NSW Perinatal Data Collection (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.
Two questions are asked about smoking behaviour in the NSW Perinatal Data Collection:
- Did the mother smoke at all during the first half of pregnancy?
- Did the mother smoke at all during the second half of pregnancy?
Smoking in pregnancy was defined as smoking in either the first or second half of pregnancy.
Data include all mothers who gave birth (stillbirth or live birth) in a NSW facility (or a home) regardless of place of permanent residence.
The number of ‘not stated’ cases varied by geographic area and year. This may reduce the reliability of the estimates in the instances where ‘not stated’ cases are a large proportion.
As Aboriginal mothers are under-reported on the Perinatal Data Collection, it is likely that the true numbers of Aboriginal mothers are substantially higher than shown. Refer to the Methods tab for more information.
Statistical Areas are grouped according to Australian Statistical Geographic Standard (ASGS) remoteness categories on the basis of Accessibility/Remoteness Index for Australia (ARIA version) score.
The NSW Perinatal Data Collection (PDC), formerly the NSW Midwives Data Collection (MDC), is a population-based surveillance system covering all births in NSW public and private hospitals, as well as homebirths. The PDC is a statutory data collection under the NSW Public Health Act 2010.
The PDC encompasses all live births, and stillbirths of at least 20 weeks gestation or at least 400 grams birth weight. Prior to 2006 the PDC encompassed all births of at least 20 weeks gestation or at least 400 grams birth weight. The data collection has operated since 1987 but with population coverage since 1990.
For every birth in NSW the attending midwife or medical practitioner completes a notification form (latest version for 2011: http://internal.health.nsw.gov.au/data/collections/mdc/NSWH%20Perinatal%20Data.pdf), or its electronic equivalent, giving demographic, medical and obstetric information on the mother and the condition of the infant. The PDC form was revised in 1998, 2006, 2011, and 2016.
There are several source systems that generate the PDC data. In 2018, 100% of PDC notifications were received electronically from public and private hospitals obstetric information systems. Electronically submitted records were received by secure upload to the state database. Historically, a proportion of records were received via completed paper forms that were submitted to the System Information and Analytics Branch of the NSW Ministry of Health, where they were compiled into the PDC database.
There are several electronic systems that generate the PDC data including ObstetriX, eMaternity, and Cerner in public hospitals and a variety of systems in private hospitals. ObstetriX is the most commonly used maternity information system in public hospitals in NSW.
Table 1. Perinatal Data Collection Notification Sources, NSW 2018
|Notification source||Local Health District or Hospital||
Per cent of PDC records 2018
All public hospitals in South Eastern Sydney, Illawarra Shoalhaven, Hunter New England, Nepean Blue Mountains and Western Sydney Local Health Districts, as well as some hospitals in Murrumbidgee, Southern NSW, Western NSW and Far West Local Health Districts for part of 2017.
|Cerner||Sydney and South Western Sydney Local Health Districts.||19.2|
|Meditech||Ramsay Private Hospitals - North Shore Private Hospital, Westmead Private Hospital, St George Private Hospital, Kareena Private Hospital and Wollongong Private Hospital.||7.6|
|Sydney Adventist Obstetric Information System||Sydney Adventist Hospital||1.8|
|Healthscope||Healthscope hospitals - Prince of Wales Private Hospital, Norwest Private Hospital, Sydney South West Private Hospital, Nepean Private Hospital and Newcastle Private Hospital||8.0|
|The Mater Hospital database||The Mater Hospital, North Sydney||2.2|
|eMaternity||All public hospitals in South Eastern Sydney, Illawarra Shoalhaven, Hunter New England, Nepean Blue Mountains and Western Sydney Local Health Districts, as well as some hospitals in Murrumbidgee, Southern NSW, Western NSW and Far West Local Health Districts for part of 2017.||59.0|
Note: The total from these sources is slightly below 100% as independent midwives and hospitals with small numbers of births report using PeriForm. These figures are not included.
The information sent to the NSW Ministry of Health is checked and compiled into one statewide dataset. One record is reported for each baby, even in the case of a multiple birth. The PDC includes notifications of births which occur in NSW which includes women whose usual place of residence is outside NSW and who give birth in NSW; it does not receive notifications of interstate births where the mother is resident in NSW. The collection is based on the date of birth of the baby. In 2018 there were a number of records with missing information that has resulted in a fluctuation in trends for analyses of subgroups.
