A recent study, published in The Lancet Global Health, highlights the substantial global and regional inequalities in maternal health outcomes across a woman’s reproductive life.

Researchers at the London School of Hygiene & Tropical Medicine and the University of Oxford looked to understand the potential risk of maternal near miss (MNM) faced by women across the globe.

A MNM is an event in which a woman nearly dies as a result of life-threatening complications that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Cases can be identified based on the World Health Organization clinical, laboratory, and management-based criteria of end organ dysfunction. Surviving a complication of this severity can have long term consequences for women’s physical, sexual, social and economic wellbeing.

In this study, researchers looked at the lifetime risk of maternal near miss. As women may experience more than one pregnancy during their lives, the authors argued that new measures are required to account for the cumulative burden of near miss morbidity across the reproductive life course. This new method estimates the risk that a female individual aged 15 years will experience a near miss before age 50, and accounts for women’s repeated exposure to the risk of MNM with each pregnancy, and survival throughout their reproductive life. 

Researchers analysed MNM data across 40 countries with available data, finding that lifetime risk of MNM varied widely. For example, a female individual aged 15 years in Guatemala has a one in six chance of experiencing MNM across her life, while in Vietnam that chance is one in 269. There is a one in 20 risk or higher in nine countries, seven of which are in sub-Saharan Africa.

Alongside analysis of MNM, researchers also examined the risk of severe maternal outcome (SMO), which is the risk of experiencing either death or MNM. They similarly found inequalities across countries, ranging from a one in 201 risk in Malaysia to a one in five risk in Guatemala. Again, researchers found a one in 20 risk or higher in 11 countries, with eight of those in sub-Saharan Africa.

These findings highlight the inequalities in maternal health outcomes across the globe. In many countries, the chance a woman will experience a MNM during her lifetime is extremely high, particularly in sub-Saharan Africa.

MNM may reflect both the low access to or poor quality of maternal care available for women, and highlights a health system’s capacity to save a woman’s life when life-threatening complications arise. These events are testament to improving access to emergency obstetric care globally.

Researchers suggest this method of estimating variation in the lifetime risk of MNM and SMO is important to support advocacy for global commitments to end preventable maternal morbidity and deaths.  

Dr Ursula Gazeley, lead author of the study, conducted while a Research Degree Student at LSHTM, said: “Our study is the first of its kind to estimate the lifetime burden of MNM and SMO, where women’s cumulative risk depends not only on the level of obstetric risk she faces with each pregnancy, but also on prevailing fertility and mortality levels.

"The lifetime risks of MNM and SMO expose the magnitude of inequalities in the burden of maternal morbidity and mortality across women's reproductive lives, and the urgent need for increased global commitment to prevent these traumatic outcomes.”

Veronique Filippi, Professor of Maternal Health and Epidemiology at LSHTM, said:  “Too many women globally, especially in Africa, still face a significant risk of maternal death or trauma. It is essential for the global community and nations to continue investing in maternity care, in alignment with the Sustainable Development Goals, to improve health outcomes for women everywhere.”

The full paper, ‘The Lifetime Risk of Maternal Near Miss morbidity in Asia, Africa, the Middle East, and Latin America: a cross-country systematic analysis’, can be found in The Lancet Global Health.