🚨 Perinatality: the report that shifts the problem to where it really is
🔍💡 Perinatality: the rise in infant mortality since 2011 is primarily due to social and population factors, not the closures of maternity wards. The IGAS report opens 24 concrete avenues for action on identification, outreach, and follow-up for the most vulnerable. 🍼
📌 Infant mortality has been rising in France since 2011: the report demonstrates, with supporting figures, that the main cause is not the organisation of maternity wards but the weight of population factors (precarity, maternal age, pre-pregnancy pathologies, unequal access to follow-up). For a field actor, this is a directly exploitable shift in perspective: it moves the effort from 'where to give birth' to 'how to identify, support, and reach out to the women furthest from care'. Specifically, it provides local action levers (pathway referent, outreach initiatives, strengthening PMI, targeted neonatal follow-up) and a framework for conducting reorganisations without suffering them.
Source :📒 Organisation of perinatality in the territories: affirming a public health logic✍️ Dr Aquilino Morelle, Alexandre Pascal, Marie-Odile Saillard (members of IGAS), with the contribution of Lucie Ligier and the Data Pole of IGAS - January 2026📜🔗LINK to the source
1️⃣ ANALYTICAL SUMMARY
A silent health crisis, primarily of a demographic nature
After a historic low in 2011 (3.5 ‰), infant mortality has risen to 4.1 ‰ in 2024, which means 2,709 children died before the age of one (p. 4). This increase is exclusively due to neonatal mortality (p. 4). France has dropped from 3rd to 23rd place in the EU: at the European average level (3.3 ‰), 529 deaths could have been avoided in 2024 (p. 5, 48). The report establishes that this deterioration is primarily linked to demographic factors — increasing maternal age, multiple pregnancies, pre-pregnancy obesity (22.8 % → 31.8 % from 2003 to 2016), precariousness, and reduced access to follow-up (p. 5-6, 48-59). Social and territorial inequalities are the common thread: the risk of neonatal death is 1.71 times higher in the 20 % of the most disadvantaged areas (p. 56).
A well-designed system but poorly managed, needing to refocus on the most vulnerable
The mission significantly downplays the influence of service restructuring: between 2000 and 2023, the number of maternity units has fallen by 37 % with no proven decisive link to the rise in mortality (p. 7-8, 61-63, 78). It considers the only increase in the activity threshold to 1,000 births as "outdated" (p. 8). The follow-up measures (early interviews, lead midwife, PMI, PRADO) are relevant but insufficiently effective and coordinated, and poorly reach vulnerable populations (p. 117-129). The report advocates for a new national strategic plan 2027-2030, reactivated management, a repositioned PMI, and a more concerted approach to local transformations (p. 11, 136; recommendations 1, 16, 18, 23-24).
2️⃣ KEY POINTS OF THE DOCUMENT
1️⃣ The cause is demographic, not organisational. The rise in neonatal mortality since 2011 can be explained by the characteristics of pregnancies (prematurity, age, pathologies, precariousness) and not by the closures of maternity wards: there is no direct or unambiguous link between supply and outcomes (p. 7-8, 17, 78). This is the argumentative foundation of the entire report.
2️⃣ Prematurity, a central lock. Approximately 55,000 children are born prematurely each year (6.9% of births) and prematurity accounts for 81% of perinatal deaths, with a risk of death about 50 times higher than that of a child born at term (p. 49). Acting upstream on its risk factors is a priority.
3️⃣ A documented social and migratory gradient. The infant mortality rate ranges from 2.2 ‰ among children of executives to 5.1 ‰ among inactive women (p. 5). The increase observed between 2010-2014 and 2015-2022 is entirely driven by mothers born abroad, a finding that the report links to precariousness and barriers to access to care, not to origin per se (p. 58-59).
4️⃣ The decline in maternity wards has not mechanically degraded access. From 1,747 maternity wards in 1972 to 457 in 2023 (-37% since 2000), the decline has mainly affected the private sector (-60% profit-making) and level 1 (450 → 160), but the number of delivery rooms has slightly increased (+3%) (p. 7, 61-63). No typical territorial model emerges internationally (Sweden and Italy, opposing densities, similar results) (p. 8, 78).