Data are reported by calendar year. For this report, the PDC was accessed via SAPHaRI.
The Accessibility/Remoteness Index of Australia Plus (ARIA plus) is a remoteness index value (or score) based on road distance to major service centres (GISCA). In 2001, the Australian Bureau of Statistics (ABS) applied ARIA cut-off scores to define the Australian Statistical Geography Standard (ASGS) Remoteness Areas (ABS).
The service centre categories are based on population size, with the smallest centres in ARIA having populations of 1,000-4,999. Localities with populations greater than 1,000 persons are considered to contain at least some basic level of services (e.g. health, education, or retail) (GISCA). Service centres with larger populations are assumed to contain a greater level of service provision. ARIA scores are based over 20,000 such localities throughout Australia.
In HealthStats NSW, remoteness areas are classified as Major cities; Inner regional or Outer regional areas (these two are referred to as 'regional' when taken together); Remote and Very remote areas ('remote' when the last two are taken together). The term 'rural and remote' is used when referring generally to areas outside Major Cities.
In this report, increasing the size of areas considered is used for estimates in analysis by remoteness from service centres. Very remote areas are often amalgamated with Remote areas and occasionally Very remote, Remote and Outer regional areas are amalgamated. Notes under the graphs confirm the extent of amalgamation. Extending the period of time in which cases are counted is also used in some indicators presenting health data by ARIA.
Postal areas are grouped according to the Australian Statistical Geographical Standard (ASGS) remoteness categories on the basis of Accessibility/Remoteness Index for Australia (ARIA+ version) score. For reporting purposes, outer regional, remote and very remote areas are aggregated in order to report reliable estimates of a range of health behaviours for non-metropolitan areas.
Australian Bureau of Statistics (ABS). 1270.0.55.005 - Australian Statistical Geography Standard (ASGS): Volume 5 - Remoteness Structure. Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1270.0.55.005July%202011?OpenDocument
National Centre for Social Applications of Geographic Information Systems (GISCA). About ARIA (Accessibility/Remoteness Index of Australia). Available at http://gisca.adelaide.edu.au/projects/category/about_aria.html
Maternal Aboriginality is under–reported on the Perinatal Data Collection. One method of assessing the extent of under–reporting and monitoring changes over time is to compare the reporting of maternal Aboriginality to the Perinatal Data Collection with reporting of maternal Aboriginality on birth registrations held by the NSW Registry of Births, Deaths and Marriages. Using record linkage, an estimate of the total number of babies born to Aboriginal or Torres Strait Islander mothers was obtained and compared with the number of babies born to Aboriginal or Torres Strait Islander mothers as reported to the Perinatal Data Collection (Table 1 below). An estimate of the total number of babies born to Aboriginal or Torres Strait Islander mothers or fathers was also obtained and compared with the number of babies born to Aboriginal or Torres Strait Islander mothers as reported to the Perinatal Data Collection (Table 2 below).
The Aboriginality of the mother, rather than the baby, is reported to the PDC. Consequently, maternal Aboriginality was used for this analysis. The number of births reported to Torres Strait Islander mothers is quite small in NSW. Aboriginal and Torres Strait Islander mothers were therefore combined for this analysis.
Records of births reported to the PDC were linked to birth registration records of the NSW Registry of Births, Deaths and Marriages (RBDM) for births occurring in the 3–year period 2007–2009. Record linkage was carried out at the Centre for Health Record Linkage (www.cherel.org.au). The overall linkage rate was 91.3% of PDC records and 97.7% of birth registration records. Some births occurring in a given year are registered by the RBDM in subsequent years. Only births registered with RBDM up to 2010 were included in this analysis, resulting in the relatively lower rate of linkage of PDC records compared to birth registration records.
In estimating under-reporting of births in the PDC, a mother was accepted as Aboriginal or Torres Strait Islander where either the PDC or RBDM birth registration record indicated that the mother was Aboriginal or Torres Strait Islander. Analysis was carried out using SAS version 9.2. Analyses concerning geographic location were based on Local Health District of residence as reported to the PDC.
