversity: A Randomized Trial, Pediatrics, Vol 143, no 1.
  10. Reibel T and Morrison L 2014, Young Aboriginal Women’s Voices on Pregnancy Care, Telethon Kids Institute and the University of WA, WA Department of Health, p. 13.
  11. Kruske S et al 2006, Cultural safety and maternity care for Aboriginal and Torres Strait Islander Australians, Women and Birth: Journal of the Australian College of Midwives. Vol 3 No 73.
Further resources

For more information on antenatal care refer to the following resources: