Declining birth rates, increasing neonatal mortality, stable caesarean section rates… A report published on Tuesday, September 20 by the French Public Health Authority describes for the first time the state of perinatal health (pregnant woman, fetus and newborn) in the country. Warns against evolution “disturbing” some indicators in ten years, especially in overseas France.
If some of them testify to o.a “high and stable level of support” in France, “The report mentions a heterogeneous situation between territories, with a worsening in the overseas departments and regions”in detail for AFP Anne Gallay, director of non-communicable diseases and trauma in public health in France.
First observation: birth rates are falling in all regions of France except Guyana. The number of births decreased from 841,000 in 2010 to 734,000 in 2019. The main reasons are the increase in maternal age at childbirth (from 29.4 years in 2010 to 30.1 years in 2019) and the decline in fertility among the youngest women.
At the same time, maternal insecurity appears to be worsening: slightly fewer births are covered by health insurance (96.8% in 2010 versus 96.0% in 2019). And mothers in an irregular situation with state medical assistance (AME, 1.6% in 2010; 2.5% in 2019) and homeless mothers (0.58% in 2015 in Ile-de-France; 2, 28% in 2019).
Although pregnant women smoked less than twenty years ago, France remains one of the European countries with the highest prevalence of maternal smoking in Europe (16.2% of women smoked in the 3rd trimester in 2016).
Some maternal pathologies are increasing during pregnancy and after childbirth, especially disorders related to hypertension (4.5% in 2010; 5.0% in 2019) and gestational diabetes (6.7% in 2010 13.6% in 2019 ). This latter increase can be partly explained by changes in screening methods and an increase in the prevalence of risk factors such as obesity or older maternal age.
The rate of caesarean sections has been stable since 2012 (around 20.2%). As for the rate of episiotomy in vaginal births, it has also fallen sharply, both for primiparous mothers, for whom it is the first baby (from 29.5% in 2010 to 10.0% in 2019), and for multiparous mothers ( from 10.5% to 2.7% over the same period).
Increase in infant mortality
Another important observation: changes in mortality are contrasting, “even disturbing” for both mother and child, Anne Gallay pointed out. Thus, the maternal mortality rate did not fall significantly between 2007–2009 (9.5 deaths per 100,000 births) and 2013–2015 (8.1 per 100,000), the date of the latest available data.
And neonatal mortality (between 0 and 27 days of life) has increased in mainland France from 1.6 deaths per 1,000 births in 2010 to 1.8 per 1,000 in 2019. “Work is ongoing to better understand the causes of this mortality”, noted Nolwenn Régnault, head of France’s perinatal public health unit. According to her, the situation can develop in any case “many countries with better results”.
In the overseas departments and regions, the overall picture is even more unfavorable. The maternal mortality rate is 4 times higher than in mainland France, the birth rate is 1.5 times higher and the infant mortality rate is 2 times higher. Guyana and Mayotte are the departments where the situation is worst.
These findings “advocate for increased prevention and promotion of perinatal health”, “better access to rights and care, especially in certain territories” overseas, the report concludes.