Does France have a problem with its infants? In recent years, deaths of newborns under the age of one have been subject to a worrying increase in France. A study by the National Institute of Health and Medical Research (Inserm), published in early March in the British scientific journal The Lancet, showed that after a fall in the infant mortality rate until 2005, the trend has started to rise again since the beginning of the 2010s. mortality rate for children under one year of age in mainland France – the overseas departments being excluded from the study – fell from 3.32 deaths per 1,000 births to 3.56 in 2019. It represents an increase of 7% in less than ten years. Half of the deaths (47.8%) occur during the first week of life, and almost a quarter (24.4%) take place in the hours after childbirth.
This trend is causing France, once well ranked, to fall in the European ranking: according to data from the European Statistical Institute Eurostat, France would thus be behind the Scandinavian countries, which have a rate of 2.1 deaths per 1,000 births, but also less advanced than Italy (2.4), Spain (2.6) or Germany (3.2). If the researchers do not pronounce definitively on the causes of this increase, several tracks are evoked, like the increase in the age of the mothers at the time of the pregnancy or the increase in the multiple pregnancies. The organization of the healthcare system and the number of doctors are also part of the preferred explanations, while France is doing less well than several of its neighbors.
The age of the mothers in question
To explain this increase, specialists cite several factors relating to the health of mothers, already mentioned in July 2021 in a report of the Research, Studies, Evaluation and Statistics Department (Drees). The latter underlined “the continuous increase in (the) age of mothers”, passed according to one INSEE study published in January, from 28.8 to 30.8 years between 1994 and 2021 on average at the time of childbirth. Similarly, 21.3% of women giving birth in 2016 were over 35, compared to just 19.3% in 2010.
Other factors likely to lead to a deterioration in the infant’s state of health, such as the multiplication of the number of smokers during pregnancy, or the increase in the proportion of overweight or obese women, were also cited. “The increase in the number of twin growths, which present a greater risk of causing excess mortality at the start of life, also plays a role,” adds Magali Barbieri, director of research at the National Institute for Demographic Studies (INED). In 40 years, the births of twins in France almost doubled, due to the age of the mothers (the oldest have twins more frequently than the youngest) and the development of treatments against sterility. Paradoxically, progress in medicine can therefore also explain this increase in infant mortality. “Children who would have been stillborn twenty years ago can now survive their birth, explains Magali Barbieri. But some of them still die afterwards. Children who would not have been counted a few years ago then enter into the figures for infant mortality”.
The Precariousness Hypothesis
In addition to the state of health of mothers and their children, this increase could be partly correlated with that of precariousness. In the UK, a study in the medical journal BMJ Open published in 2019 thus showed that an “unprecedented increase in infant mortality between 2014 and 2017 disproportionately affected the poorest regions of the country” while “leaving the richest regions untouched”. In France, according to the latest available figures, Seine-Saint-Denis recorded five infant deaths out of 1,000 births in 2018, compared to an average of 3.6 out of 1,000 births in the rest of metropolitan France. A department strongly marked by the precariousness of mothers and their children. To these social disparities can also be added the origin of the mother. “Immigrants may have more difficult access to healthcare, either in their country of origin or when they arrive in France, notes Gérard-François Dumont, demographer and teacher-researcher at the Sorbonne. optimal can lead to complications at birth”. These women, who are often in less good health, may thus present risk factors: hypertension, diabetes, overweight.
But these arguments fail to shed light on the whole problem. In Italy, a country better ranked than France in terms of infant mortality, the average age of women at the time ofdelivery was even higher in 2017 than that of French women: more than 31 years. “There is probably not a single factor that explains it, but we need to understand why France knows it in particular”, notes Professor Jean-Christophe Roze, head of the neonatal medicine department at the Center Hospitalier Universitaire de Nantes. and co-author of the study published in Tea Lancet. However, a lot of data is missing to understand it: civil status data does not include medical data to know the weight of the infant at birth, for example. The mother’s state of health or care pathways are also not mentioned. While calling for a more precise knowledge of these risk factors, Gérard-François Dumont for his part underlines a point that distinguishes France from the rest of the good European students in terms of infant mortality: the healthcare system.
A healthcare system problem?
What if the increase observed was mainly linked to a degradation of the circuit? Between 1997 and 2019, 338 maternity hospitals out of 885 closed, according to a study by geographer Emmanuel Vigneron, a decrease of 40% in twenty years. “Abolishing maternity wards means weakening the monitoring of pregnancies in geographical areas where the health supply is already less”, considers the researcher. But this reasoning is not unanimous: Jean-Christophe Roze thinks that the increase in infant mortality could be one of the consequences of the degraded working conditions in these small establishments. “Today, we want to maintain maternity wards in certain places when we do not have the medical staff, he explains. This poses a problem, because we find ourselves in establishments with a deteriorated quality of care. “.
For the pediatrician, the absence of practitioners in the most isolated French regions must lead to a public health choice. “The younger generation does not want to practice in these areas, and you cannot force them to do so, otherwise practitioners will turn to specialties other than perinatal, he believes. and choose: either we accept the risk that a birth in a somewhat isolated region may present, or we agree to travel a little further to go and give birth in a secure place”. And to cite the example of Finland: with its number of maternity wards lower than that of France, the country is doing better in terms of infant mortality. But in this decentralized system, much of the maternal and child care is provided by nurses with their own practice. “It is a debate that we must have on the organization of care, and which is likely to be difficult, continues the specialist. But to name it well, we will also need to have more precise information. ‘we determine where these deaths come from.