Reproductive Health Indicators Australia 2002
Reproductive Health Indicators Australia, 2002 is the first national report on the reproductive health of men and women in Australia. It provides comprehensive information on forty-four indicators covering fertility, subfertility, family planning, pregnancy, childbirth, sexually transmissible infections and cancers of the reproductive tract. This report is an important reference and information source for all Australians with an interest in reproductive health.
The Reproductive Health Indicators, Australia, 2002
report was commissioned by the Department of Health and Ageing to provide an accessible, systematic overview of Australia's reproductive health. This report was administered by the Australian Institute of Health and Welfare (AIHW) National Perinatal Statistics Unit, and represents the collaborative efforts of a number of professional, research, policy and consumer groups.
This inaugural report uses a set of reproductive health indicators to provide a synthesis of findings on a broad range of reproductive health topics. The set of indicators adopted for this report provides an overall 'picture' of Australia's reproductive health and highlights a number of important emerging reproductive health issues and trends. An assessment of the data sources currently available to measure reproductive health in Australia is also provided, setting the agenda for the formation of a comprehensive framework and integrated national surveillance system for Australia's reproductive health. This report will no doubt be an important reference for clinicians, policy makers and consumers alike.
Reproductive health is of central importance to people's lives and is fundamental to what it means to be human. The importance of reproductive health is being increasingly recognised at an individual, societal and global level. The issues it encompasses are different for men and women and change over a person's lifetime. Definitions of reproductive health vary, but for the purposes of this report, encompass the reproductive and sexual health of men and women during their reproductive lives, and includes reproductive outcomes such as fertility, pregnancy, childbirth, and diseases of the reproductive tract. In this report reproductive health is also reflected and measured by the physiological, behavioural and health-care factors that are important determinants of reproductive health.
The primary objectives of this inaugural report on Australian reproductive health indicators are:
- to provide a snapshot of Australia's reproductive health status, by systematically measuring a set of reproductive health indicators. This enables risk and protective factors relevant to reproductive health to be highlighted, and provides a basis from which international and sub-population comparisons can be made;
- to provide base lines for prospective measurement and monitoring of Australia's reproductive health. The indicators presented in this report will act as a benchmark against which future analyses of reproductive health will be measured;
- to provide a comprehensive and cohesive description of currently available information sources for measuring Australia's reproductive health. An assessment of the usefulness and value of each data source is provided, and further information requirements explored;
- to provide a foundation from which a comprehensive conceptual and information framework on reproductive health can be developed.
There are many indicators that can be used to measure the reproductive health status of a population. The indicators chosen in this report are based upon a subset of indicators developed by the World Health Organization (WHO) (WHO 1999), customised for the Australian context. Forty-four indicators where chosen for inclusion in the report, covering six key areas: fertility, subfertility, sexually transmissible infections, cancers of the reproductive tract, family planning and pregnancy and childbirth (including prenatal/antenatal health factors, pregnancy and assisted conception, childbirth, maternal health outcomes and fetal and infant health outcomes).
Each of the 44 indicators is presented in a clear two-page format, which includes definition, context, data sources and relevant measures. Where possible, disaggregation by age, sex, geographical location and other appropriate categories has been performed to provide an insight into the health status of various sub-populations.
Australia compares well in a world context of reproductive health. In 1999, the crude birth rate in Australia was 13.1 per 1,000 population, and the total fertility rate was 1.75, which is comparable to countries such as the United Kingdom, United States, Canada, France, Sweden and Japan (ABS 2000a; UNPD 2000). In the same year, the national caesarean rate in Australia was almost 22%, the highest level ever recorded in Australia (AIHW National Perinatal Statistics Unit perinatal collection), and the vaginal birth after a caesarean section rate was almost 25%. These rates are comparable to other more developed countries; however the WHO recommends a figure of 15% as a reasonable national rate for caesarean section (Caan & Messent 2002; Eberhardt et al. 2001; WHO 1985).
The infant mortality rate in 1999 was 5.7 per 1,000 live births compared with 8 per 1,000 live births among the more developed countries monitored by WHO (ABS 2000b; UNPD 2000; Moon, Rahman & Bhatia 1998). The proportion of low birthweight infants in Australia was 7% of all births, which is similar to that of other developed nations (UNPD 2000).
Approximately 750 and 1,200 women were diagnosed with cervical and ovarian cancer respectively in 1997. Incidence and mortality rates for cervical cancer have declined over the previous decade, due partly to population-based cervical screening, while the incidence and mortality rates for ovarian cancer have remained relatively constant (AIHW & AACR 2000). The incidence and mortality rates for these cancers are similar to other English-speaking developed countries (IARC/WHO 2001).
The data used in this report come from a variety of sources, ranging from national population-based data to small community-based studies. The four principal national data sources were the AIHW National Hospital Morbidity Database, the AIHW National Perinatal Data Collection, Health Insurance Commission data and Australian Bureau of Statistics data. A detailed description and assessment of each of these data sources and other important secondary data sources is included.
A key finding of this report is that there is a need to strengthen the quality, breadth and cohesiveness of information available on reproductive health in Australia. Almost half the indicators presented in this report were considered incomplete (21: 48%), primarily because of a lack of national data and/or State- and Territory-based data. While comprehensive data on fertility rates, birth rates and cancers are available, other indicator areas such as maternal morbidity, infertility and family planning generally reflect a lack of standardised definitions and data collection tools. This assessment serves to emphasise that significant gaps remain in our knowledge of reproductive health.
This report supports the need for the development of a national conceptual and information framework for reproductive health. Such a framework must include a clear and accepted definition of reproductive health, a conceptual model of reproductive health, a list of core reproductive health indicators, and a plan for a comprehensive and cohesive surveillance and performance measurement system. The selection of the 44 core indicators and the identification and evaluation of currently available reproductive health data sources provides an invaluable foundation from which to advance the understanding and measurement of reproductive health for the benefit of all Australians.