How to stop the high infant mortality rate in France? Quietly published at the beginning of August, an official report puts forward some ideas, without necessarily judging the continuation of a policy of closing small maternity wards to be relevant.
This report from the General Inspectorate of Social Affairs (IGAS), a joint body of the social ministries, dates back to January but was only published on Tuesday evening, six months late, after an article from Le Canard Enchaîné revealing his existence.
The observation is well-known and already documented: France suffers from high rates of newborn mortality, a worrying decline in health, dating back fifteen years", which puts her in a " unfavorable international position“.
More than 4 out of 1,000 babies die before their first birthday in France.
Once well placed among developed countries, France has fallen to the bottom of the rankings since the beginning of the 2010s, with more than four babies out of 1,000 dying before their first birthday in 2024.
In 2024, " If France had known the average EU infant mortality rate of 3.3 per thousand, the deaths of 529 children in their first year could have been avoided. and that would have been 1,057 children with "the results of Italy or Portugal, i.e. an infant mortality rate of 2.5‰", according to the report.
The cause is not unique, the three authors remind us, among them former advisor to François Hollande, Aquilino Morelle, for whom " The influence of population-related factors appears to be decisive, although it is not possible to assign it a precise weighting.“In other words, several factors are at play, without knowing to what extent: the increasingly later age of pregnancies, which increases the risk of complications, the rise in multiple pregnancies, which are often more complex…”
Read also Infant mortality in France: avoidable errors in care among the multiple causes
Social and territorial inequalities exacerbate the risks for newborns
Added to this is a preponderant role of social and territorial inequalities which, in an increasingly documented way, amplify the risk of death of the newborn or its mother.
The report notes that the overseas regions, generally more disadvantaged, have the most worrying figures. The situation has also worsened in Île-de-France.
On the other hand, the authors dismiss the often debated hypothesis that the closures of small maternity wards, which have been underway for several years, would explain the rise in neonatal mortality.
They note that some countries are performing better, both by concentrating births in large maternity hospitals and by maintaining small facilities, such as Italy.
“ Therefore, proposing (…) as a solution to a serious, multifaceted and multifactorial public health problem, the sole measure of increasing the minimum activity threshold for maternity wards”, today at 300 births per year, "would constitute a mechanical, outdated response"", according to them.
The issue is sensitive. Many local elected officials oppose the closure of maternity wards, presented as a cause of the decline in care, while medical societies believe that these establishments, due to a lack of activity, represent a danger to mothers and children.
Read also Newborn mortality is increasing in France, but only among the least advantaged.
Healthcare workers are denouncing the discreet publication of the report in August.
But for the report, " "The key to reducing the risk of infant mortality lies in..." first during pregnancy, " in the ability to prevent, detect and then manage risky situations "and after childbirth, in that one" to take care of young children whose condition requires it in neonatal services“.
The Ministry of Health welcomed " a thorough, very rich piece of work » even to "fuel the public debate"“.
Among the healthcare professionals interviewed by AFP, gynecologists and midwives, the report's conclusions are hardly surprising, but its discreet publication is irritating, especially since Minister Stéphanie Rist has been promising to take action for several months.
“ August is not a good month for in-depth and demanding reading."Isabelle Derrendinger, president of the national council of the Order of Midwives, told AFP that she regrets this choice," indicative of how perinatal care and women's health are treated in France“.
“ It is incomprehensible that it took months to obtain a report that doesn't even address the central issue of the human resources deficit." added Olivier Morel, secretary of the National College of Gynecologists and Obstetricians (CNGOF).
In early July, Ms. Rist announced several measures. These largely correspond to the recommendations of the IGAS (General Inspectorate of Social Affairs), including the implementation of preventative measures and the revision of decrees on perinatal care, deemed outdated. The issue of maternity wards, however, has been postponed until October.
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