5️⃣ 24 recommendations, mostly of priority 1. They cover the follow-up (pathway referent, reference maternity, outreach), neonatology (ratio of one neonatal intensive care bed for 1,000 births), the revision of the 1998 decrees, the repositioning of the PMI, a new strategic plan 2027-2030 and a concerted method for transforming the offer (p. 12-16; recommendations 1 to 24).
3️⃣ ACTION TRACKS FOR LOCAL ACTORS
1️⃣ Target outreach towards those furthest from care. Organise a systematic outreach approach in each department (follow-ups from Health Insurance, targeted campaigns) for women in precarious situations, geographically or culturally isolated (p. 9, recommendation 8). This is the lever with the highest yield given the social gradient.
2️⃣ Designate a single pathway referent. Systematise a referent professional or a reference maternity to secure the orientation towards the appropriate level, respecting the explicit choice of the woman (p. 9, recommendation 7).
3️⃣ Strengthen neonatal follow-up for vulnerable mothers. Deploy a departmental action plan co-led by ARS / Health Insurance / PMI for the postnatal follow-up of mothers and children presenting social vulnerabilities or isolation (p. 128, recommendation 15), mobilising general practitioners where paediatricians are lacking.
4️⃣ Rearm the PMI as a key player. Rely on PMI services (nearly 10,870 FTE in 2023, seeing up to 90% of children after birth) and halt their weakening highlighted by the "Peyron report" (p. 128-129, recommendation 16). Identified unmet need: the mission has not conducted an ad hoc investigation on the PMI, which remains to be carried out.
5️⃣ Streamline coordination through information sharing. Standardise and share professional resources (computerised patient files) to avoid breaks in care between community, hospital, and maternal and child protection services (p. 149, recommendation 22).
6️⃣ Anticipate and consult on any transformation of the service. In the face of a reorganisation or closure, involve all stakeholders in advance, integrate the symbolic dimension ("end of a story") and anticipate the role of media and social networks as a sounding board (p. 150-154, recommendations 23-24). Necessary adaptation: equip the regional health agencies, often isolated in the face of conflict situations.
4️⃣ ADDITIONAL REFERENCES
🔍➕ For more information, see the articles referenced by "Health Practices" on the topic of perinatality ➡️🔗 https://www.pratiquesensante.com/blog/tag/perinatalite-376
1️⃣ Public Health France — "Perinatal health in France: 10 years of contrasting developments" (8 July 2026). Updates the indicators 2012-2024 (mortality, prematurity, perinatal mental health, congenital anomalies) and completes the epidemiological analysis of the IGAS report.
2️⃣ DGCS — "The first 1000 days of the child. Technical file 2025-2027" (January 2026). 65 operational measures (outreach, maternal and child protection, home interventions, post-partum depression, overseas territories): this is the strategic and concrete counterpart of the plan called for by IGAS.
3️⃣ Public Health France — "Mental health of women during the perinatal period in France in 2021" (summary, 10 July 2026). Illuminate recommendation 2 of the report (postpartum depression, maternal suicide): 17% of depressive symptoms at 2 months, 73% without access to antenatal care.
(The three URLs have been verified as active and accessible at the time of writing.)
5️⃣ FREQUENTLY ASKED QUESTIONS (FAQ)
1️⃣ Are maternity closures responsible for the rise in infant mortality?
No. The mission concludes that the restructurings do not appear to have had a notable effect on neonatal mortality since 2011 and that there is no direct link between the organisation of services and this recovery (p. 7-8, 17).
2️⃣ Should the activity threshold for maternity units be raised to 1,000 births?
The report considers this solution "mechanical, outdated and imposed" on a multifactorial problem: a new wave of concentration would not resolve the population difficulties at the root of the degradation (p. 8).
3️⃣ What are the main risk factors to target on the ground?
Prematurity, advanced maternal age, multiple pregnancies (risk x5), obesity and pre-pregnancy conditions, socio-economic precariousness and inadequate follow-up of the women furthest from care (p. 5-6, 49-59).
4️⃣ What does the report say about social and territorial inequalities?
The risk of neonatal death is 1.71 times higher in the most disadvantaged areas; these social inequalities largely explain the territorial disparities and constitute an avoidable factor (p. 56-57).
