To advance and promote the discipline and professional practice
of public health epidemiology in Ontario

Multiple Birth Rate Core Indicator

  • The ratio of births following a multiple gestation pregnancy per total births

Method of Calculation

Multiple Birth Rate
total number of multiple births (live births & stillbirths)
total number of births (live births & stillbirths)
Multiple Live Birth Rate
total number of multiple live births
total number of live births

Recommended Subset Analysis Categories

Multiple Births
  • all twins
  • triplets
  • quadruplets
  • quintuplets
  • and higher-order births
Multiple Live Births

Mother's Age

Gestational Age

Geographic Areas of Patient Residence
  • Ontario , public health unit, municipality, and smaller areas of geography based on aggregated postal code.
  • TA data does not contain postal code.
  • BORN data: Ontario, public health unit

Data Sources

Numerator & Denominator: Option 1
Numerator & Denominator: Option 2 
Numerator & Denominator: Option 3

Original Source:

Vital Statistics, Office of Registrar General (ORG), Service Ontario

Distributed by:

Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH Ontario (IntelliHEALTH)

Suggested Citation:

Ontario Vital Statistics Live Birth Data [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].

Original Source:

Discharge Abstract Database (DAD), Canadian Institute for Health Information (CIHI)

Distributed by:

Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH Ontario (IntelliHEALTH)

Suggested Citation:

Inpatient Discharges [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].

Original Source:

Better Outcomes Registry Network (BORN) Ontario

Distributed by:

Better Outcomes Registry Network (BORN) Ontario

Suggested Citation:

BORN Information System [years], Date Extracted: [date].

Analysis Checklist  

  • The IntelliHEALTH licensing agreement does not require suppression of small cells, but caution should be used when reporting at a level that could identify individuals, (e.g. reporting at the postal code level by age and sex). Please note that privacy policies may vary by organization. Prior to releasing data, ensure adherence to the privacy policy of your organization.
  • Aggregation (e.g. combining years, age groups, categories) should also be considered when small numbers result in unstable rates.
  • Exclude births to mothers that reside out-of-province. Births to Ontario mothers that occur out-of-province are not included in the data.
  • Include all births, not just those for mothers aged 15-49 years.
  • Include live births with birth weight <500 g. For more information, refer to the Reproductive Health Core Indicators Documentation Report. 
  • HELPS Data: Historically, PHUs obtained data for live births, stillbirths, therapeutic abortions, congenital anomalies, and deaths from the Ministry of Health through HELPS (the HEalthPlanning System). Although these data are no longer commonly used, some PHUs may still be accessing these data files. Information about the data can be found in the HELPS Data Source resource.

Vital Statistics
  • In IntelliHEALTH under Standard Reports, folder "01 Vital Stats", open "Birth Summary V2". This report summarizes information on births by age group and mother's residence (Ontario, PHU and LHIN). IntelliHEALTH also provides population data (total population, female population aged 15-49 years) for the calculation of rates. Refer to the Notes tab for information. Open tab "1.2 Births x PHU x Type x Age" to obtain public health unit data and tab "1.1 ON Births x Type x Age" to obtain Ontario data. The report can be modified, renamed and saved under your own folder or can be exported into Excel.
  • The predefined report provides live birth and population data for the calendar years from 2000 to the most recent available. Table options can be edited to change the number of years of data presented. For years that are not displayed modify the calendar year filter to include the required years.
  • The live birth summary table includes births to age groups less than 15 and older than 49 years of age. Include only births to females 15-49 years of age.
  • The data contained in the Birth Summary V2 report includes births to Ontario mothers in Ontario only.
  • The notes section of the report provides important data caveats and information and should be consulted.
  • Refer to the Vital Statistics Live Birth Data Source and Vital Statistics Stillbirth Data Source for more information about the data.

  • Under the Inpatient Discharge Main Table data source from the ‘05 Inpatient Discharges' folder, use the "Hospital births x births, delivery type" predefined report. This report can be modified, renamed and saved under your own folder.
  • The report provides hospital birth counts (Admit Entry Type = N for Newborn or S for Stillbirth) for Ontario and by PHU, including only Ontario residents (Patient Province equal to ON).
  • The calendar year for date of admission is used (Admit CYear) rather than date of discharge since the date of admission will be the same as the birthdate for newborns.
  • Even though counts are grouped by calendar year of admission, it is the actual number of discharges that are counted. 
  • The field "ICD10-CA Code All Dx" provides detailed information about singleton and multiple births. This information is available in the predefined report or can be selected with filter "ICD10-CA Code All Dx matches pattern Z38*".
  • Multiple birth information is available from CY2003 onwards.

  • Public Health Units access the BORN data through public health reports or data cubes.
  • Refer to the BORN Information System resource for more information about the data.

