Original Article The impact of the baby bonus on maternity services in New South Wales Samantha J. LAIN, 1 Christine L. ROBERTS, 1 Camille H. RAYNES-GREENOW 1 and Jonathan MORRIS 2 1 Perinatal Research Group, Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, and 2 Department of Obstetrics, Royal North Shore Hospital, St Leonards, New South Wales, Australia Background: In 2004, the Federal Government introduced the baby bonus, a one-off payment upon the birth of a child. Aims: To assess the impact of an increase in the number of births on maternity services in New South Wales following the introduction of the baby bonus payment in July 2004. Methods: A population-based study, using NSW birth records, of 965 635 deliveries from 1998 to 2008 was carried out. The difference between the predicted number of births in 2005–2008, estimated from trends in births from 1998 to 2004, and the observed number of births in NSW hospitals in 2005–2008 were calculated. We also estimated the increase in cost to the health system of births in 2008 compared with previous years. Results: Compared with trends prior to the introduction of the baby bonus, there were an estimated 11 283 extra single- ton births per year in NSW hospitals by 2008. There were significant increases in the number of deliveries performed in tertiary, urban and rural public hospitals; however, the number of deliveries in private hospitals remained stable. Com- pared with predicted estimates, in 2008, there were over 8700 more vaginal deliveries, over 1000 more preterm births and over 45 000 extra infant hospital days each year. Compared with 2004, in 2008, the estimated cost of births in NSW hospitals increased by $60 million, Conclusions: The increase in births following the introduction of the baby bonus has significantly impacted maternity ser- vices in NSW. Key words: Australia, health policy, health services research, obstetrics, population-based study. Introduction The baby bonus, a cash payment introduced in 2004 by the Australian federal government to increase fertility, has attracted media attention and public debate over its merits. An increase in births in Australia has been reported since 2004. 1 In New South Wales (NSW), following the introduc- tion of the baby bonus, there was an increase in births to women having their third child or higher and the reversal of a downward trend in births to teenagers. 2 The impact of the baby bonus on birth rates has been evaluated, but not the subsequent effect on the healthcare system. Media reports have claimed that an increase in births has placed more pres- sure on maternity services 3 and births have been shifted to local hospitals to reduce the pressure on tertiary hospitals. 4 The aim of this study was to determine the impact of the baby bonus on the NSW health system, by measuring the increase in absolute numbers of patients utilising maternity and newborn services and the corresponding increase in costs. Methods The study population included all women who gave birth in NSW from 1 January 1998 to 31 December 2008. Data were obtained from the NSW Midwives Data Collection (MDC), a legislated population-based surveillance system of all births in NSW of ‡20-week gestation or a baby ‡400 g birth weight, including stillborns. We examined trends in the number of women giving birth (referred to as births) from 1998 to 2008 for a number of factors relating to pregnancy and childbirth, including mode of delivery, hospital type, the number of women receiving regional analgesia or anaesthesia (either epidural, spinal or combined spinal-epidural), the number of third- or fourth-degree perineal tears, the number of preterm births, newborn admissions to a special care nursery or neonatal intensive care unit and total newborn days of stay at the birth hospital. Hospital type was classified into four groups: tertiary, urban (non-tertiary), rural and private hospitals. A validation study comparing the MDC with hospital medical records found that all but one of the Correspondence: Ms Samantha J. Lain, Research Officer, Perinatal Research Group, Kolling Institute of Medical Research, University of Sydney, c ⁄ - Level 2, Building 52, Royal North Shore Hospital, St Leonards, NSW 2065, Australia. Email: samlain@med.usyd.edu.au Received 10 September 2009; accepted 27 November 2009. Ó 2010 The Authors 25 Journal compilation Ó 2010 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Australian and New Zealand Journal of Obstetrics and Gynaecology 2010; 50: 25–29 DOI: 10.1111/j.1479-828X.2009.01126.x he Australian and New Zealand Journal of Obstetrics and Gynaecology