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Objectives An accurate picture of infant mortality informs society of its social progress. It is a key indicator of how effective public health policies and programs are in caring for the most vulnerable in our society. Currently, at the population level, Victorian data on Aboriginal and Torres Strait Islander births and deaths are excluded from Australian vital statistics. The Victorian Aboriginal Mortality Study aimed to provide a more complete and accurate population profile of Aboriginal births in Victoria using population data linkage of Victorian statutory and administrative datasets. Approach Two population statutory datasets, the Victorian Perinatal Data Collection (VPDC) and Victorian Registry of Births, Deaths and Marriages (RBDM) were linked, using probabilistic matching with mother’s name and surname, child’s date of birth and sex, for all births that occurred in Victoria between 1988 and 2008, inclusive to more accurately ascertain births to mothers and fathers who identified as Aboriginal and/or Torres Strait Islander (hereafter respectfully ‘Aboriginal’). Results Over 1.34 million files, reporting births between 1988 and 2008, were linked. However, due to data integrity issues for Indigenous identification prior to 1998, the years between 1999 and 2008 only were used in the development of the birth cohort. Matching the VPDC with the RBDM resulted in identifying an additional 4,333 live births where mother and/or father identified as Aboriginal, representing an 87% increase in the number of births previously recorded as Aboriginal by the VPDC*. The largest increase (186%) in the number of births where mother and/or father identified as Aboriginal births was observed within the Victorian metropolitan areas. Conclusion This is the first time that the VPDC and RBDM birth data were linked in Victoria. The matched birth information established a more complete population profile of Aboriginal and/or Torres Strait Islander births. These data will provide a more accurate baseline to enhance the Victorian and Australian governments’ ability to plan services, allocate resources and evaluate funded activities aimed at eliminating disparity experienced by Aboriginal and/or Torres Strait Islander peoples. Importantly, it has established a more accurate denominator from which to calculate Aboriginal infant mortality rates for Victoria, Australia. *Until 2009, the mother’s Indigenous identification only was recorded in the VPDC

OBJECTIVE: To review Indigenous infant mortality, stillbirth, birth weight, and preterm birth outcomes in Australia, Canada, New Zealand and the United States. METHODS: Systematic searches of published literature and a review and assessment of existing perinatal surveillance systems were undertaken. Where possible, within country comparisons of Indigenous to non-Indigenous birth outcomes are included. RESULTS: Indigenous/non-Indigenous infant mortality rate ratios range from 1.6 to 4.0. Stillbirth rates, where data are available, are also uniformly higher for Indigenous people. In all four countries, the disparities in Indigenous/non-Indigenous infant mortality rate ratios are most marked in the post-neonatal period. With few exceptions, the rates of leading causes of infant mortality are higher among Indigenous infants than non-Indigenous infants within all four countries. In most cases, rates of small for gestational age and preterm birth were also elevated for Indigenous compared to non-Indigenous infants. CONCLUSIONS: There are significant disparities in Indigenous/non-Indigenous birth outcomes in Australia, Canada, New Zealand and the United States. These Indigenous/non-Indigenous birth outcome disparities fit the criteria for health inequities, as they are not only unnecessary and avoidable, but also unfair and unjust.

Objective To examine health outcomes in Australian Aboriginal and Torres Strait Islander children experiencing perinatal risk and identify protective factors in the antenatal period. Methods Baby/Child cohorts of the Longitudinal Study of Indigenous Children, born 2001–2008, across four annual surveys (aged 0–8 years, N = 1483). Children with ‘mild’ and ‘moderate-to-high’ perinatal risk were compared to children born normal weight at term for maternal-rated global health and disability, and body-mass-index measured by the interviewer. Results Almost one third of children had experienced mild (22%) or moderate-to-high perinatal risk (8%). Perinatal risk was associated with lower body-mass-index z-scores (regression coefficients adjusted for pregnancy and environment factors: mild = -0.21, 95% CI = -0.34, -0.07; moderate-to-high = -0.42, 95% CI = -0.63, -0.21). Moderate-to-high perinatal risk was associated with poorer global health, with associations becoming less evident in models adjusted for pregnancy and environment factors; but not evident for disability. A range of protective factors, including cultural-based resilience and smoking cessation, were associated with lower risk of adverse outcomes. Conclusions Perinatal risks are associated with Australian Aboriginal and Torres Strait children experiencing adverse health particularly lower body weight. Cultural-based resilience and smoking cessation may be two modifiable pathways to ameliorating health problems associated with perinatal risk.