A groundbreaking study published in The Lancet Global Health has uncovered significant global and regional disparities in the risk of life-threatening maternal complications across a woman's reproductive life. The research highlights the urgent need for improved maternal healthcare worldwide, particularly in regions where the risk of severe maternal health issues is highest.
Key Findings
Co-authored by experts from the Leverhulme Centre for Demographic Science and the London School of Hygiene & Tropical Medicine, the study is the first to provide a comprehensive analysis of the lifetime risk of maternal near miss (MNM) — a scenario where a woman survives a life-threatening complication during pregnancy or childbirth. The research examined data from 40 countries across Asia, Africa, the Middle East, and Latin America, dating back to 2010.
The study defined a maternal near miss as an event where a woman narrowly avoids death due to severe pregnancy-related complications. The World Health Organization (WHO) identifies such cases using clinical and lifesaving intervention-based criteria, including organ dysfunction, emergency hysterectomy, and blood transfusions.
Disparities Across Regions
The findings reveal stark global disparities. Women in some regions face significantly higher risks of maternal near miss throughout their reproductive years. For instance, the lifetime risk of experiencing an MNM was found to be as high as one in six in Guatemala (2016), compared to just one in 269 in Vietnam (2010). Similarly, Nigeria (2012) showed a lifetime risk of maternal death at one in 17, in contrast to one in 12,778 in Japan (2010).
Countries with high maternal near miss risks often have high maternal mortality rates, with sub-Saharan Africa and regions like Central America showing some of the greatest disparities. These inequalities are largely influenced by factors such as obstetric risk, fertility rates, and access to quality healthcare.
"Women in countries with higher total fertility rates, such as the Democratic Republic of Congo, are more vulnerable to maternal near miss events. Conversely, nations with lower fertility rates, like China, tend to have reduced risks," said Ursula Gazeley, lead author and Postdoctoral Researcher at the Leverhulme Centre for Demographic Science.
Impact on Women's Wellbeing
Surviving a maternal near miss has long-term effects on women's physical, psychological, and economic well-being. The cumulative risk across multiple pregnancies is often underestimated, as existing data primarily considers individual cases rather than the lifetime prevalence.
"Maternal near miss events reflect the capability of healthcare systems to save lives during critical situations. They underline the importance of expanding access to, and the quality of, emergency obstetric care," explained co-author Antonino Polizzi, a DPhil student at the Leverhulme Centre.
Regional Inequalities in Severe Maternal Outcomes
The study also evaluated the lifetime risk of severe maternal outcomes, defined as either death from a maternal cause or an MNM event. These risks varied greatly across regions, ranging from one in 201 in Malaysia (2014) to one in five in Guatemala (2016). The burden was particularly high in sub-Saharan Africa, where eight countries showed lifetime risks exceeding one in 20.
"This research provides a sobering view of the substantial global inequalities in maternal health. It underscores the need for global action to enhance maternal care and address preventable morbidity and mortality," said Dr. José Manuel Aburto, co-author and Associate Professor at the London School of Hygiene & Tropical Medicine.
Recommendations for Future Action
The study recommends adopting the WHO's criteria for classifying maternal near misses across all healthcare settings, including high-income nations. This would standardise data collection, enabling more accurate comparisons and assessments of global maternal health risks. Enhanced surveillance systems could help monitor MNM events and improve national data quality, leading to more effective policy-making.
A notable limitation of the study was its reliance on existing maternal near miss data from countries that follow WHO criteria, which often excludes high-income nations. Consequently, the study may not provide a complete global picture, highlighting the need for better data collection systems worldwide.
An Urgent Call for Change
The researchers emphasise that addressing these inequalities is critical for improving maternal health outcomes. "Our findings illustrate the significant disparities in maternal near miss morbidity, which serve as a call to action for the global health community to focus on improving outcomes," Gazeley stated. "By understanding these risks, we can advocate for better care systems and save lives."
Conclusion
The comprehensive analysis presented in this study sheds light on the urgent need for stronger, more equitable healthcare systems that can address the life-threatening risks faced by women during pregnancy and childbirth. Improved access to quality emergency obstetric care, better training for healthcare professionals, and stronger health infrastructure are essential to reducing these disparities and improving outcomes for women around the world.
The full paper, titled "The Lifetime Risk of Maternal Near Miss Morbidity in Asia, Africa, the Middle East, and Latin America: A Cross-Country Systematic Analysis," is available in The Lancet Global Health.
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