A falling birth rate, rising neonatal mortality, a stable caesarean section rate… For the first time, a report published on Tuesday, September 20 by the French public health agency describes the state of perinatal health (pregnant woman, fetus and newborn) in the country. The alert on an evolution “worrying” of certain indicators, in ten years, particularly in Overseas France.
If some of them bear witness 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”detailed to AFP Anne Gallay, director of non-communicable diseases and trauma at Public Health France.
First observation: the birth rate is falling 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 (from 29.4 years in 2010 to 30.1 years in 2019) and in the decrease in fertility among the youngest women.
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 (0.58% in 2015 in Ile-de-France; 2.28% 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.
The caesarean section rate has been stable since 2012 (around 20.2%). As for the episiotomy rate in vaginal births, it has fallen sharply at the same time, both for primiparous women, for whom it is the first baby, (from 29.5% in 2010 to 10.0% in 2019) and for multiparas (from 10.5% to 2.7% over the same period).
Increase in neonatal mortality
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 data available.
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 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 panorama is generally even more detailed. The maternal mortality rate is 4 times higher than in mainland France, the mortality rate is 1.5 times higher and the neonatal mortality rate is 2 times higher. Guyana and Mayotte are the departments where the situation is the worst.
These findings “advocate for increased prevention and promotion of perinatal health”, “better access to rights and care, particularly in certain territories” overseas, the report concluded.