Reporting of Aboriginal and Torres Strait Islander peoples on population health and health-related datasets may be improved using record linkage, a process referred to as “enhanced” reporting. Methods for enhanced reporting have been described in detail elsewhere (PPHD 2012).
For NSW overall, the estimated percentage of births to Aboriginal or Torres Strait Islander mothers reported to the Perinatal Data Collection ranged from 74.2% to 84.4% between 2007 and 2009. In 2009, reporting varied markedly between Local Health Districts, ranging from 66.3% in the South Western Sydney Local Health District to 96.8% in the Mid North Coast Local Health District, with reporting generally better in rural compared to urban areas (Table 2 and Figure 2 below). The total number of babies born to Aboriginal or Torres Strait Islander mothers in 2009 is estimated to be 3,474, about 19% higher than the number reported to the Perinatal Data Collection. Under–reporting means that numbers of births presented in this chapter should be interpreted with caution.
Table 1 shows the number of babies born to Aboriginal or Torres Strait Islander mothers as reported to the Perinatal Data Collection (which collects Aboriginality of the mother only) and the number of babies born to Aboriginal or Torres Strait Islander mothers or fathers as reported to the NSW Registry of Births, Deaths and Marriages between 2007 and 2009.
The estimated percentage of births to Aboriginal or Torres Strait Islander mothers or fathers in NSW, that were registered in the Perinatal Data Collection as births to Aboriginal mothers ranged from 55.4% (in 2008) to 59.4% (in 2009) in the period between 2007 and 2009. In 2009, this under-estimating ranged from 43.5% in the Nepean Blue Mountains Local Health District to 73.0% of the true figures, in the Mid North Coast Local Health District. There are, therefore, substantial numbers of babies with non- Aboriginal or Torres Strait Islander mothers and Aboriginal or Torres Strait Islander fathers, who are not represented in the numbers reported in this chapter and numbers in Local Health Districts are affected differently.
|Year of birth–Local Health District||PDC births||RBDM births||"Births reported to both PDC/RBDM"||"Total estimated Aboriginal births"||Level of reporting|
|South Western Sydney||161||246||93||314||51.3|
|South Eastern Sydney||86||113||36||163||52.8|
|Nepean Blue Mountains||144||129||86||187||77|
|Hunter New England||661||537||406||792||83.5|
|Mid North Coast||149||95||87||157||94.9|
|South Western Sydney||174||255||108||321||54.2|
|South Eastern Sydney||59||200||41||218||27.1|
|Nepean Blue Mountains||148||126||90||184||80.4|
|Hunter New England||750||651||519||882||85|
|Mid North Coast||172||113||103||182||94.5|
|South Western Sydney||173||203||115||261||66.3|
|South Eastern Sydney||65||86||46||105||61.9|
|Nepean Blue Mountains||118||140||82||176||67|
|Hunter New England||664||558||460||762||87.1|
|Mid North Coast||184||122||116||190||96.8|
|Year of birth–Local Health District||PDC births||RBDM births||"Births reported toboth PDC/RBDM"||"Total estimated Aboriginal births"||Level of reporting|
|South Western Sydney||161||363||97||427||37.7|
|South Eastern Sydney||86||155||37||204||42.2|
|Nepean Blue Mountains||144||209||88||265||54.3|
|Hunter New England||661||848||417||1092||60.5|
|Mid North Coast||149||157||90||216||69|
|South Western Sydney||174||387||111||450||38.7|
|South Eastern Sydney||59||254||41||272||21.7|
|Nepean Blue Mountains||148||214||92||270||54.8|
|Hunter New England||750||969||524||1195||62.8|
|Mid North Coast||172||185||107||250||68.8|
|South Western Sydney||173||334||121||386||44.8|
|South Eastern Sydney||65||145||47||163||39.9|
|Nepean Blue Mountains||118||235||82||271||43.5|
|Hunter New England||664||887||469||1082||61.4|
|Mid North Coast||184||190||122||252||73|
Centre for Epidemiology and Evidence. New South Wales Mothers and Babies 2010. Sydney: NSW Ministry of Health, 2012. Available at http://www.health.nsw.gov.au/hsnsw/Publications/mothers-and-babies-2010.pdf
Population and Public Health Division. Improved reporting of Aboriginal and Torres Strait Islander peoples on population datasets in New South Wales using record linkage–a feasibility study. Sydney: NSW Ministry of Health, 2012. Available at http://www0.health.nsw.gov.au/pubs/2012/pdf/imprvd_report_pop.pdf
The current data collection form for the NSW Perinatal Data Collection (PDC) commenced in 2016. Codes are described in the NSW Perinatal Data Collection Manual - 2016 Edition, which is available on the internet at http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2015_025.pdf
In 2019 there were 95,133 births to 93,758 mothers in NSW, a decrease of 1.3% from 96,391 births in 2015. The percentage of multiple (twin and triplet) pregnancies has remained fairly stable over recent years at about 1.4%.
