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Mothers

During 2000-02, Indigenous mothers comprised 3.5% of all mothers who gave birth in Australia (table 6.1). The proportion of Indigenous mothers ranged from less than 1% in Victoria to 39% in the Northern Territory. The reported number of Indigenous mothers was highest in Queensland (8,212), followed by New South Wales (6,370), Western Australia (4,631) and the Northern Territory (4,242).

6.1 Indigenous mothers, by state and territory - 2000-02
	Indigenous mothers
	no.	%(a)
New South Wales	6 370	2.5
Victoria	1 208	0.7
Queensland	8 212	5.6
South Australia	1 288	2.5
Western Australia(b)	4 631	6.3
Tasmania	na	na
Northern Territory	4 242	38.5
Australian Capital Territory(c)	177	1.3
Australia	26 128	3.5
na not available
(a) The proportion of Indigenous mothers in each jurisdiction.
(b) Data may differ from those published by the Department of Health, Government of Western Australia.
(c) Includes ACT and non-ACT residents who gave birth in the ACT. Among the 177 Indigenous mothers who gave birth, 128 were ACT residents.
AIHW, National Perinatal Data Collection.

Fertility rate

The total fertility rate (TFR) provides an estimate of the average number of children that a woman would have throughout her reproductive life if she were to experience the age-specific birth rate in a particular year. In 2003, the TFR for Indigenous women was estimated to be 2.15 babies, compared with 1.76 babies in the total Australian female population (ABS 2004a). Indigenous TFRs vary across the states and territories. The highest Indigenous fertility rate in 2003 occurred in the Northern Territory (2.83 babies), followed by Western Australia (2.32) and Queensland (2.21).

However, the fertility of Indigenous women may be underestimated because of the incomplete identification of Indigenous status in birth registrations. It should also be noted that because a considerable number of Indigenous babies are born to non-Indigenous women, measures of the fertility of Indigenous women inevitably underestimate the impact of these births on the growth of the Indigenous population.

High fertility at younger ages contributes to the relatively high fertility of Indigenous women. Teenage births are more common among Indigenous women than among other women (Sullivan & Lancaster 1999). In 2003, the teenage (15-19 years) birth rate among Indigenous women was more than four times the overall Australian teenage birth rate. Teenage pregnancies are associated with a number of adverse reproductive outcomes such as foetal complications and low birthweight (Fraser et al. 1995). The peak age group for births to Indigenous women was 20-24 years (133 babies per 1,000), compared with 30-34 years for all women (113 babies per 1,000) (graph 6.2).

6.2 Age-specific birth rates(a), by Indigenous status of the mother - 2003

In the National Perinatal Data Collection, 78% of Indigenous mothers who gave birth during the period 2000-02 were under 30 years of age, compared with 49% of non-Indigenous mothers (graph 6.3). The proportion of Indigenous mothers aged less than 20 years was highest in the Northern Territory (31%), followed by Western Australia (23%) and New South Wales (22%) (table 6.4). This compared with only 5% of non-Indigenous mothers in the Northern Territory, 5% in Western Australia and 4% in New South Wales.

6.3 Maternal age, by Indigenous status of the mother - 2000-02

6.4 Births, by maternal age and Indigenous status of the mother - 2000-02
		Under 20 years		20-34 years		35 years or over		Total(a)
		no.	%	no.	%	no.	%	no.	%
New South Wales
	Indigenous	1 379	21.6	4 530	71.1	453	7.1	6 370	100.0
	Non-Indigenous	9 916	4.0	192 901	77.5	45 973	18.5	248 913	100.0
Victoria
	Indigenous	258	21.4	844	69.9	105	8.7	1 208	100.0
	Non-Indigenous	5 652	3.1	141 524	77.1	36 306	19.8	183 495	100.0
Queensland
	Indigenous	1 587	19.3	6 009	73.2	616	7.5	8 212	100.0
	Non-Indigenous	7 818	5.7	108 209	78.7	21 482	15.6	137 509	100.0
South Australia
	Indigenous	265	20.6	918	71.3	105	8.2	1 288	100.0
	Non-Indigenous	2 557	5.0	39 973	78.2	8 608	16.8	51 138	100.0
Western Australia(b)
	Indigenous	1 082	23.4	3 271	70.6	278	6.0	4 631	100.0
	Non-Indigenous	3 257	4.7	53 977	78.1	11 843	17.1	69 077	100.0
Northern Territory
	Indigenous	1 304	30.7	2 712	63.9	218	5.1	4 242	100.0
	Non-Indigenous	361	5.4	5 274	78.3	1 091	16.2	6 734	100.0
Australian Capital Territory(c)
	Indigenous	33	18.6	131	74.0	13	7.3	177	100.0
	Non-Indigenous	444	3.3	10 433	76.8	2 710	19.9	13 588	100.0
Australia(d)
	Indigenous	5 908	22.6	18 415	70.5	1 788	6.8	26 128	100.0
	Non-Indigenous	30 005	4.2	552 291	77.7	128 013	18.0	710 454	100.0
(a) Includes births where the mother's age was not stated. Excludes births to mothers whose Indigenous status was not stated.
(b) Data may differ from those published by the Department of Health, Government of Western Australia.
(c) Includes ACT and non-ACT residents who gave birth in the ACT. Among ACT resident Indigenous mothers who gave birth in the ACT, 18.0% were under 20 years, 73.4% were aged 20-34 years and 8.6% were aged 35 years or over.
(d) Excludes data for Tasmania.
AIHW, National Perinatal Data Collection.

