The lifetime risk of maternal mortality: concept and measurement.
OBJECTIVE
The lifetime risk of maternal mortality, which describes the cumulative loss of life due to maternal deaths over the female life course, is an important summary measure of population health. However, despite its interpretive appeal, the lifetime risk of dying from maternal causes can be defined and calculated in various ways. A clear and concise discussion of both its underlying concept and methods of measurement is badly needed.


METHODS
I define and compare a variety of procedures for calculating the lifetime risk of maternal mortality. I use detailed survey data from Bangladesh in 2001 to illustrate these calculations and compare the properties of the various risk measures. Using official UN estimates of maternal mortality for 2005, I document the differences in lifetime risk derived with the various measures.


RESULTS
Taking sub-Saharan Africa as an example, the range of estimates for the 2005 lifetime risk extends from 3.41% to 5.76%, or from 1 in 29 to 1 in 17. The highest value resulted from the method used for producing official UN estimates for the year 2000. The measure recommended here has an intermediate value of 4.47%, or 1 in 22.


CONCLUSIONS
There are strong reasons to consider the calculation method proposed here more accurate and appropriate than earlier procedures. Accordingly, it was adopted for use in producing the 2005 UN estimates of the lifetime risk of maternal mortality. By comparison, the method used for the 2000 UN estimates appears to overestimate this important measure of population health by around 20%.
Wilmoth
John
J
Department of Demography, University of California, Berkeley, CA, USA. jrw@demog.berkeley.edu
D000293:Adolescent; D000328:Adult; D005260:Female; D040361:Healthy People Programs; D006801:Humans; D008428:Maternal Mortality; D008875:Middle Aged; D015233:Models, Statistical; D011247:Pregnancy; D018570:Risk Assessment / Q000379:methods; D055815:Young Adult