"France must better monitor its infant mortality"

• According to a study published in early March in the journal

  The Lancet Regional Health Europe

  , infant mortality has been increasing in France since 2012, after decades of continuous decline.

• The causes of this phenomenon remain unknown to date, and the authors of the study, including Professor Jean-Christophe Rozé, president of the French Society of Neonatology, plead for better monitoring of infant mortality in France.

• But also for "a rationalization of care", as he explains to

  20 Minutes

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An unexplained phenomenon.

And a curve that we would never have imagined to see rising again.

After a continuous decline since the Second World War, infant mortality, a key indicator of the health of a population, has increased again in France in recent years.

This was observed by a team of researchers from Inserm, University of Paris, AP-HP and Nantes University Hospital, in collaboration with teams from the University of California, as part of of a study published in early March in the scientific journal

.

Between 2012 and 2019, the infant mortality rate fell from 3.32 deaths per 1,000 births to 3.56, an increase of 7% in less than ten years.

Figures that distance France from Sweden and Finland, whose infant mortality rates are lower.

However, "by reaching a rate equivalent to the Scandinavian countries, this would mean 1,200 fewer deaths each year in France, which is considerable", explains to

Professor Jean-Christophe Rozé, president of the French Society of Neonatology and co-author of the study.

A big issue.

Since 2012, infant mortality has started to rise again in France, but the exact causes are unknown.

How to explain it?

And how to change the situation?

It's an anomaly, it's not normal that we don't have elements to explain it.

France should better monitor its infant mortality.

Especially since we would have the means to do so, the indicators exist: it is a question of recording the deaths, their circumstances, of retracing the course of care for the mother and the child, of having data precise on all follow-up, from pregnancy to childbirth.

Is there a link with factors such as late pregnancy, smoking, lack of medical monitoring?

Today, these assumptions are not verified.

However, it is quite possible to set up an

surveillance system , by creating a framework that allows connections between the various existing databases.

A dedicated team of professionals should then be assigned the continuous monitoring of these indicators, similar to what exists in other countries, such as the United Kingdom.

In France, we lack a public health culture, and without that, we won't get there.

Sweden is cited as the best student, with one of the lowest mortality rates in the world.

What does it do better than France?

Is it a problem of resources, of personnel?

It is an exemplary country which nevertheless has far fewer maternity wards than we do, but whose organization is more efficient.

Swedes are reasonable while we are not rational.

We need to engage in a dispassionate and rational health debate.

We must reform the supply of perinatal care, so we must find solutions to maintain local care - in town - as much as necessary, while maintaining the possibility of physiological deliveries and surrounded by all the security required on large technical platforms.

It's entirely possible.

The problem in France is above all medical overcrowding: obstetrics as well as pediatrics or anaesthetics.

Despite the closures in recent years of small maternity wards, there are certainly still too many in the territory, and in which there are no longer enough caregivers.

There is a shortage of everything, obstetricians, midwives, nurses.

The question of salaries is obvious, but there are many other factors in this crisis of vocations, which is part of a phenomenon that has not been taken into account: the major sociological change in the new generations of carers, including the relationship to work has changed.

The young health professionals work very well,

fully respect the protocols and wish to work in a secure environment and with absolute respect for the balance between professional and personal life.

The priestly model of the notable who spent three out of four nights in the hospital is over.

It's a new model that needs to be totally rebuilt.

But how to rationalize a new French model of Scandinavian inspiration?

If we don't optimize the management of resources, we can't pay the personnel at the right level and keep them, and those who remain burn out.

On the other hand, if we rationalize by putting people in the right place, that changes everything.

You can have more staff per technical platform, provided you have fewer technical platforms.

In total, this does not make more caregivers, but they are distributed more efficiently.

Take a small maternity ward that hosts less than 600 deliveries per year, or less than two per day on average.

We know full well that there will be guards without the slightest birth.

However, you have a structure that is still mobilized day and night.

We need a better distribution of forces, especially since in small structures where certain medical procedures are performed less often, there is a loss of expertise, and therefore a potential increase in risk.

This is what has led Finland and Sweden to undertake a major restructuring of their care supply: they have proportionally fewer maternity wards, and are considering reducing the number even further.

But they are developing a whole approach to the care of mothers adapted accordingly: by developing local monitoring capacities during pregnancy, and by setting up a transport and accommodation system to bring mothers closer to the maternity ward, when they are geographically distant, in the days preceding the due date.

This is something that is already offered in France for future mothers who live more than 45 minutes from a maternity hospital.

Other progress is to be welcomed: the Directorate General for Health Care (DGOS) has been convinced to experiment, on the Swedish model, with the early discharge of premature babies, by setting up mobile teams at home.

And the results are there.

So we can see that things are moving, but slowly.

Hence the need for rapid and effective reform to bring infant mortality down again to Sweden's level.

And thus avoid 1,200 deaths of babies each year, and as many family tragedies.

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• Maternity

• Babe

• Mortality

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• Pregnancy

• Childbirth