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 authors have declared no competing interest.

This work was supported by UG PhD studentship from the UK Economic and Social Research Council [ES/P000592/1].

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Ethical approval was not required as to demonstrate our new indicator we used population-level data available in the public domain (World Population Prospects). All data used in this article are freely available for download from the UN World Population Prospects Download Center: https://population.un.org/wpp/Download/Standard/MostUsed/

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All data used in this article are freely available for download from the UN World Population Prospects Download Center: https://population.un.org/wpp/Download/Standard/MostUsed/. All code used in this analysis is available from the Open Science Framework repository: https://osf.io/8brgp/?view_only=19cea2858df94b2b877d4ff57cfa7e48 .

https://osf.io/8brgp/?view_only=19cea2858df94b2b877d4ff57cfa7e48