5️⃣ What role for the PMI?
It must be repositioned everywhere as the central actor in perinatality, particularly for vulnerable populations, while it is going through a major crisis (p. 128-129, recommendation 16).
6️⃣ How can we better support the most vulnerable women?
Through organised outreach approaches, a pathway reference, strengthening targeted neonatal follow-up, and better coordination of local actors (p. 9-10, recommendations 8, 7, 15).
7️⃣ How can we conduct a local reorganisation without major conflict?
By anticipating, consulting all stakeholders early, taking the symbolic burden of a closure seriously, and managing communication with the media and social networks (p. 150-154, recommendations 23-24).
6️⃣ REWRITING IN EASY TO READ LANGUAGE
The problem
In France, more and more babies are dying before the age of 1.
In 2024, 2,709 babies died before their first birthday.
This number has been rising since 2011.
France is performing worse than its European neighbours.
The real cause
It is not because we are closing maternity wards.
The real cause is the health and lives of mothers.
For example:
- older mothers;
- mothers expecting twins;
- overweight or unwell mothers before pregnancy;
- poor mothers or those not well monitored during pregnancy.
What needs to be done
We need to help mothers as early as possible.
We need to reach out to mothers who visit the doctor infrequently.
A professional is needed who follows each mother from start to finish.
We need to help the PMI services. The PMI helps mothers and babies.
We need to properly prepare for changes in maternity wards.
We need to discuss it with everyone before deciding.
7️⃣ CROSS-ANALYSIS — VALUES OF HEALTH PRACTICES
- Literacy : the report recommends making the information provided to women throughout their journey more readable and comprehensive, but does not provide tools suitable for different levels of understanding (p. 132, recommendation 17).
- Empowerment : the logic remains primarily institutional; the involvement of women is limited to respecting their explicit choice of establishment (recommendations 7, 10).
- Participation : co-construction is mainly considered for transformations of the offer, through the association of users and communities (recommendations 9, 24).
- Community health : the collective dimension appears through the CLS, "1,000 days" workshops, and territorial action, but remains poorly structured in dedicated pathways (p. 142).
- Ethics : data on immigration are explicitly linked to precariousness and access to care, which prevents a stigmatising reading, although it does not problematise all biases (p. 58-59).
- Human rights : equity is at the heart of the argument, with a strong emphasis on reducing avoidable social and territorial inequalities (p. 56-57).
- Intersectorality : recommended partnerships between ARS, Health Insurance, departmental councils/PMI, CPTS and local authorities (recommendations 3, 15, 16, 22).
- Partnership : the tripartite contractualisation State/ARS/Department is presented as a model to be generalised (p. 142).
- Fight against discrimination : access inequalities are widely addressed; non-judgment and cultural adaptation of care are mentioned as issues, without detailed provisions (p. 58, 210).
8️⃣ EVALUATION OF THE RELIABILITY OF THE RESOURCE
Scientific relevance : high. The report relies on recent official sources (INSEE 2024, DREES, SpF, ENP, CépiDc-Inserm studies), a comprehensive survey of ARS and specific statistical work from the IGAS Data Pole, with international comparisons. The data is dated and referenced. Point of caution: the central thesis (predominant population factors) is well-argued but takes a position in a contested debate; some correlations are presented with the necessary caution by the authors themselves (p. 78, 293).
Operational relevance : strong. The 24 recommendations are concrete, prioritised, with responsible authorities and deadlines (p. 12-16). Limitation for the field: several measures fall under national management (strategic plan, SNIP, decrees) and require political and budgetary decisions; local effectiveness will depend on the resources of PMI and ARS, which the report acknowledges are weakened.
Internal coherence : the report assumes a fruitful tension between the observation (the supply is not the cause) and certain recommendations that nonetheless concern the organisation of the supply (revision of the 1998 decrees, neonatology), which is consistent with its logic of "health security on a case-by-case basis" (recommendations 9, 19-20).
9️⃣ STRATEGIC HASHTAGS
#healthpractices #Perinatality #InfantMortality #HealthInequalities #PublicHealth #MovingTowards #PMI #1000FirstDays
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