Indicator Comments

  • Mothers with multiple gestation pregnancies are more likely to have anemia, pre-eclampsia, preterm labour and caesarean delivery, while multiple birth infants are more likely to experience low birth weight, poor fetal growth, preterm birth, and perinatal death (1).
  • In the long term, children born from a multiple birth may be at increased risk for cerebral palsy and other neurodevelopmental disabilities (2).
  • The multiple birth rate has increased in Canada from 2.2 per cent of total births in 1995 to 3.0 per cent in 2004 (3).
  • The upward trends in multiple birth rates are likely the result of increased use of assisted reproductive technology (ART) in Canada to enhance fertility, as well as an increasingly older average maternal age at conception (4-6).  Older women are more likely to have natural multiple gestation pregnancies, and are also at increased risk for infertility which increases the usage of assisted reproductive technology (7).
  • Mother's age is reported at time of delivery.
  • Some reports use rate of live births while others use both live births and stillbirths.

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Live birth – the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life such as heartbeat, umbilical cord pulsation, or definite movement of voluntary muscles, whether the umbilical cord has been cut or the placenta is attached. A live birth is not necessarily a viable birth.

Stillbirth - death prior to the complete expulsion or extraction from its mother of a product of conception. The death is indicated by the fact that after such separation the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Only fetal deaths where the product of conception has a birth weight of 500 grams or more or the duration of pregnancy is 20 weeks or longer are registered in Canada.

Miscarriages - pregnancies that end by spontaneous abortion before 20 weeks gestation. Some pregnancy rates are calculated using an estimate of miscarriages based on survey data. This is because most miscarriages do not require in-patient treatment.

Therapeutic abortion - the deliberate termination of a pregnancy resulting in the death of the fetus or embryo. Also called induced abortion.

Fetal loss - includes stillbirth, miscarriage, and ectopic pregnancy. Definitions vary according to whether ectopic pregnancy is included or not.

Pregnancy - the gestation process, from conception through to the expulsion of the product of conception from the body whether through miscarriage, therapeutic abortion, cesarean section, or vaginal delivery.

Cited References
  1. Lee YM, Cleary-Goldman J, D'Alton ME. The impact of multiple gestations on late preterm (near-term) births. Clin Perinatol. 2006; 33(4):777,92; abstract viii.
  2. Rand L, Eddleman KA, Stone J. Long-term outcomes in multiple gestations. Clin Perinatol. 2005;32(2):495,513, viii.
  3. Public Health Agency of Canada. Canadian perinatal health report, 2008 Edition. Available from: Accessed July 15, 2011.
  4. Blondel B, Kogan MD, Alexander GR, Dattani N, Kramer MS, Macfarlane A, et al. The impact of the increasing number of multiple births on the rates of preterm birth and low birthweight: an international study. Am J Public Health. 2002; 92(8):1323-30.
  5. Brinsden PR. Controlling the high order multiple birth rate: the European perspective. Reprod Biomed Online. 2003;6(3):339-44.
  6. Martin JA, Park MM. Trends in twin and triplet births: 1980-97. Natl Vital Stat Rep. 1999;47(24):1-16.
  7. Alexander GR, Slay Wingate M, Salihu H, Kirby RS. Fetal and neonatal mortality risks of multiple births. Obstet Gynecol Clin North Am. 2005;32(1):1,16, vii.


Lead Authors

Jessica Deming, Region of Waterloo Public Health

Mary-Anne Pietrusiak, Durham Region Health Department

Core Indicator Reviewers

Deborah Carr, Oxford County Health Unit

Sherri Deamond, Durham Region Health Department (Core Indicators Work Group member)

Ahalya Mahendra, Public Health Agency of Canada (Core Indicators Work Group Member)

Contributing Authors

Reproductive Health Sub-group


Revision History

 This Core Indicator Product webpage is maintained by the Reproductive Health Subgroup.  
Date Review Type Author Changes PDF
March 2010 Formal Review Reproductive Health Sub-Group
  • Replaced Mandatory Health Programs section with updated Ontario Public Health Standards outcomes.

March 30, 2012 - January 16, 2013  Formal Review  Reproductive Health Sub-Group
  • Three data sources cited with analysis check-list for each. 
  • All births included - no longer exclude births with birth weight less than 500g
September 14, 2019
Website Update:
No Content Review 
Caitlyn Paget, 
on behalf of the CIWG 
    No changes made to indicator definitions.
    Migrated to new website structure and format, including:
  • Reorganized content to provide high-level information at a glance, and move in-depth analytic information into dedicated sections for users to access when needed.
  • Renamed "Basic Categories" section to "Recommended Subset Analysis Categories"; "Definitions" renamed to "Glossary".
  • Replaced both "Cross-References to Other Indicators" and "OPHS" sections with "Related OPHS Topics" to crosslink with relevant Core Indicators webpages including OPHS program standard(s) and associated indicator(s).
  • Added descriptive sub-headings to the Analysis Checklist and Indicator Comments sections.
  • Removed "Corresponding Health Indicator(s) from Statistics Canada and CIHI" and "from Other Sources" sections.
  • Updated Revision History table, and added PDF copy of previous version for reference.


APHEO's Core Indicators Project has been developed through collaboration across the field of public health in Ontario, 
to provide standardized methodology for population health assessment, to measure complex concepts of individual and community health.
Please contact for further information.