Falling birth rate, rising neonatal mortality, stable cesarean section rate … For the first time, a report published Tuesday, September 20 by the French public health agency describes the state of perinatal health (pregnant woman, fetus and newborn) in the country. It warns of an evolution “worrying” of some indicators, in ten years, in particular in overseas France.
If some of them testify to “high and stable support level” 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 noncommunicable diseases and trauma at Public Health France.
First observation: the birth rate is falling in all regions of France, with the exception of 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 at childbirth (from 29.4 years in 2010 to 30.1 years in 2019) and in the decrease in fertility among younger women.
Gestational diabetes
At the same time, the precariousness of mothers appears to be worsening: slightly fewer births are covered by health insurance (96.8% in 2010 versus 96.0% in 2019). And there are more mothers in an irregular situation with 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).
Some maternal pathologies in pregnancy and postpartum are on the rise, 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). The latter increase is partly explained by changes in screening methods and the increased 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 the vaginal parts, it is in sharp decline at the same time, both for the primiparas, for which it is the first child, (from 29.5% in 2010 to 10.0% in 2019) and for multipares (from 10.5% to 2.7% in the same period).
Increased neonatal mortality
Another important observation: the changes in mortality are mixed, “also worrying” for both mother and baby, Anne Gallay pointed out. Therefore, the maternal mortality rate did not significantly decrease 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 old) 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”, noted Nolwenn Régnault, head of the perinatal unit of Public Health France. The situation can still progress, according to her, “many countries with better results”.
In the overseas departments and regions the general picture is even more unfavorable. The maternal mortality rate is 4 times higher than in mainland France, the stillbirth 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 worst.
These results “advocate for greater prevention and promotion of perinatal health”, “better access to rights and care, especially in some territories” abroad, the report concludes.
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