The future is increasingly uncertain for the Lilas maternity ward in Seine-Saint-Denis. It should be clarified next December but the end of deliveries on the site seems inevitable. The closure of this establishment would then be part of the trend in France which has tended to reduce the number of small maternity hospitals since the 1970s.
The Lilas maternity ward, in Seine-Saint-Denis, should not be one for much longer. The Île-de-France Regional Health Agency (ARS) is planning a new meeting in December 2023 to “finalize” the project. The Lilas site must become a women’s health center where endometriosis, pre-natal and post-natal care will be taken care of, but where it will no longer be possible to give birth. The “maternity” part must be transferred to Montreuil hospital, a little over three kilometers from Les Lilas.
This Seine-Saint-Denis maternity ward should therefore be added to the long list of maternity wards which are closing. Since the 1970s, in mainland France, the number of these establishments has only fallen. Nearly 33% of maternity hospitals have closed in 20 years, between 2001 and 2021. In nearly 50 years, since 1972, three quarters of these establishments have even disappeared.
Among the “sacrificed”, we can cite the maternity ward of Die, in Drôme, at the end of 2017, that of Blanc, in Berry in 2018 or even that of Bernay, in 2019, in Eure. This trend towards closure is not really linked to the drop in the number of births in mainland France since in almost 50 years, since 1972, births have fallen by “only” 20%.
This phenomenon is rather linked to health policies put in place since the 1970s. The public authorities want to concentrate births towards the best-equipped maternity wards, for security reasons, they say, to the detriment of the least equipped. This is also why in 1998, the Perinatal Decrees organized maternity units into four categories, to better match “the level of risk for the patient and the newborn and the type of receiving maternity unit”explains the Directorate of Research, Studies, Evaluation and Statistics (Drees).
In detail, a type 1 maternity ward is an establishment which has an obstetrics department. It is type 2a when a neonatology department is on the same site as the obstetrics department. A maternity ward becomes type 2b when it also has a neonatal intensive care unit. And finally, an establishment is type 3 when it has all these services and also a neonatal intensive care unit. Drees notes that depending on the type of maternity ward, the size of establishments increases. In 2020 for example, an establishment “type 1 carries out on average 774 deliveries per year, a type 2a maternity unit, 1,410, a type 2b maternity unit, 1,961, and a type 3 maternity unit, 3,142”.
In its 2022 report on health establishments, the Drees notes that this policy of restructuring and concentration of maternity wards is having the expected effects, given that type 2 and 3 establishments are becoming established over the years. In 1996, 43% of deliveries took place in type 2 and 3 maternity units and in 2020 this increased to 81%. In other words, all this takes place to the detriment of type 1 maternity wards, small maternity wards, which are also the first to be targeted by closures. “The reduction in supply observed since 2002 has concentrated on maternity units carrying out fewer than 1,000 deliveries and especially on those with fewer than 500 deliveries”specifies a report from the Court of Auditors, in December 2014.
A report submitted last February to the Academy of Medicine also recommends the closure of around a hundred other small maternity wards, more precisely those which provide fewer than 1,000 deliveries per year. Maintaining these structures is “illusory” according to this report. Several reasons are put forward: “The disaffection of users for type 1 structures is increasing spontaneously and in parallel with the difficulties in recruiting medical and paramedical staff”, “the desire of staff to work within sufficiently resourced teams”, “the growing and often majority recourse to temporary work which leads to iterative temporary closures” And “an increase in maternal vital risk in the smallest structures and in the absence of continuity of care that can be provided by an obstetrics and anesthesia team 24 hours a day”.
Beyond these arguments, the financial difficulties encountered by these small maternity hospitals should not work in their favor. The report of the Court of Auditors at the end of 2014 mentions in particular “the structural underfinancing of maternity wards which can only find a balance from 1,100 to 1,200 deliveries per year due to a long-standing disconnection from rates and real costs”.