Between 2015 and 2019:
• The proportion of mothers who were teenagers continued to fall, from 2.5% to 1.7%.
• The proportion of births to mothers over 35 years of age has increased slightly from 23.4% to 25.9%.
• The rate of low birth weight (less than 2,500 grams) has remained stable, ranging from 6.4% to 6.8%.
• The perinatal mortality rate was 8.0 per 1,000 births in 2019, decreased from 8.2 per 1,000 births in 2015.
Aboriginal and Torres Strait Islander mothers and babies
Between 2015 and 2019:
• The number of reported births to Aboriginal or Torres Strait Islander mothers increased from 3,872 to 4,479, representing 4.0% and 4.7% respectively of all babies born in NSW.
• The percentage of Aboriginal or Torres Strait Islander mothers who were teenagers fell substantially from 15.4% to 10.5%.
• The perinatal mortality rate of 10.3 per 1,000 births in Aboriginal or Torres Strait Islander mothers in 2019 is higher than the rate of 7.9 per 1,000 births experienced among babies born to non-Aboriginal or Torres Strait Islander mothers.
• The percentage of Aboriginal or Torres Strait Islander mothers who commenced antenatal care before 14 weeks increased from 55.6% to 75.3%.
The health of Australian mothers and babies is generally good by world standards. Maternal deaths are rare, and perinatal mortality rates are low.
The average woman in NSW can currently expect to give birth to 1.9 babies in her lifetime.
NSW mothers are getting older with the mean maternal age at first birth around 29 years and at subsequent birth just over 30. The proportion of teenage mothers is declining.
Aboriginal mothers and babies, those from socioeconomically disadvantaged areas, and some overseas-born mothers and their babies continue to experience worse outcomes than other NSW mothers and babies.
The NSW Ministry of Health maintains two population-based surveillance systems that collect information concerning pregnancy and birth: the NSW Perinatal Data Collection and the NSW Register of Congenital Conditions. They assist in monitoring the health of mothers and babies, and maternity service planning in NSW.
The implementation of the NSW Aboriginal Maternal and Infant Health Strategy has improved access to culturally appropriate maternity services for Aboriginal mothers.
The NSW Maternal and Perinatal Mortality Review Committee reviews each death of a mother or newborn baby to assess the cause and identify any possible avoidable factors. This information is used to improve services for mothers and babies.
NSW Ministry of Health at http://health.nsw.gov.au, in particular see the annual New South Wales Mothers and Babies report, published by the Centre for Epidemiology and Evidence. The latest edition is available at http://www.health.nsw.gov.au/hsnsw/Publications/mothers-and-babies-2018.pdf
Australian Bureau of Statistics at http://www.abs.gov.au, in particular see Births (ABS Cat no 3301.0)
Australian Institute of Health and Welfare at http://www.aihw.gov.au in general and in particular the AIHW's National Perinatal Statistics Unit and the annual publication: Australia’s mothers and babies.
healthdirect at http://www.healthdirect.gov.au
Population and Public Health Division. Improved reporting of Aboriginal and Torres Strait Islander peoples on population datasets in New South Wales using record linkage–a feasibility study. Sydney: NSW Ministry of Health, 2012. Available at: http://www.health.nsw.gov.au/hsnsw/Publications/atsi-data-linkage-report.pdf
Australian Council on Healthcare Standards. Obstetrics Indicator User Manual. Sydney: ACHS. Available at: https://www.achs.org.au/
Data from the NSW Population Health Survey is used to measure the NSW State Government targets on reducing smoking in the population and is comparable with other sources of information on smoking in NSW.
