PRESS RELEASE
6 May 2024
Thematic public report
PERINATAL POLICY:
MEDIOCRE HEALTH RESULTS, GREATER
MOBILISATION
REQUIRED
While the resources earmarked for perinatal policy are increasing (€9.3 billion in 2021, up
9
% on 2016) and the birth rate is falling (-5.3
% over the same period), the health results
observed call into question the efficiency of the allocated resources. The main perinatal
health indicators - stillbirths, neonatal mortality and maternal mortality - show that France
performs very poorly compared with other European countries. France ranks 22
nd
out of 34
European countries in terms of neonatal mortality.
In this report, perinatal care is defined as
the period from the end of the first trimester of pregnancy to the child's first birthday. The
end of pregnancy and the first few months after giving birth are a delicate period for infant
development. Many factors determine their physical and psychological well-being and their
emotional and cognitive development. Their effects can be immediate but can also be
manifest throughout an individual's life and have considerable consequences for healthcare
costs. In this context, the evaluation of public policy with regard to perinatal care continues
and further develops previous work by the Court of Accounts on maternal and child health
and the organisation of care in this area.
Worsening perinatal health indicators marked by major inequalities
Female obesity or excess weight are risk factors for perinatal health, as are addictive habits and
the consumption of drugs, alcohol and tobacco, which remains at high levels. In addition, the
proportion of late pregnancies is increasing and now accounts for almost a quarter of all births
in France. These are associated with increased risks for both mothers and children, as well as
greater obstetric complications. Perinatal health is characterised by major social and territorial
inequalities. The vulnerability of families and mothers, as measured by income, qualifications
or access to social security cover, is associated with greater maternal and infant morbidity and
complications. These inequalities are greater for mothers born abroad, whose social situation
correlates with greater morbidity and risk, even though almost a quarter of births are to foreign
mothers. Lastly, the overseas territories face particular difficulties.
Inadequate and inefficient healthcare provision
The organisation and quality of care provision play a decisive role in risk prevention. However,
the current situation achieves neither the safety standards nor the efficiency expected of health
services. The regulations governing the technical operating conditions for maternity units
appear to be out of step with both changes in the way care is provided and with the
restructuring of healthcare services in recent decades. Furthermore, changes to the latter are
inadequately supervised by the health authorities, against a backdrop of severe pressure on
human resources. Around twenty maternity units are still failing to meet the minimum
threshold of 300 births per year, set in 1998 to ensure the quality and safety of care. As regards
neonatal critical care, the wide disparities between regions require provision to be increased in
certain regions. Lastly, women with high-risk pregnancies should always be able to be
monitored in facilities that are equipped to deal with any complications. These findings call for
a review of perinatal care organisation so that care safety can be improved. In order to
consolidate the demographic balance in the perinatal professions, efforts must be made to
provide training for birth professionals, taking into account the actual location and nature of
practice of current professionals.
A public policy too limited in scope
In terms of prevention there have been some positive developments, such as the increase in
the number of rare diseases screened for in newborns. However, shortcomings persist. The
screening and vaccination campaigns run by the health authorities have a limited impact on the
most at-risk groups, who should be targeted as a priority. More systematic use of early prenatal
and postnatal sessions could help individual situations among mothers to be better taken into
account. The recent "first 1000 days" strategy aims to prevent the psychological and
developmental risks associated with the perinatal period. However, the inadequacy of certain
measures and the lack of perinatal psychiatric care limit the prevention and treatment of
psychological distress. Above all, the "first 1000 days" strategy does not include any measures
relating to the quality and safety of perinatal care. In this context, it would be preferable to
postpone the current dismantling of the "Prado maternity" home help service, which has
proved its effectiveness and should be maintained until other means of coordinating perinatal
care pathways have demonstrated equal appropriateness. Lastly, support mechanisms for
parenthood should be made more coherent and easier to understand. These mechanisms
would enable us to concentrate efforts on the most effective measures and better coordinate
the work of social players and healthcare professionals.
Read the report
PRESS CONTACTS:
Julie Poissier
◼
Head of Media & Social Networks
◼
T
+33 (0)6 87 36 52 21
◼
julie.poissier@ccomptes.fr
Sarah Gay
◼
Press Relations Officer
◼
T
+33 (0)6 50 86 91 83
◼
sarah.gay@ccomptes.fr
@Courdescomptes
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