How can we improve perinatal health in France? This is the subject of the report of the fact-finding mission led by senators and published on Wednesday, September 11. From Public Health France to the Court of Auditors, several bodies have sounded the alarm. “France has been experiencing a marked decline for more than ten years compared to its European neighbors”note the senators in their report, stressing that “the main public health indicators are no longer progressing, or are even deteriorating”.
To reach this conclusion, the elected members of the Senate conducted dozens of hearings of stakeholders in the sector, making several trips to the Ile-de-France region, the Grand Est region and Brittany. Here is what we should remember from their conclusions:
Particularly high infant mortality in France
The senators point out a worrying deterioration in certain indicators, in particular that of infant mortality, the rate of which in France “has been higher than the European average since 2015”while this one “was one of the lowest in Europe at the end of the 20th century”Citing Eurostat data from 2022, they point out France’s poor position in this area, situated in 22nd place in the European Union, with 4 deaths per 1,000 children under 1 year old, “far behind Sweden (2.2), Finland (2), Italy (2.3) or Spain (2.6)”.
To explain the phenomenon, the report distinguishes two cases: the mortality of newborns presenting a high risk of mortality, such as very premature babies, who represent approximately 1% of births, and that of babies born at term, known as “low risk”. For the first category, this increase in infant mortality is explained by “less systematic care for extremely premature babies in France”but also by “a neonatal resuscitation care offer insufficient and poorly distributed across the territory”.
For newborns considered to be at low risk, epidemiologist Pierre-Yves Ancel, heard by senators, believes that “This excess mortality is probably avoidable, because it appears to result from suboptimal care and a lack of of care organization”The expert thus highlights “the difficulties in ensuring the triple continuity of care in obstetrics, pediatrics and anesthesia”report the senators, and point out “a context of limited human resources and medical time” and in particular “the use of temporary workers which disorganizes existing teams”The president of the French Society of Neonatology, Jean-Christophe Rozé, also heard, agrees: “Mortality is avoidable, the main problem is the continuity of care”The researchers interviewed also said: “deplored the lack of studies on morbidity and mortality of low-risk newborns”.
Marked territorial disparities
The senators noted significant disparities between regions and departments. The indicators in terms of perinatal health are “more unfavorable” in the overseas territories than in mainland France, note the authors of the report. Thus, infant mortality rates rose, between 2020 and 2022, to 6.6‰ in Réunion, 9.5‰ in Mayotte, 7.5‰ in Guadeloupe and 8.2‰ in Martinique and Guyana compared to 3.4‰ in mainland France.
In mainland France, three regions “stand out by an infant mortality rate higher than the national average”. These are the Ile-de-France, the Centre-Val de Loire and the Grand Est (notably the former Champagne-Ardenne region). In terms of non-overseas departments, the highest infant mortality rates were recorded in the Lot (6.2‰), Seine-Saint-Denis (5.8‰), Indre-et-Loire, Haute-Vienne and Lozère, all three of which have rates above 5‰.
These departments, “with very diverse characteristics (urban and rural)”, “do not allow the profile of a fragile territory to be highlighted”note the senators. Thus, “the departments with the most degraded indicators” are “sometimes even well-equipped with health establishments like Indre-et-Loire which has a university hospital in Tours” and two maternity hospitals in Chambray-lès-Tours and Chinon. “The interlocutors heard in the hearing were not able to offer an explanation for these disparities”they add.
Suicide, the leading cause of maternal mortality
With 15 deaths each year, suicide is the leading cause of death among young mothers after the birth of their child. To address this issue, the senators commissioned an opinion survey, conducted by the CSA institute, which highlighted certain “gaps” for young mothers. Thus, “one in five women say they are not satisfied with the information provided about postpartum and have not benefited from postnatal follow-up”.
Although 96% of women who gave birth between 2022 and 2024 say they know what postpartum depression is and have been educated about it, the specialists surveyed reported “the guilt and stigma still too often associated with perinatal depression”. “Twenty years ago, we didn’t talk about perinatal mental health like we do today”explains Elise Marcende, president of the Maman Blues association, quoted in the report. She also notes a certain ambivalence of social networks, which convey both images “of an ideal motherhood”Who “can be very anxiety-provoking”And “numerous accounts on which women discuss their psychological or perinatal suffering (…) and all aspects of motherhood”.
To improve this support, the mission rapporteurs recommend strengthening the “awareness-raising and training of professionals, particularly midwives, in the identification of depressive symptoms, as well as in the identification of medical, psychological and social vulnerabilities (particularly situations of precariousness and violence)”which are risk factors for depression during pregnancy and after childbirth. And thus allow “to anticipate this risk from the prenatal period”.
Review the training of caregivers and the attractiveness of their profession
To improve perinatal health, the authors of the Senate report stress the importance of reviewing the training of caregivers. To do this, they call “that the teaching of pediatrics be strengthened in the training program of all professionals who will subsequently be required to care for children”. They estimate “essential” the implementation “of a specific training plan for health professionals”including pediatric nurses, midwives, pediatricians or obstetrician-gynecologists, “to the management of mental health issues and the identification of risk situations”.
The senators also deplore the fact that, since a reform of nursing training in 2009, pediatrics has not been “no longer the subject of dedicated teaching in institutes of nursing training (Ifsi)”They specify that the order of nurses requests the establishment of a “real in-depth training in pediatric care for all state-certified nurses in general care”as well as the “return of a pediatric specialty” to train pediatric nurses. This training “must be accompanied by better recognition of state-certified pediatric nurses”Who “today constitute the main paramedical health professionals trained inspecifically to pediatrics”.