National Maternal Mortality Data Collection (NMMD) The data for the National Maternal Mortality Data Collection are collated from state and territory maternal mortality review committee sources. The Australian Institute of Health and Welfare (AIHW) obtained jurisdictional approval for release of these data to the AIHW. The Australian Institute of Health and Welfare (AIHW) is a major national agency set up by the Australian Government under the Australian Institute of Health and Welfare Act 1987 (Cwlth) to provide reliable, regular and relevant information and statistics on Australia’s health and welfare. It is an independent corporate Commonwealth entity established in 1987, governed by a management board, and accountable to the Australian Parliament through the Health portfolio.
The AIHW aims to improve the health and wellbeing of Australians through better health and welfare information and statistics. It collects and reports information on a wide range of topics and issues, from health and welfare expenditure, hospitals, disease and injury, and mental health, to ageing, homelessness, disability and child protection.
The AIHW also plays a role in developing and maintaining national metadata standards. This work contributes to improving the quality and consistency of national health and welfare statistics. The AIHW works closely with governments and non-government organisations to achieve greater adherence to these standards in administrative data collections to promote national consistency and comparability of data and reporting.
One of the main functions of the AIHW is to work with the states and territories to improve the quality of administrative data and, where possible, to compile national data sets based on data from each jurisdiction, to analyse these data sets and disseminate information and statistics.
The Australian Institute of Health and Welfare Act 1987, in conjunction with compliance to the Privacy Act 1988 (Cwlth), ensures that the data collections managed by the AIHW are kept securely and under the strictest conditions with respect to privacy and confidentiality.
Under a Memorandum of Understanding with the Department of Health, the AIHW is responsible for the management of the NPMDC. The AIHW maintains a coordinating role in the collection, including providing secretariat duties to the National Maternal and Perinatal Mortality Advisory Group, undertaking data development and highlighting implementation and collection issues.
Australian state and territory health authorities supply data to the AIHW under individual data agreements between AIHW and each state and territory. The AIHW is the data custodian of the NPMDC and receives, compiles, edits and verifies the NPMDC data in collaboration with the state or territory health authority that supplied the data. State and territory health authorities retain ownership of the jurisdictional level data and must approve any jurisdictional level output before it is released. The NMMDC data are compiled primarily from state and territory maternal death data collections or, where not available, other state and territory data sources. Data are requested on the death of all women reported to have died while pregnant or within 42 days of the end of pregnancy in Australia from 2006–2016. Specifications for data items in the NMMDC were developed using nationally standardised data as entered into the National health data dictionary. It includes data items relating to the mother, including demographic characteristics and factors relating to the pregnancy, labour and birth; details of death; classification of death and data items relating to the baby, including birth status; and any additional case summaries.
A National Maternal and Perinatal Mortality Advisory Group was convened in 2015 to oversee the process of data collection for the maternal and perinatal death reports and has taken over the responsibilities of the previous National Maternal Mortality Advisory Committee. NMMDC data are collected annually. Most jurisdictions need at least 12 months lead time to undertake post-mortem investigations, data entry and validation as required after the end of the data collection period. The AIHW is working with states and territories to improve the timeliness of these data. Inaccurate responses may occur in all data provided to the AIHW. The AIHW does not have direct access to maternal mortality committee records to determine the accuracy of the data provided. However, the AIHW undertakes validation on receipt of data. Data received from states and territories are checked for completeness, validity and logical errors. Potential errors are queried with jurisdictions, and corrections and resubmissions are made in response to these edit queries. The AIHW does not adjust data to account for possible data errors without the permission of the state or territory that supplied the data.
Errors may occur during the processing of data by the states and territories or at the AIHW. Processing errors prior to data supply may be found through the validation checks applied by the AIHW. The data are corrected when verification of an error is supplied. The AIHW does not adjust the data to correct for missing values.
Prior to publication, state/territory-level data are referred back to jurisdictions for checking and review. Note that because of data editing and subsequent updates of state/territory information, numbers reported may differ from those in reports published by the states and territories. Due to small numbers contained in the NMMDC, caution should be taken when interpreting these data. Due to their health and privacy legislation, only limited summary data on maternal deaths are supplied by Western Australia. Maternal deaths in Australia 2016 is a web based report published available on the AIHW website < https://www.aihw.gov.au/reports/mothers-babies/maternal-deaths-in-australia-2016/contents/report>.
Requests for unpublished data can be made by contacting the AIHW on (02) 6244 1000, by email to info@aihw.gov.au or through the AIHW’s custom data request service at https://www.aihw.gov.au/our-services/data-on-request.
The organisational structure, including relevant legislation, policy and process for maternal death data collection, varies by state and territory. The NMMDC reflects these variations. In all cases, the best available information has been used to form the NMMDC. An overview of each state’s maternal death data collection process is outlined below:
- The New South Wales Ministry of Health is notified of maternal deaths through a variety of organisations and methods, including hospitals, the Department of Forensic Medicine at Glebe, Ministry of Health systematic searches of New South Wales population health data sets (for example Admitted Patient Data Collection and the New South Wales Perinatal Data Collection) and through the National Coronial Information System. The number of maternal deaths for each year is assessed against Australian Bureau of Statistics (ABS) mortality data, where available (deaths with an International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10) cause of death code commencing with an ‘O’) to maximise ascertainment.
- In Victoria, maternal deaths are identified through direct notification by health services, Victorian Perinatal Data Collection Unit (birth forms), the Coroner’s Office, the Registrar of Births, Deaths and Marriages and through media reports. Under the Public Health and Wellbeing Act 2008, the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) is responsible for receiving and reporting information regarding maternal deaths, including late maternal deaths; the cases are classified and reviewed by the maternal mortality sub-committee of CCOPMM. In 2010, automatic electronic notification through coronial e-Medical Deposition Form was introduced, and that form includes a tick box ‘was the patient pregnant in the last 12 months’.
- Queensland Health conducts dedicated searches of hospital administrative data sets intended for the sole purpose of identifying maternal deaths. In 2012, the Minister of Health approved changes to the Public Health Act 2005 to mandate reporting of maternal deaths to the Department (working with the Queensland Maternal and Perinatal Quality Council).
- South Australia Health has no formal process of maternal death notification. The Maternal Mortality Committee accesses multiple notifications, including review of media articles, word of mouth, clinicians, pathologists and sentinel event reporting from hospitals. Although there is a tick box on death certificates to indicate if a woman has been pregnant in the last 3 months, this has never been a source of notification to the Maternal Mortality Committee of a maternal death. Hospital separation discharge codes are also reviewed as a quality check to identify maternal deaths. However, to date, this process has never informed the Maternal Mortality Committee of a maternal death the committee was not already aware of. Similarly, sentinel event reporting has not identified a new maternal death to this committee.
- The Tasmanian Department of Health and Human Services is notified of maternal deaths through the following sources: health statistics, the Register of Births, Deaths and Marriages and local clinicians who are members of the Tasmanian Council of Obstetric and Paediatric Mortality and Morbidity (state-wide) and local hospital morbidity and mortality committees.
- In Western Australia the Maternal Mortality Committee appoints an investigator when it is notified of such a death. After the committee considers the report of that investigator the committee chair reports to the Executive Director of Public Health on the findings of the committee.
- Review of maternal deaths in the Australian Capital Territory was previously carried out in conjunction with such review in New South Wales. Since 2011 the ACT Maternal and Perinatal Morbidity and Mortality Committee has completed such review independently.
- Northern Territory Department of Health undertook a process of maternal death ascertainment and review specifically to supply data to the NMMD.
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