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Case Reports
. 2024 Feb 1;53(1):dyad169.
doi: 10.1093/ije/dyad169.

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

Ursula Gazeley  1   2 , Antonino Polizzi  3 , Julio E Romero-Prieto  2 , José Manuel Aburto  2   3   4 , Georges Reniers  2 , Veronique Filippi  1
Affiliations
Case Reports

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

Ursula Gazeley et al. Int J Epidemiol. .

Abstract

Background: The lifetime risk of maternal death quantifies the probability 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. However, relative to mortality, women are at an even higher risk of experiencing life-threatening maternal morbidity called 'maternal near miss' (MNM) events-complications so severe that women almost die. As maternal mortality continues to decline, health indicators that include information on both fatal and non-fatal maternal outcomes are required.

Methods: We propose a novel measure-the lifetime risk of MNM-to estimate the cumulative risk that a 15-year-old girl will experience a MNM in her reproductive lifetime, accounting for mortality between the ages 15 and 49 years. We apply the method to the case of Namibia (2019) using estimates of fertility and survival from the United Nations World Population Prospects along with nationally representative data on the MNM ratio.

Results: We estimate a lifetime risk of MNM in Namibia in 2019 of between 1 in 40 and 1 in 35 when age-disaggregated MNM data are used, and 1 in 38 when a summary estimate for ages 15-49 years is used. This compares to a lifetime risk of maternal death of 1 in 142 and yields a lifetime risk of severe maternal outcome (MNM or death) of 1 in 30.

Conclusions: The lifetime risk of MNM is an urgently needed indicator of maternal morbidity because existing measures (the MNM ratio or rate) do not capture the cumulative risk over the reproductive life course, accounting for fertility and mortality levels.

Keywords: Maternal health; demographic methods; lifetime risk; maternal morbidity; maternal mortality; maternal near miss.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Simulated age distributions of the maternal near miss ratio in Namibia 2019. All distributions have a maternal near miss ratio for ages 15–49 years combined of 8.03 per 1000 live births
See this image and copyright information in PMC

References

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