Australia’s stillbirth rate has reached its highest reported level in more than two decades, prompting renewed calls for better prevention, culturally appropriate maternity care and more accurate reporting of why babies die.
New Australian Institute of Health and Welfare data shows 3,178 babies died during the perinatal period in 2023—about nine every day. The deaths included 2,491 stillbirths and 687 babies who died within 28 days of birth.
The national perinatal mortality rate rose from 10.3 deaths per 1,000 births in 2022 to 11.1 in 2023. The stillbirth rate increased to 8.7 per 1,000 births, its highest reported level since at least 2004, while the neonatal death rate remained stable at 2.4 per 1,000 live births.
The figures have caused alarm among bereaved families, clinicians and stillbirth researchers, but the AIHW has cautioned against interpreting the increase as proof that preventable deaths have risen by the same amount.
Australia’s national definition includes babies born without signs of life from 20 weeks’ gestation or weighing at least 400 grams. It also includes deaths following terminations after 20 weeks, many involving severe congenital conditions or serious risks to the mother.
The AIHW says changes in notification practices, the characteristics of women giving birth and a rise in terminations after 20 weeks have all contributed to the recorded increase. Its analysis found later terminations were an important part of the rise between 2019 and 2023.
Researchers from the Centre of Research Excellence in Stillbirth have similarly warned that headline rates can create a misleading picture if they are not separated by gestational age and whether a pregnancy ended through termination.
Writing in the Medical Journal of Australia, the researchers said much of the recent increase appeared to be driven by terminations after 20 weeks. They called for national agencies to also report stillbirth rates from 28 weeks, excluding terminations, because that measure is more closely aligned with Australia’s main prevention programs.
Victorian hospital figures have also attracted scrutiny after Sale Hospital recorded the state’s highest five-year gestation-standardised perinatal mortality ratio for 2018 to 2022.
Sale recorded a ratio of 1.66, followed by Shepparton Hospital and Waverley Private Hospital, both at 1.44.
However, the figures are not crude death rates and should not be reported as 1.66 or 1.44 deaths per 1,000 births.
A ratio of 1 represents the number of deaths expected after standardising for gestational age. Sale’s result of 1.66 indicates that observed deaths were 66 per cent above the number expected under that calculation—not that 1.66 babies died per 1,000 births.
The Victorian report also does not describe Sale, Shepparton or Waverley Private as the state’s “worst” hospitals.
The accompanying funnel plot does not show those hospitals outside the upper 95 per cent statistical control limit, meaning the differences may be influenced by chance variation, particularly where relatively small numbers of deaths are involved.
Safer Care Victoria explicitly warns that results from smaller hospitals are subject to wider variation and should be interpreted cautiously. Hospitals should be compared with services of similar size and capability, and performance should be assessed across multiple indicators rather than one measure alone.
The Victorian hospital measure also uses a much narrower group than the national stillbirth figures.
It pools five years of data, includes only deaths involving babies born from 32 weeks and excludes congenital anomalies, terminations and babies weighing under 150 grams. Hospitals with fewer than five eligible deaths over the five-year period are excluded entirely.
The calculation adjusts for gestational age but not for transfers between hospitals. A death is attributed to the hospital where the baby was born, even when the baby was later transferred to a larger specialist centre.
Those limitations mean the figures can help hospitals identify cases requiring review, but cannot alone establish that clinical care caused a higher result.
Victoria’s chief midwifery officer Elisa McDonald said every perinatal death was independently reviewed to understand what occurred and identify possible improvements to care.
National data shows the risk is not distributed evenly.
Perinatal mortality remains highest among babies born to the youngest and oldest mothers. The rate has increased since 2021 among babies born to women aged 24 and under, while mothers aged under 20 and those aged 40 or older face a higher risk of pregnancy complications and adverse outcomes.
Families living in remote communities and those experiencing socioeconomic disadvantage also face poorer outcomes. Access to timely antenatal care, ultrasound services, specialist monitoring and culturally safe information can vary considerably depending on where a woman lives and the maternity service available to her.
Congenital anomalies were the leading classified cause of perinatal death in 2023, accounting for 28 per cent of cases. Most deaths occurred before labour began.
Despite the importance of understanding why a baby died, an autopsy or related post-mortem examination was recorded in only between 33 and 39 per cent of perinatal deaths from 2019 to 2023.
That category includes full and limited autopsies, external examinations and cases where the type of examination was not identified. The relatively low rate can leave families without a definitive explanation and limit the information available to improve future care.
The Australian Commission on Safety and Quality in Health Care recommends that every stillbirth undergo a structured investigation, including examination of the placenta and umbilical cord, maternal and pregnancy history, clinical photographs, external examination and an offer of autopsy unless a clear cause has already been established.
Some clinicians have raised concerns about women giving birth without a registered midwife or doctor. However, the national figures released by the AIHW do not establish freebirth as a demonstrated cause of the increase. The agency identifies several possible contributors but says careful analysis is required before changes in headline rates can be attributed to a particular model of care.
Stillbirth prevention efforts have focused on identifying fetal growth restriction, helping women stop smoking, encouraging side sleeping from 28 weeks, improving awareness of changes in fetal movement and supporting informed decisions about the timing of birth.
The national Safer Baby Bundle aims to reduce stillbirth after 28 weeks by 20 per cent. Its earlier implementation in Victorian services was associated with a 21 per cent reduction in late-gestation stillbirth, showing that progress can be occurring in preventable late-pregnancy deaths even while the broader legal-definition rate rises.
Researchers are also calling for prevention programs to recognise that risk is not identical across every population.
A Victorian study involving more than 12,000 South Asian-born women found that offering fetal surveillance from 39 weeks was associated with a 64 per cent reduction in term stillbirth, from 2.3 to 0.8 deaths per 1,000 births. The researchers found no corresponding increase in neonatal intensive care admissions or other major neonatal harm.
The findings support a more individualised approach in which maternal health, fetal growth, gestational age, country of birth, access to services and personal circumstances are considered rather than relying on one national intervention for every pregnancy.
The latest figures do not provide a simple explanation for why Australia’s recorded stillbirth rate has risen. Part of the increase reflects changes in reporting and the inclusion of later terminations, while some may represent genuine changes in outcomes.
What the data does show is that thousands of families continue to experience the death of a baby each year, hospital-level comparisons require careful interpretation, and prevention programs cannot be treated as complete simply because national plans have been introduced.
The next step will require clearer data separating preventable late-gestation stillbirths from other perinatal deaths, thorough reviews of individual cases and consistent access to evidence-based, culturally safe maternity care across metropolitan, regional and remote Australia.
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