A Global Comparison of the Lifetime Risk of Maternal Near Miss Morbidity

Ursula Gazeley , London School of Hygiene and Tropical Medicine
Antonino Polizzi, University of Oxford
Julio E. Romero-Prieto, London School of Hygiene and Tropical Medicine (LSHTM)
José Manuel Aburto, London School of Hygiene and Tropical Medicine (LSHTM)
Georges Reniers, London School of Hygiene and Tropical Medicine (LSHTM)
Veronique Filippi, London School of Hygiene and Tropical Medicine (LSHTM)

The lifetime risk of maternal near miss (LTR-MNM) is a novel measure which quantifies the probability that a 15-year-old girl will experience a life-threatening maternal complication during her reproductive lifetime, accounting for survival from age 15-49 and fertility levels. Morbidity of this severity has long-term sequalae for women’s physical, psychological, and sexual wellbeing. Global comparisons of the LTR-MNM are needed to better understand the burden of severe maternal morbidity across the reproductive life course. We calculate the LTR-MNM for five countries with population-based, nationally- or regionally representative data on MNM morbidity (Namibia, South Africa, Suriname, Brazil, and China), using World Population Prospects data on fertility and mortality. With the lifetime risk of maternal death (LTR-MD), we also estimate the lifetime risk of severe maternal outcome (LTR-SMO = LTR-MNM + LTR-MD) to calculate the relative contribution of MNM morbidity to maternal ill-health for countries at different stages of the obstetric transition. We estimate that the LTR-MNM ranges from a 1 in 145 risk in China (2015 estimate) to 1 in 35 in Namibia (2019 estimate). Similarly, the LTR-SMO ranges from 1 in 137 risk of maternal death or MNM morbidity in China, to a 1 in 28 risk in Namibia. The relative contribution of MNM to the LTR-SMO for China and Namibia are 94% and 79%, respectively – corresponding to Namibia’s earlier position in the obstetric transition. Our results demonstrate the utility of the LTR-MNM to compare the burden of MNM morbidity across countries and the need for nationally representative, population-based estimates of MNM.

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 Presented in Session 49. Social Inequalities in Sexual and Reproductive Health