Neonatal mortality and maternal pathologies on the rise, falling birth rates, territorial inequalities… For the first time, Public Health France is delivering a report on perinatal health in France over almost a decade, between 2010 and 2019. 160 pages describe the state of health pregnant women, fetuses and newborns, during pregnancy until postpartum – the period following childbirth. While French maternities are in tension for lack of staff, the result is mixed. “Worryingeven, for certain indicators.
The birth rate is thus falling throughout the country – with the exception of Guyana: in 2019, 734,000 babies were born, compared to 841,000 in 2010. In question: a more advanced childbirth age – age average was 30.1 years in 2019 – and a decline in the fertility of women between 24 and 35, who are also fewer and fewer.
Overall, the report shows a “high and stable level of support” in France. But over the pages stand up health inequalities and a very heterogeneous situation from one territory to another.
Worse situation in Overseas
And for good reason. Overseas France concentrates the strongest inequalities. The maternal mortality rate is four times higher there than in mainland France; that of stillbirths 1.5 times greater. Infants under 28 days die twice as many as those born in France. These statistics are weighed down above all by Guyana and Mayotte: mothers are generally less followed up during their pregnancy and more precarious. In Guyana, a third of deliveries are not covered by health insurance. Two thirds of pregnant women have no social security cover in Mayotte, they are also younger than in the rest of France.
But the overall situation of perinatal health in France is just as worrying. Firstly because neonatal mortality – that of infants between their birth and their 27th day of life – is getting worse. 1.8 deaths per 1,000 births were recorded in 2019, compared to 1.6 in 2010. Without the precise causes of this deterioration being known. “Work is underway to improve [les] to understand“says Nolwenn Régnault, head of the perinatal unit of Public Health France. The situation can in any case progress, she continues, “many countries with better results».
Hypertension and diabetes on the rise
Maternal mortality did not decrease significantly over the period. It affected just over 8 women out of 100,000 live births in 2015. Certain maternal pathologies are increasing, such as hypertension – which affected 5% of mothers in 2019 – or gestational diabetes, which has increased by half in nine years. and concerned more than 13% of pregnant women in 2019. The evolution of screenings can, in part, explain this increase – but not completely. The prevalence of risk factors increases. Higher maternal age is one. Obesity is another reason, and it is growing among pregnant women – along with overweight. In 2016, more than 60% of parturients had a normal BMI, nearly 9 points less than in 1998. However, obese women are three times more likely to suffer from severe complications, mainly gestational diabetes or hypertension.
Smoking, “major modifiable risk factor for maternal and fetal morbidityis another point of concern. Admittedly decreasing, it is still significant: in 2016, 16% of women smoked during their 3rd trimester of pregnancy. France even acts as a bad student among its European neighbors. The precariousness of pregnant women does not help this picture: in Ile-de-France, 2.8% of them were homeless in 2019, against 0.58% in 2015.
These results call for a rapid response, particularly in terms of prevention. The indicators presented will be updated every two years, specifies Geneviève Chêne, Director General of Public Health France. This is enough to refine prevention campaigns and guide public policies.