Risk factors during pregnancy

Among the risk factors for poor perinatal and child health are alcohol use, tobacco and drug use during pregnancy.

Smoking

Smoking during pregnancy can have a number of detrimental effects on the foetus including low birthweight and spontaneous abortion. Smoking during pregnancy can also have a detrimental effect on the newborn including sudden infant death syndrome, asthma, lower respiratory tract infections, middle ear diseases and stillbirth (Zubrick et al. 2004).

In 2002, data were available from five states and territories: New South Wales, Western Australia, South Australia, the Australian Capital Territory and the Northern Territory. Aboriginal and Torres Strait Islander mothers accounted for 11% of mothers who smoked during pregnancy in these five jurisdictions (Laws & Sullivan 2004).

According to the NSW Midwives data collection, in 2003, 57% of Indigenous mothers in New South Wales reported smoking at some point during pregnancy, compared with 14% of other mothers (NSW Health Department, Centre for Epidemiology and Research 2005).

In the Western Australian Aboriginal Child Health Survey (WAACHS), approximately 49% of mothers of Aboriginal children in Western Australia had smoked or chewed tobacco during pregnancy (table 6.5).

Alcohol consumption

Excessive alcohol intake during pregnancy is associated with an increased risk of alcohol withdrawal symptoms in the baby, foetal alcohol syndrome and perinatal mortality (Zubrick et al. 2004). The Bibbulung Gnareep Solid Kid Study, which involved 274 Aboriginal families from the Perth area, looked at a range of factors influencing poor birth outcomes and poor health in the first 12 months of life. The study found that among other factors, maternal consumption of excess alcohol, namely spirits, during pregnancy was associated with poorer birth outcomes (Eades 2004).

In the WAACHS, the mothers of an estimated 23% of Aboriginal children in Western Australia reported they had consumed alcohol at some point during their pregnancy and an estimated 17% had both smoked and consumed alcohol while pregnant.

Marijuana and other drug use

In the WAACHS, mothers of 9% of Western Australian Aboriginal children had used marijuana during pregnancy. Marijuana usage declined with increasing remoteness, from 11% in metropolitan areas to 2% in areas of extreme (geographic) isolation. Other drugs such as amphetamines and cocaine were reported for less than 1% of mothers.

Effect of substance use during pregnancy on birthweight

The WAACHS estimated the effects of tobacco, alcohol and marijuana use during pregnancy on birthweight by linking survey data to birth records on the Maternal and Child Health Research Data Base (MCHRDB). Mothers who used both alcohol and tobacco during pregnancy were almost twice as likely to have had a low birthweight baby as mothers who did not smoke or drink during pregnancy (15% compared with 8%) (table 6.5).

Overall, tobacco use during pregnancy was associated with a 200 gram reduction in mean birthweight of Aboriginal infants, and tobacco and alcohol use combined was associated with a 250 gram reduction in average birthweight. The effects of low birthweight are discussed in the following section on babies and children.

6.5 Low birthweight Aboriginal babies(a), by maternal substance use during pregnancy - 2001-02
		Alcohol, no tobacco	Tobacco, no alcohol	Both alcohol and tobacco	No alcohol or tobacco	Total	Babies (no.)(b)
Mean birthweight	grams	3 270	3 110	3 060	3 310	3 200	. .
Low birthweight	%	10.2	11.0	15.4	7.8	10.3	2 180
Proportion of babies	%	6.0	32.1	17.3	44.6	100.0	21 200
. . not applicable
(a) Whose primary carer was their mother.
(b) Data are weighted estimates and have been derived by weighting the survey sample to reflect the Western Australian Aboriginal population.
Zubrick et al. 2004.

Maternal mortality

Between 1997 and 1999, Indigenous status was recorded for 75 (83%) of the 90 maternal deaths during childbirth. Seven deaths were of Aboriginal and Torres Strait Islander mothers, accounting for 9% of the deaths where Indigenous status was known (Slaytor et al 2004). The maternal mortality ratio for Aboriginal and Torres Strait Islander women was approximately 24 per 100,000 confinements in 1997-99 and is more than three times as high as the maternal mortality ratio for other women (7 per 100,000 confinements). These rates must be interpreted with caution due to the very small number of Indigenous maternal deaths.