Safer Baby Bundle: Australia Program Reduces Stillbirth & Perinatal Mortality

Australia’s national stillbirth prevention program, the Safer Baby Bundle, is showing promising results in reducing both stillbirths and perinatal mortality, according to the first comprehensive analysis of its impact. The program, comprised of evidence-based clinical guidelines and educational resources, aims to equip healthcare providers and expectant mothers with the knowledge and tools to prevent the tragedy of stillbirth.

In Australia, the statistics are sobering: more than six babies are stillborn each day, and an additional two die within the first 28 days of life. In 2022 alone, over 3,000 perinatal deaths occurred, representing approximately one percent of all births. The Safer Baby Bundle represents a concerted effort to improve these outcomes.

Early Results from Victoria Show Encouraging Trends

Researchers from the Hudson Institute of Medical Research, Monash University, and Monash Health recently evaluated the Bundle’s impact in Victoria, Australia. Their findings, published in a series of three papers in the Australian and New Zealand Journal of Obstetrics and Gynaecology, offer a cautiously optimistic outlook.

The research team, led by Dr. Keeth Mayakaduwage and Associate Professor Miranda Davies-Tuck, investigated whether the Safer Baby Bundle reduced stillbirth and perinatal mortality rates, altered the underlying causes of perinatal death, and ensured equitable benefits across different population groups.

The analysis compared outcomes before (January 2014 – June 2019) and after (July 2019 – December 2020) the implementation of the Safer Baby Bundle, focusing on singleton births of at least 28 weeks gestation. Congenital anomalies and terminations were excluded from the study.

The results demonstrated a trend toward reduced stillbirth rates in hospitals that adopted the Safer Baby Bundle, moving from 2.08 to 1.64 per 1000 births (relative risk: 0.79, 95% confidence interval: 0.62-1.00, p = 0.05). More significantly, a statistically significant reduction in perinatal mortality was observed in these same hospitals, decreasing from 2.52 to 2.02 per 1000 births (relative risk: 0.80, 95% confidence interval: 0.65-0.99, p = 0.041). Importantly, hospitals that did not implement the Bundle showed no significant changes in either stillbirth or perinatal mortality rates.

Dr. Mayakaduwage emphasized that the implementation of the Safer Baby Bundle was associated with a reduction in preventable deaths “without an increase in unintended harms such as cesarean section, induction of labor, preterm birth, or neonatal intensive care admission.”

Further analysis revealed that stillbirths attributed to unexplained causes and specific perinatal conditions declined in hospitals utilizing the Safer Baby Bundle, suggesting improvements in the identification and management of fetal risk factors during pregnancy.

Equity Concerns Remain

Despite the overall positive trends, the study also highlighted disparities in the program’s impact. While the Safer Baby Bundle demonstrated benefits for the overall population, these benefits were not consistently experienced across all demographic groups. Specifically, no improvement was observed among several migrant groups, and, concerningly, perinatal mortality rates actually increased among Indigenous women during the study period.

Associate Professor Davies-Tuck underscored the importance of addressing these inequities, stating that “stillbirth reduction is achievable at scale, while also highlighting that universal programs may not benefit all populations equally if they are not culturally tailored.”

Adapting the Bundle for Diverse Communities

Recognizing the need for culturally sensitive approaches, the Centre of Research Excellence in Stillbirth has adapted the Safer Baby Bundle for both Indigenous women and migrant and refugee communities in Australia. This adaptation process involved a collaborative co-design approach, developed in partnership with these communities to ensure relevance and effectiveness.

Professor Euan Wallace AM, Chief Research and Innovation Officer at Monash Health, added that the research “shows that a structured, system-wide approach can reduce preventable deaths while maintaining safety for mothers and newborns. Importantly, it also identifies populations who did not experience these benefits.”

Dr. Mayakaduwage noted that the current evaluation predates the rollout of these culturally adapted versions of the Bundle, and ongoing evaluations will be crucial to determine whether these adaptations lead to improved outcomes and greater equity for these underserved groups.

The Safer Baby Bundle emphasizes the importance of identifying at-risk babies earlier, responding appropriately to warning signs, and providing timely, evidence-based antenatal care. As the program continues to evolve and adapt, it holds the potential to significantly reduce the devastating impact of stillbirth and improve perinatal outcomes for all Australian families.

More information:

Keeth L. B. Mayakaduwage et al, Reducing Perinatal Mortality in Victoria, Australia: Early Insights From the Safer Baby Bundle Implementation, Australian and New Zealand Journal of Obstetrics and Gynaecology (2025). DOI: 10.1111/ajo.70082

Keeth L. B. Mayakaduwage et al, Impacts on Causes of Perinatal Death After Safer Baby Bundle Implementation in Victoria, Australia, Australian and New Zealand Journal of Obstetrics and Gynaecology (2025). DOI: 10.1111/ajo.70084

Keeth L. B. Mayakaduwage et al, Reach and Impact of the Safer Baby Bundle Among Groups Disproportionately Affected by Stillbirth in Victoria, Australia, Australian and New Zealand Journal of Obstetrics and Gynaecology (2025). DOI: 10.1111/ajo.70085