The effect of migration and acculturation on risk of stillbirth in Western Australia

Duration: Two years

Leader: Associate Professor Craig Pennell

Team: Dr Maryam Mozooni; Professor David Preen

Institute: The University of Western Australia

Stillbirth accounts for more than 2,000 deaths in Australia annually with a national rate of 7 per 1,000 births. This is more than 17 times the rate of Sudden Unexpected Deaths in Infancy (SUDI) in Australia which is now at an incredibly low rate of 0.4 per 1,000 births due to decades of research and a hugely successful public health campaign led by Red Nose. Assoc. Prof. Pennell and his team plan to apply many of the lessons learned with SUDI over the past 25 years to the problem of stillbirth in Australia.

The burden of stillbirth has both short term and long lasting effects for the immediate and broader family. The psychological impact is substantial, and the ripple effect can interfere with the wellbeing of a population beyond those directly involved.

The significance of migration cannot be underestimated for families, society and governments. The current global migration crisis is attracting unprecedented media attention and is unlikely to be resolved in the short term. Evidence suggests that migration is related to adverse outcomes in pregnancy and early life. Recent research has shown that country of origin influences risk of stillbirth; however, the pathways responsible for this are not well understood. The well described process of gradual adoption of habits and beliefs of the host country by migrants over time is known as acculturation. Preliminary evidence from the subject group suggests that acculturation influences the risk of stillbirth.

Immigration is the principal component of population growth in Australia. This is most evident in Western Australia where 30% of women who give birth each year were born overseas.

Western Australia is the only Australian state where the number of migrant families, those with at least one parent born overseas, exceeds that of non-migrant families.

Western Australia has a unique resource of linked health data which has enabled researchers to successfully conduct hundreds of precise public health related studies over the past two decades with significant impact on population health in Australia. The full potential of this resource for migrant studies of stillbirth has not been explored.

This project will leverage this unique resource to study more than 200,000 births through multiple linked health registries over a 10-year period. The project will investigate the effect of country of birth and acculturation on the risk of stillbirth in WA. Due to the depth and breadth of linked registries, this project has an unprecedented ability to identify factors influencing the rate of stillbirth; this will inform public health policy and development of strategies for the prevention of stillbirth.

Progress Report September 2018

High income countries are challenged by the greater risk of stillbirth among migrants and women from ethnic minorities. About 50% of all stillbirths around the world occur during birth and are deemed preventable by good obstetric care. Although these stillbirths are believed to be rare in high income countries, in some regions they constitute up to 20% despite availability of good quality obstetric care. Little was known in Australia about the association between ethnic and migration background and stillbirths that happen during child-birth after labour started. Our study, for the first time in Australia, explored different types of stillbirth.

In Western Australia, we showed that stillbirth was more frequent among women with non-white backgrounds born overseas, particularly those with African or Indian backgrounds, than for Australian-born women. Also, the rate of pre-term stillbirth before labour started was higher among migrants of Māori background compared to Australian-born women, even after controlling for many factors in the analysis. About 24% of stillbirths happened during child-birth, mostly among African women and women from “other” non-white background.

Further investigation of pattern of service utilisation, particularly for those from Indian or African backgrounds, is required for developing strategies to avert preventable stillbirths.