• 11.2% of adults aged 16 years and over (12.1% of men and 10.2% of women) smoked daily in NSW in 2019 and 15.5% (18.0% of men and 13.1% of women) were current (daily or occasional) smokers. Estimates were produced from the NSW Adult Population Health Survey (self-reported using Computer Assisted Telephone Interviewing or CATI).
• 13.9% of NSW adults aged 18 years and over (17.0% of males and 10.9% of females) were daily smokers, as estimated from the 2017-18 National Health Survey (interviewer-administered questionnaire).
• 8.8% of mothers smoked during pregnancy in 2019, as reported to the NSW Perinatal Data Collection.
• 6.4% of students aged 12-17 years (7.0% of boys and 5.7% of girls) were current smokers, as estimated from the 2017 NSW School Students Health Behaviours Survey (self-completed questionnaire).
• 26.4% of Aboriginal adults aged 16 years and over smoked daily in NSW in 2018-2019 and 31.5% were current (daily or occasional) smokers. Estimates were produced from the NSW Adult Population Health Survey (self-reported using CATI).
• 43.2% of Aboriginal mothers smoked during pregnancy in 2019, as reported to the NSW Perinatal Data Collection.
Self-reported data on current smoking have been collected for adults in NSW since 1997 through the NSW Population Health Survey, since 1977-78 through the National Health Survey (from 1995), since 1985 through the National Drug Strategy Household Survey, and since 2011 through the Australian Health Survey.
Self-reported data on current smoking have been collected for students in NSW since 1984 through the NSW School Students Health Behaviours Survey.
Prevalence estimates, although differing slightly between surveys because of different sampling frames, participation rates and modes of collection (telephone, self-completed questionnaires, face-to-face personal interview and drop-and-collect), have all been decreasing over time.
A total of 62,930 hospitalisations were attributed to smoking in NSW in 2018-19, which was approximately 2.0% of all hospitalisations.
The rate of hospitalisations attributable to smoking decreased in males by nearly 36%, compared to a 15% decrease among females in NSW between 2001-02 and 2018-19. Rates have stabilised in recent years.
The rate of hospitalisations attributable to smoking increased in both Aboriginal males and Aboriginal females by 32% aand 24% respectively in the period between 2009-10 and 2018-19.
A total of 6,702 deaths were attributed to smoking in NSW in 2018, which was 12.5% of all deaths in 2018. In 2018, the rate of deaths attributable to smoking in males and females was 84.2 and 50.3 deaths per 100,000 population, respectively.
Australian Institute of Health and Welfare. National Drug Strategy Household Survey report. Available at: https://www.aihw.gov.au/about-our-data/our-data-collections/national-drug-strategy-household-survey
Australian Bureau of Statistics. National Health Survey: First Results, 2017-18. Available at: https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~2017-18~Main%20Features~New%20South%20Wales~10002
Tobacco smoking is one of the biggest causes of premature death and is a leading preventable cause of chronic disease in New South Wales. It is a major risk factor for cardiovascular disease, a range of cancers, chronic obstructive pulmonary disease, coronary heart disease and a variety of other diseases and conditions. Approximately one in five of all cancer deaths are due to tobacco smoking.
There is a no safe level of exposure to second-hand tobacco smoke. In adults, breathing second-hand smoke can increase the risk of heart disease, lung cancer and other lung diseases. It can worsen the effects of existing illnesses such as asthma and bronchitis. For children, inhaling second-hand smoke is even more dangerous. Children are more likely to suffer health problems due to second-hand smoke such as bronchitis, pneumonia and asthma.
Australia has one of the most comprehensive tobacco control policies and programs in the world. The aim of the tobacco control programs in NSW is to contribute to a continuing reduction of smoking prevalence rates in the community.
Information on NSW Health tobacco and smoking control programs and policies is available at: http://www.health.nsw.gov.au/tobacco.
Cancer Institute at: https://www.cancerinstitute.org.au/
I Can Quit at http://www.icanquit.com.au
Information on NSW Health programs and policies is available at http://www.health.nsw.gov.au/tobacco.
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
I Can Quit at http://www.icanquit.com.au