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

Summary 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. Key messages We propose a new indicator – the lifetime risk of maternal near miss – to estimate the risk of a 15-year-old girl experiencing a severe life-threatening maternal complication over her reproductive life course, accounting for survival between the ages 15-49. This indicator is needed because no existing measure of maternal near miss morbidity prevalence (ratio or rate) accounts for the cumulative risk of severe complications with each pregnancy. We demonstrate two methods for the calculation of the lifetime risk of maternal near miss, the choice of which depends on whether (i) estimates of the maternal near miss ratio by age group or, (ii) a summary estimate for ages 15-49 years, are available. We advocate for the use of this indicator to compare trends in maternal near miss morbidity alongside trends in maternal mortality.