The latest national perinatal survey, conducted in France in 2021, has just released its conclusions. For the first time, reliable data has been collected on the famous follow-up of mothers two months after giving birth. Details.
[Mise à jour du 7 octobre à 16h54] For a long time and even today, the medical follow-up of women after childbirth was set aside or at the very least, it was poorly supervised. Just look at the numbers on postpartum depression. This disease, which affects between 10 and 20% of young mothers, is still very taboo and sometimes misdiagnosed. The last investigation national perinatal (ENP) of 2021, carried out among 12,723 women residing in Metropolitan France and made public on October 6, was interested for the first time in the section of the mental health of mothers in post-delivery follow-up. Until now, the study, conducted every five years since 1995 by Inserm and co-managed in particular by the Directorate General for Health (DGS) and Public Health France, focused only on “medical practices during pregnancy and childbirth as well as demographic and social characteristics of women and families”. This new field of inquiry makes it possible to learn lessons about the experience of young mothers after giving birth. On this subject, thethe survey results revealed that “16.7% of women have symptoms suggestive of postpartum depression”, says the report. A malaise evaluated thanks to theEPDS screening tool (a 10-question questionnaire) two months after delivery. Otherwise, 15.5% of them admitted to having had a difficult or very difficult time during their pregnancy. About 10% of these women have even been confronted with inappropriate attitudes or words from caregivers during their pregnancy, childbirth or stay in the maternity ward and 6.7% to inappropriate gestures. These data show a certain reality.
Developments in post-delivery follow-up
Because other positive indicators, this time, have been observed with regard to support from health professionals. According to the national perinatal survey, Overall, the women interviewed are satisfied with the follow-up they have received. “More than 90% say they are ‘satisfied’ or even ‘very satisfied’ with their medical care during their pregnancy follow-up and with their care in the delivery room”, underlines the document. 79.1% of women were able to benefit from a home visit by a midwife. Precious tips especially for put baby on his back and thus avoid sudden infant death syndrome have been given and similar. In contrast, to calm the child’s crying, only half of them said they had received advice. However, it remains essential to prevent shaken baby syndrome. Progress therefore remains to be made to see these figures increase. Also to know that the results should also be taken through the prism of the health crisis, the survey having been carried out in March 2021, during the third wave of the epidemic.
The state of perinatal health in France
In 2022, Public Health France published another report on the state of health of the pregnant woman, the fetus and the newborn, during the period of pregnancy until the postpartum period. This document provides a global and detailed vision of perinatal health in France and overseas for 10 years, from 2010 to 2019 or before the health crisis. By analyzing precise data and indicators, the report points to a “worrying situation of perinatal health” in our country. We learn in particular that there is a “stable and high level” care, a good point, but for all that “social inequalities in health” are widening in the overseas departments and regions.
Increase in the average age at childbirth
Throughout France, the average age at childbirth among women has increased in ten years, falling from 29.3 years in 2010 to 30 years and 3 months in 2018, except in Mayotte where it remained stable (27 years). Depending on the region, there are certain contrasts. In mainland France, the age is higher in Ile-de-France (31.2 years in 2016-2019), while overseas, “women give birth younger, especially in Guyana, Reunion and Martinique”, says the report. Furthermore, according to Public Health France, maternal age induces a number of factors during pregnancy and childbirth. In adolescents under 15, as in women over 35, prematurity, low birth weight, and congenital anomalies are more frequent complications, with an increased risk beyond the age of 40.
Declining number of births
The birth rate is falling in all regions in mainland France and also in the overseas departments, “with the exception of Guyana where there is an overall upward trend in births.” Every year, births have decreased, between 2010 and 2019 there were 810,000 births, and in 2019, 733,000. Some departments stand out from others, such as Pays de la Loire and Île-de-France which have higher rates higher birth rates. According to the National Health Agency, which relied on INSEE data, this reality is explained in particular by “the decline in the population of women between the ages of 20 and 40 since the mid-1990s, as well as by the decline in their fertility.”
Rising prematurity rate
Among birth data, in France, the rate of prematurity has been on the rise since the 1990s. It fell from 4.5% in 1995 to 6% in 2016, according to a former National perinatal survey. In detail, in metropolitan France it is 7.2% and 11.9% in the overseas departments and regions. These premature births are partly explained by risk factors such as intrauterine growth retardation, the mother’s health history, genetics or pregnancies that are too close together.
Risk factors with dramatic consequences
Risk factors that impact the health of pregnant women, fetuses and newborns persist. Some are major risk factors such as smoking, responsible for maternal and fetal morbidity (ectopic pregnancyprematurity, etc.). At European level, in 2016, France was the country “having the highest prevalence of maternal smoking” : 16.2% of pregnant women smoke during the third trimester. These data show that “prevention must be reinforced in smokers planning a pregnancy so that they increase their chance of quitting smoking when they are pregnant, whatever the term”details Public Health France.
Data on changes in BMI (body mass index) also showed “an increase in overweight and obesity between 1998 and 2016”. Women are affected. “The morbid obesity rate estimated from childbirth fell from 0.4% in 2010 to 0.8% in 2019 for the whole of France.” This finding is more marked overseas, except in Mayotte.
An alarming situation overseas
In the report, the data and observations show very clearly that the situation regarding the state of perinatal health is particularly alarming in the overseas departments and regions. Overall in this area, we see “a maternal mortality rate 4 times higher than in mainland France“, but also “a stillbirth rate 1.5 times higher and a neonatal mortality rate (death between 0 and 27 days of life) 2 times higher”. Risk factors are also more frequent and certain health indicators are critical. “Guyana and Mayotte are the departments where the situation is the most unfavorable”, specifies the document.