This is one of the key indicators of human development: infant mortality is on the rise again in France after decades of decline since the end of the Second World War.

A study published in early March in the scientific journal The Lancet shows that 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 10 years.

Long considered a good student in this area, France is now seen as a dunce in Europe.

“If we had the mortality rate of Sweden or Finland, there would be 1,200 deaths each year of fewer children under the age of one,” explains to AFP Martin Chalumeau, pediatrician and epidemiologist, who supervised this study conducted mainly by INSERM researchers.

In detail, the scientists studied a period from 2001 to 2019 using INSEE data.

Their results show that during this period, 53,077 deaths of infants under the age of one were recorded among the 14,622,096 live births, representing an average infant mortality rate of 3.63 per 1,000. a quarter of these deaths occurred during the infant's first day of life, half during the first week after birth.

"We were among the best students for a long time, then the trend has changed since 2005 and it goes back from 2012 to 2019", details Martin Chalumeau.

"Unable" to provide an explanation

These results thus confirm the conclusions of previous surveys on France's inability to reduce its infant mortality rate for a decade.

A trend deemed sufficiently worrying by Professor Jean-Christophe Rozé to alert the cabinet of the former Minister of Health, Agnès Buzyn, from 2020. 

“We were very well received but it was just before the Covid-19 epidemic and therefore logically there were other priorities, explains the president of the French neonatology society and co-author of the latest study. published in The Lancet. Like his colleagues, he wants the next government to make this issue a public health priority because “today, we are unable to explain this increase.

That's what's dramatic," adds the hospital practitioner at the Nantes University Hospital.

Indeed, France is sorely lacking in usable data to explain the deaths of young children.

Thus, congenital malformations or birth weight, which could provide valuable information to researchers, are not mentioned on the death certificate.

"We have information scattered in several databases and we are unable to properly reconstruct the path of the patients. Is it because of poor pregnancy monitoring? Is it linked to the place of delivery or to a pathology?, asks Jean-Christophe Rozé.

High-risk pregnancies

To explain the reasons for this increase in infant mortality, scientists must content themselves with hypotheses, starting with the increase in births at risk linked to increasingly late pregnancies and the progression of smoking or obesity.

These risk factors are multiplied among the most precarious women, especially immigrant women, explains Magali Barbieri of the National Institute for Demographic Studies (INED).

"Immigrants may have more difficult access to care as well as pregnancy monitoring or even a generally degraded state of health. The metropolitan department with the highest infant mortality is also the one with the highest immigrant population: the Seine-Saint-Denis", specifies the researcher interviewed in 2021 by the newspaper Liberation.

"There are also more and more multiple pregnancies associated with prematurity which is accompanied by mortality and morbidity", notes Jean-Christophe Rozé.

"However, it's the same with our neighbors so that doesn't explain why our situation is deteriorating compared to other countries."

"No pilot on the plane"

Should we then see a degradation of the care pathway for pregnant women?

In France, according to the Court of Auditors, half of French maternities have closed in 20 years.

However, the average level of care has not necessarily dropped, according to Jean-Christophe Rozé, because these maternities have been closed due to low activity.

"However, there is a very strong link between the number of patients treated and the quality of care. Intensive care units specializing in very prematurity, the more they do, the better they do", adds the practitioner who denounces a lack security in certain local establishments.

>> To see: Give birth elsewhere than in the hospital?

In France, alternatives are developing

In an attempt to explain the rise in infant mortality, other public health experts point to the weakness of the prevention policy in France and in particular the lack of maternal and child protection services (PMI).

Responsible for supporting young parents during the first months of the child, the weakening of this local network and its consequences for the follow-up of infants was the subject of a parliamentary report in 2019, recalls the newspaper the World.

If the working hypotheses are numerous, the researchers are unanimous on one point: in the absence of funds allocated to conduct more in-depth studies, this increase in infant mortality will remain a blind spot in public health policy.

"As if there was no pilot on the plane", summarizes Professor Rozé.

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