There is document of about 160 pages, published this Tuesday by Public Health Francecollects a series of data on the health status of pregnant women, fetuses and newborns in the period from pregnancy to postpartum (the return of diapers), from 2010 to 2019.
According to the health agency, it therefore allows for the first time an overall description of the state of perinatal health in France. While some indicators testify to a “high and stable level of care” in France, “the report shows heterogeneous situations between territories, with a deterioration in overseas departments and regions”, indicated Anne Gallay, Director of Noncommunicable Diseases and Trauma at Public Health France.
First observation: a declining birth rate 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 and in the decrease in fertility among younger women.
For the whole of France, the average age at childbirth dropped from 29.4 years in 2010 to 30.1 years in 2019.
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 the State Medical Aid (AME, 1.6% in 2010; 2.5% in 2019) and homeless mothers (0.58% in 2010 in the 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 third 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%).
The episiotomy rate for vaginal deliveries is also in sharp decline, both for first-time mothers – first babies – (from 29.5% in 2010 to 10.0% in 2019) and for multiparas (from 10.5% to 2.7% in the same period).
Neonatal mortality on the rise
Another important observation: the evolution of mortality is mixed, “even worrying” for both mother and child, underlined Anne Gallay.
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 at Public Health France. However, the situation may progress, according to her, “many countries show better results”.
In the Overseas Departments and Regions the general picture is even more unfavorable: maternal mortality four times higher than that of mainland France, a 1.5 times higher stillbirth rate, a two times higher neonatal mortality rate.
Guyana and Mayotte are the departments where the situation is worst.
These results “support greater prevention and promotion of perinatal health”, “better access to rights and treatment, particularly in some territories” abroad, concludes the report.
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