Malta reported the highest rate of total neo-natal mortality (until 28 days of life) due to congenital anomalies, with 2.3 deaths per 1,000 live births. This may be explained by the fact that induced abortion for foetal anomalies is illegal in Malta.

The Department of Health Information and Research yesterday announced the release of the ‘European perinatal health report’ (EPHR). This document was developed as part of an EU project and presents a comprehensive overview of perinatal (the period immediately before and after birth) health in 25 member states of the European Union and Norway. Malta has participated actively in the development of this report which is based on 2004 data.

The report describes the various surveillance systems and data sources related to perinatal health available in EU member states. Relevant data for Malta has been provided by the Department of Health Information and Research through the National Obstetrics Information System (NOIS), the National Mortality Register and the Malta Congenital Anomalies Register. For further details about this report you can access the NOIS (National Obstetrics Information System) website on http://www.sahha.gov.mt/pages.aspx?page=92 .

Malta had the smallest annual number of births reported from all the participating countries. Small number of events, especially rare events, makes comparisons with other countries difficult. Another difficulty when making country comparisons is the fact that in Malta induced abortion for foetal anomalies is illegal and thus infants with potentially fatal conditions will reach delivery and pass away soon after birth. This has the effect of increasing foetal, neonatal (first month after birth) and infant (up to one year of age) mortality and morbidity rates, and also the induction and operative delivery rates.

Childbearing in both the lower and higher maternal age groups is associated with an increased risk of pre-term birth, growth restriction and mortality in the perinatal period. Malta has a teenage delivery rate of 5.8 per cent of all women delivering. It ranges from 1.3 per cent in Denmark to 9.3 per cent in Latvia. These variations reflect different cultures and practices. A total of 11.7 per cent of women were registered as delivering at 35 years or older in Malta. This rate ranged from 7.5 per cent in Slovakia to 24.3 per cent in Ireland.

Smoking during pregnancy has been associated with foetal growth restriction, pre-term birth and perinatal death. 7.2 per cent of women in Malta reported smoking during pregnancy. This is a comparatively low rate and may be an underestimate as many women are reluctant to report smoking habits at their antenatal visits when this information is collected. The highest rate reported was 22 per cent for Wales and the lowest was 4.8 per cent for Lithuania.

Pregnancy and childbirth is a natural process and should require minimal medical intervention. Rates of induced labour and caesarean section in developed countries have increased in the last decade. Both procedures are associated with risks for the mother and foetus and provide an indicator of obstetric practice.

The rate of vaginal non-instrumental births in Malta was 67.8 per cent of total births. This rate varied in the different countries ranging from 82.8 per cent in Slovenia to 53.8 per cent in Portugal. 3.8 per cent of total births were instrumental vaginal deliveries including forceps, ventouse and breech extractions while the rest (28.3 per cent) were births by caesarean section.

The highest caesarean section rate was reported from Italy at 37.8 per cent of total births, followed by Portugal (33.1 per cent), Ireland (29.5 per cent) and Malta (28.3 per cent). The lowest rate was reported from Slovenia at 14.4 per cent.

85.4 per cent of births in Malta occurred in a large maternity unit catering for over 3,000 births per year while 14.5 per cent of births occurred in small maternity units catering for less than 300 births per year.

Breastfeeding is considered of benefit to babies in terms of both nutrients and resistance to infection. The rate of newborns breastfed during the first 48 hours was reported as 68.4 per cent for Malta. Four countries reported lower rates: Ireland (45.6 per cent), France (62.3 per cent), Northern Ireland (63.0 per cent) and Wales (67.0 per cent). The highest rate of breast feeding in the first 48 hours was reported from Sweden at 97.9 per cent.

Maternal deaths are rare events in all EU countries. Malta did not register any maternal deaths in 2003 or 2004.

The neonatal mortality (number of deaths up to 28 completed days of birth) was 4.4/1000 live births for Malta (highest 5.7 for Latvia and lowest 1.6 for Cyprus). Most neonatal deaths are associated with pre-term birth and congenital anomalies. As Malta does not allow induced abortion for foetal anomalies, it is understandable that neonatal mortality rates will be increased.

Infant mortality (number of deaths following live birth and until one year of age) for Malta was reported at 5.9/1000 live births (highest 9.4/1000 live births for Latvia and lowest 3.0/1000 live births for Sweden and Norway).

Malta reports the highest rate of total neonatal mortality (until 28 days of life) due to congenital anomalies (2.3/1000 live births). This may be explained by the fact that induced abortion for foetal anomalies is illegal in Malta. The percentage of early neonatal deaths (until 7 days of life) due to congenital anomalies is also high at 41.7 per cent. This is followed by Ireland at 40.1 per cent.

The EPHR is a first attempt at bringing together standardised perinatal health indicators for Europe. It has proven that it is feasible to collect such indicators and will hopefully act as a catalyst for resourcing ongoing perinatal health indicator data collection and reporting across Europe.

The Department of Health Information and Research said it acknowledged the important contribution of all data providers to the National Obstetrics Information System (NOIS) register, who provide data on a voluntary basis and without whose co-operation such work would not be possible. The National Mortality Register and Malta Congenital Anomalies Register have also provided important data towards the compilation of this European Perinatal Health Report.