Background
Cervical cancer disproportionately affects women in low-and lower-middle income countries (‘LMICs’) and is one of the leading causes of cancer death in younger women, resulting in a relatively higher rate of maternal orphans. Maternal orphans have been shown to experience increased child mortality and reduced educational and health outcomes. An earlier study found that, in 2020 alone, there were an estimated 1 million maternal orphans due to cancer, with 210,000 of these due to cervical cancer. In 2020, the World Health Organization (WHO) launched the ’90-70-90’ strategy to eliminate cervical cancer: 90% of girls fully vaccinated against HPV by age 15, 70% of women screened by age 35 and again by 45, and 90% of women identified with cervical disease receiving appropriate management. The Cervical Cancer Elimination Modelling Consortium found that 62.6 million deaths could be averted over the course of a century across 78 LMICs if the 90-70-90 targets are met by 2030.

Objectives
In this analysis, we build on this earlier work to quantify the number of maternal orphans due to cervical cancer over the period 2020-2120 in the absence of scale-up of elimination strategies, and quantify the impact of cervical cancer elimination strategies across 78 LMICs on the number of maternal orphans over the same period, thus providing a better understanding of the broader societal benefits of reaching cervical cancer elimination.

Methods
We used the Policy1-Cervix platform to evaluate deaths due to cervical cancer over the course of a century, assuming no scale-up of the elimination targets across 78-LMICs, and assuming the WHO’s 90-70-90 elimination targets are reached by 2030 across 78-LMICs. To estimate the number of maternal orphans due to cervical cancer, we developed a multicohort microsimulation module incorporating UN population and fertility predictions to estimate maternal orphans (aged <18 years) resulting from women dying of cervical cancer over the period 2020-2120. As parity is a known co-factor in cervical cancer, we also assumed that women who die from cervical cancer have 10% higher fertility than the LMIC average, as was assumed for the earlier evaluation of maternal orphans due to cancer.

?Results
From 2020-2120, 70 million deaths are predicted to occur due to cervical cancer in the absence of elimination scale-up across 78-LMICs. These deaths are predicted to result in a total of 28 million maternal orphans, 1.4 million of whom would be aged under 5 years. If the elimination targets are reached, 63 million women’s lives would be saved over the century, resulting in 23 million fewer maternal orphans due to cervical cancer, including 1.2 million fewer maternal orphans aged <5 years. Almost three-quarters of these averted maternal orphans would occur in Sub-Saharan Africa.

Conclusions
The intergenerational consequences of reaching WHO’s cervical cancer elimination targets will be substantial, with over 23 million maternal orphans averted across 78-LMICs over the rest of the century, the majority of these averted in Sub-Saharan Africa. The realization of the elimination targets in LMICs is expected to have profound positive consequences for families and communities,