Background
Maternal near‐miss indices are World Health Organisation (WHO) recognised indicators that may improve our understanding of factors associated with maternal morbidity and mortality. In Papua New Guinea (PNG) where maternal mortality is among the highest in the world, only one study has documented near‐miss indices in a tertiary‐level hospital, but none from provincial hospitals where the majority of under‐privileged women access healthcare services.

Aims
To determine the near‐miss ratio, maternal mortality index (MMI), and associated maternal indices for Modilon Hospital in Madang Province of PNG.

Methods
All women attending Modilon Hospital who met the WHO maternal near‐miss definition and/or a WHO‐modified (PNG‐specific) near‐miss definition, were prospectively enrolled.

Results
There were 6019 live births during the audit period; 163 women presented with life‐threatening conditions (153 near‐misses and 10 maternal deaths). The maternal near‐miss ratio was 25.4/1000 live births and the maternal mortality ratio (MMR) was 166/100 000 live births, with a maternal death to near‐miss ratio of 1:15.3. The severe maternal outcome ratio was 27.1/1000 live births and the total mortality index was 6.8%. Higher proportions of near‐miss women were aged ≥30 years, nulliparous, illiterate, from rural communities, lacked formal employment, referred from peripheral health facilities, unbooked, had history of still births and were anaemic.

Conclusion
Sociodemographic factors such as women’s rights, education level and status in society, in addition to appropriate health reforms with greater financial and political support are urgently needed to ensure underprivileged women in rural PNG have access to family planning, supervised deliveries and skilled emergency obstetric care.