Maternal Deaths Due to Suicide, Accidental Poisoning and Undetermined Intent Within 5 Years Following Childbirth: A Population-Based Study

Objectives: Investigate the incidence of maternal deaths by suicide, accidental poisoning and undetermined intent within 5 years following childbirth. Design: Linked population-level data. Setting: New South Wales, Australia. Population: All women who gave birth from 2002 to 2020. Methods: Sociodemographic characteristics, diagnostic and healthcare use were compared between deceased mothers and mothers alive for 5 years following childbirth. Relative Risk Ratios (RRRs) were examined using multinomial logistic regression. Main Outcome Measures: Deaths by suicide, undetermined intent and accidental poisoning. Results: Five-year death rates per 100 000 live births were 12.87 for suicide, 10.49 for accidental poisoning, 2.30 for undetermined intent and 25.66 for the three causes and remained stable over the study period. Deaths due to the abovementioned causes accounted for 21.75% of all deaths within 5 years after live birth, slightly increased as a proportion of all deaths compared to the early period, between 2002 and 2009. Compared to mothers who were alive 5 years postpartum, mothers who died by suicide, accidental poisoning and undetermined intent were more likely to be younger (age ≤ 24) (25% vs. 9%), Australian born (80+% vs. 65%), and identify as First Nations background (12+% vs. 2.3%). The RRRs were significantly higher for alcohol (ranged 15–27), substance use (ranged 12–69), mental health (ranged 9.5–14) and self-harm (ranged 20–34), related hospitalisations among mothers who died by suicide, accidental poisoning and undetermined intent compared to mothers alive for 5 years. Conclusion: Suicide, undetermined intent and accidental poisoning accounted for more than one in every five maternal deaths within 5 years postpartum.