a “worrying” evolution of certain indicators

Overseas, the maternal mortality rate is 4 times higher than in mainland France, the stillbirth rate 1.5 times higher, and the neonatal mortality rate 2 times higher.

A falling birth rate, rising neonatal mortality, a stable caesarean section rate… For the first time, a report describes the state of perinatal health in France, with an evolution “worrying” of certain indicators, in ten years, particularly in Overseas France. This document of some 160 pages, published Tuesday, September 20 by Public Health France, compiles a series of data on the state of health of pregnant women, the fetus and the newborn during the period from pregnancy to post- partum (the return of diapers), from 2010 to 2019. According to the health agency, it thus allows for the first time a global description of the state of perinatal health in France.

If certain indicators point to a “high and stable level of support” in France, “the report mentions heterogeneous situations between the territories, with a deterioration in the overseas departments and regions”told AFP Anne Gallay, director of non-communicable diseases and trauma at Public Health France.

The precariousness of mothers is getting worse

First observation: a declining birth rate in all regions of France, except in Guyana. The number of births decreased from 841,000 in 2010 to 734,000 in 2019. The main reasons lie in the increase in the maternal age of childbirth and the decrease in fertility among the youngest women. For the whole of France, the average age at childbirth fell from 29.4 years in 2010 to 30.1 years in 2019.

At the same time, the precariousness of mothers seems to be worsening: slightly fewer deliveries are covered by health insurance (96.8% in 2010 compared to 96.0% in 2019). And there are more mothers in an irregular situation requiring State Medical Aid (AME, 1.6% in 2010; 2.5% in 2019) and homeless mothers (5.8% in 2010 in Ile-de-France; 22.8% in 2019).

Although pregnant women smoke 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). Certain maternal pathologies during pregnancy and postpartum are on the increase, in particular 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 is partly explained by changes in screening methods and by the increase in the prevalence of risk factors, such as obesity or higher maternal age.

Sharp decline in episiotomies

The caesarean section rate has been stable since 2012 (around 20.2%). The episiotomy rate for vaginal births has also fallen sharply, both for primiparas – first babies – (from 29.5% in 2010 to 10.0% in 2019) and for multiparous (from 10.5 % to 2.7% over the same period).

Another major observation: the changes in mortality are contrasting, “see worrying” both for the mother and the child, underlined Anne Gallay. Thus, the maternal mortality rate did not decrease 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 metropolitan France, from 1.6 deaths per 1,000 births in 2010 to 1.8 per 1,000 in 2019. “Work is underway to better understand the causes of this mortality”, a statement from Nolwenn Régnault, head of the perinatal unit of Public Health France. The situation can in any case progress, according to her, “many countries with better results”.

In the overseas departments and regions, the overall picture is even more clear: a maternal mortality rate 4 times higher than in mainland France, a stillbirth rate 1.5 times higher, a mortality rate neonatal twice as high. Guyana and Mayotte are the departments where the situation is the worst. These findings “Advocating for stronger prevention and promotion of perinatal health”, “better access to rights and care, in particular in certain territories” overseas, the report concluded.

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