Lifetime risk of maternal near miss morbidity: A novel indicator of maternal health

Abstract

The lifetime risk of maternal death is the risk that a 15-year-old girl will die of a maternal cause in her reproductive lifetime. Its intuitive appeal means it is a widely used summary measure for advocacy and international comparisons of maternal health. But relative to mortality, women are at a higher risk of experiencing life-threatening maternal morbidity called 'maternal near miss events' - complications so severe that women almost died. As maternal mortality continues to decline, stronger health indicators that include information on both fatal and non-fatal maternal outcomes are required. Thus, we propose a novel measure - the lifetime risk of maternal near miss - to estimate the risk a girl will experience at least one maternal near miss in her reproductive lifetime, accounting for survival from ages 15-49. This new indicator is urgently needed because existing measures of maternal morbidity prevalence (near miss ratio or rate) do not capture the cumulative risk over the reproductive life course. We use estimates of fertility and survival from the World Population Prospects for Kenya in 2021 along with simulated data on the maternal near miss ratio to demonstrate the calculation of the lifetime risk of maternal near miss. We estimate that the lifetime risk of maternal near miss in Kenya is 1 in 37, compared to a lifetime risk of maternal death of 1 in 59.

The Lifetime Risk of Maternal Near Miss morbidity in Asia, Africa, the Middle East, and Latin America: a cross-country systematic analysis

“…12,14 We also provide the first cross-country estimates of the LTR-SMO -the risk that a 15-yearold girl would experience either a maternal near miss complication or die from a maternityrelated cause during her reproductive lifetime, once accounting for fertility and mortality levels in the population. This is an important tool for advocacy: most maternal near miss complications and almost all maternal deaths are preventable 14 . The LTR-SMO emphasises the true burden of adverse maternal outcomes to women's lives, their families, communities, and health systems, and the work still needed to end preventable forms of maternal morbidity and mortality 12,14,30 .…”

“…The LTR-MNM therefore presents a more accurate picture of the scale of global inequity in severe maternal morbidity than would be implied by differences in the MNM ratio alone. 12,14 We also provide the first cross-country estimates of the LTR-SMO -the risk that a 15-yearold girl would experience either a maternal near miss complication or die from a maternityrelated cause during her reproductive lifetime, once accounting for fertility and mortality levels in the population. This is an important tool for advocacy: most maternal near miss complications and almost all maternal deaths are preventable 14 .…”

“…This is an important tool for advocacy: most maternal near miss complications and almost all maternal deaths are preventable 14 . The LTR-SMO emphasises the true burden of adverse maternal outcomes to women's lives, their families, communities, and health systems, and the work still needed to end preventable forms of maternal morbidity and mortality 12,14,30 .…”

“…This measure is an important tool to inform and strengthen global efforts to reduce all forms of preventable maternal mortality and morbidity. 12,14 New research is needed to compare the LTR-MNM across countries to better understand global inequities in the burden of MNM morbidity over women's reproductive lives. Our objective is to compare the global distribution of the LTR-MNM, the LTR-SMO, and heterogeneity in the relative contribution of morbidity vs. mortality to the LTR-SMO.…”