Michelle Ananda-Rajah (Higgins, Australian Labor Party) Share this | Hansard source

I'd like, firstly, to thank the member for Werriwa and the other members for sharing their stories today. I must say I'm profoundly affected by this discussion, because it has dredged up, even in me, trauma from many years ago relating to pregnancy loss. What I would say is that all pregnancy losses are devastating. It is a hidden tragedy and a taboo associated with a stigma which we in this House are striving to dispel, and today it starts. The mental health effects are profound. They range from depression and anxiety to PTSD, relationship breakdown and strain, and a loss of productivity. The impacts are wide, and they reverberate through the ages. Even many years after my own pregnancy loss, I'm still so badly affected, because I remember how profoundly alone I was in that loss. I really felt that no-one could reach me.

Miscarriage is very common, as you all know. It affects at least one in five women with a known pregnancy. It is defined as occurring before 20 weeks gestation. Stillbirth, on the other hand occurs after 20 weeks. It's less common but affects six in 1,000 live births in Australia. That means that every day around six babies are stillborn. It's just devastating.

In many a case, we don't know what causes these terrible, terrible outcomes. We think that they may be due to genetic or congenital abnormalities or other types of maternal conditions—things that are known, like gestational diabetes, pre-eclampsia or smoking. But, even for those 20 to 45 per cent of families who do not know what has caused this, it is absolutely devastating. They're left not knowing, absolutely bewildered, like deer in headlights in the aftermath of this grief, which can be all-encompassing and can engulf them.

Stillbirths—like many health conditions, as you know—track with disadvantage. In my maiden speech, I talked about the social determinants of health, something that I'm very familiar with as a doctor: poor education, social isolation, poverty, racism and unemployment. The rate of stillbirth in the general population is around six to seven per 1,000, but it is much higher for Aboriginal and Torres Strait Islander people, at nine per 1,000. For women from migrant or refugee groups, it's higher still. For women living in outer regional areas, it's 7.5 per 1,000. For women in remote Australia, it's 14 per 1,000. That's double the average rate. For women younger than 20 years, again it is 14 per 1,000. It's unacceptably high.

We know that up to a third of stillbirths can be prevented if optimal care is provided. I would like to commend the previous government for their National Stillbirth Action and Implementation Plan. We have accepted all of those findings, and I look forward to seeing this actually coming to fruition. I would say that there are certain interventions that do work, and it's important we talk about them, because we can all be ambassadors for these interventions: encouraging smoking cessation—very important; improving the detection and management of impaired fetal growth; encouraging women to understand babies' movements—fetal movement is a really important but subtle sign that can be missed; and avoiding sleeping on your back, particularly in the latter stages of pregnancy, mainly because it impairs blood flow. It squashes the big vessels in the back.

All of the above can, of course, be addressed with really good antenatal care, and we have excellent antenatal care in Australia, but it's poorly accessed in a lot of parts of Australia because we are a big, wide land. We know that this is a problem particularly for First Nations women. Only 63 per cent of them in 2017 accessed antenatal care. That just seems extraordinarily low for a First World country.

I would say also that education shouldn't just stop with women; it needs to be extended to health professionals like me. I'm not an obstetrician, and it was really this talk which gave me the opportunity to do a deep dive and try to fully understand some of the factors. But we need to multiply this across the whole medical profession so that everyone understands what's going on.

I would say, finally, that we need better research to understand the causes of stillbirth, because the trauma can persist for decades. This is why it is important that we have excellent grief counselling that is of high quality and timely so that we can mitigate the impacts on families and their loved ones for years to come.

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