a “worrying” evolution of certain indicators

Abroad, 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 declining birth rate, an increasing 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 160-page document, published on Tuesday, September 20, by Public Health France, compiles a series of data on the state of health of pregnant women, fetuses and newborns during the period between pregnancy and postpartum ( return of diapers). ), from 2010 to 2019. According to the health agency, it 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”Anne Gallay, director of noncommunicable diseases and trauma at Public Health France, told AFP.

The precariousness of mothers worsens

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

The precariousness of mothers seems to be worsening at the same time: slightly fewer births are covered by health insurance (96.8% in 2010 compared to 96.0% in 2019). And there are more mothers in an irregular situation with State Medical Assistance (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 have been smoking for less than twenty years, 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 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). This last increase is explained in part by changes in screening methods and by the increased prevalence of risk factors, such as obesity or older maternal age.

Strong decrease in episiotomies

The cesarean section rate has remained stable since 2012 (around 20.2%). The rate of episiotomy in vaginal deliveries has also fallen sharply, both in primiparous women -first babies- (from 29.5% in 2010 to 10.0% in 2019) and in multiparous women (from 10.5% to 2.7% in the same period).

Another important observation: changes in mortality are contrasting, “even worrying” for both mother and child, Anne Gallay stressed. 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 last 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 being done to better understand the causes of this mortality”, said Nolwenn Régnault, head of the perinatal unit at 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 general picture is even more unfavorable: a maternal mortality rate 4 times higher than that of mainland France, a stillbirth rate 1.5 times higher, a neonatal mortality rate 2 times higher. Guyana and Mayotte are the departments where the situation is worst. these findings “advocate for greater prevention and promotion of perinatal health”, “better access to rights and care, particularly in certain territories” abroad, the report concludes.

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