Perinatal health: 10 years of contrasting developments

📜🔗LINK to the source

1. ANALYTICAL SUMMARY

A decade of progress caught up by warning signals

In ten years, France has seen its births decline (≈ 660,000 in 2024, which is 160,000 fewer than in 2012) and the profile of mothers transform: average age at delivery of 31.1 years, more than one in four women aged 35 or older (p. 4). This demographic evolution is coupled with a deterioration in preconception health: nearly 38% of women of childbearing age are overweight or obese, gestational diabetes has doubled (7.5% in 2012 → 15% in 2024), and hypertensive disorders are on the rise (p. 4). Mixed results: overall prematurity has decreased (6.7% compared to 7.3%) but extreme prematurity is increasing and infant mortality has risen to 4.08 ‰, placing France 21st in Europe out of 27 (p. 4-5).

Underutilised early levers, underestimated maternal mental health

The report documents a significant deficit in upstream prevention: only 27.2% of women take folic acid before pregnancy, early prenatal care covers only 62% of women and postnatal care 25% (p. 5-6). Perinatal mental health appears as a priority: nearly 200,000 women/year affected by psychological distress at two months postpartum, suicide among the top two causes of maternal mortality since 2013, and 73% of non-utilisation of antenatal care among women in difficulty (p. 10-11). In response, the agency lists free resources and effective interventions (Panjo, guides, websites, bilingual booklets) that can be mobilised from the preconception period (p. 12-16).

2. KEY POINTS OF THE DOCUMENT

1. Infant mortality is the most concerning signal: 4.08 deaths per 1,000 live births in 2024, an average increase of 1% per year between 2014 and 2024, with a significant drop in the DROM (> 6 ‰) and the Grand Est (≈ 5 ‰). Perinatal conditions account for more than half of infant deaths in 2023, congenital anomalies nearly 20% (p. 4-5).

2. Preconception health is deteriorating: gestational diabetes has doubled in twelve years (7.5% → 15%), overweight/obesity affects nearly 38% of women of childbearing age, against a backdrop of increasing maternal age. These combined factors increase pregnancy complications (p. 4).

3. First joint analysis of 5 population registers: national prevalence of major congenital anomalies at 3.5% (352.5 cases / 10,000 births), higher than the European average (2.7%), over the period 2019-2021; 24% of cases underwent an IMG. The risk of genetic anomalies increases significantly with maternal age (up to ×8 after 40 years) (p. 5).

4. Upstream prevention remains very underutilised: 27.2% taking folic acid before pregnancy, 15.7% receiving advice on CMV, early prenatal care at 62% and postnatal at 25%, with significant territorial disparities (lower usage in Île-de-France, Centre-Val-de-Loire, Guyane) (p. 5-6).

5. Perinatal mental health is finely quantified: at 2 months postpartum (mainland, 2021), ≈ 17% with depressive symptoms, > 27% with anxiety, ≈ 5.5% with suicidal thoughts; 83% of depressed women are also anxious; up to > 30% depression in Guadeloupe. Suicidal thoughts rise to 5% at twelve months postpartum, and 73% of women with antenatal mental health difficulties do not seek care (p. 10-11).

3. ACTION TRACKS FOR LOCAL ACTORS

1. Prioritise early contact by actively promoting prenatal care (mandatory since 2020) and early postnatal care (since 2022), which have low coverage (62% and 25%): these consultations are associated with better access to mental health care (p. 5-6, p. 11).

2. Systematise information on folic acid supplementation from the pregnancy project, relying on the leaflet/poster "I think baby – I think B9" available on mangerbouger.fr, to close the gap with the current 27.2% (p. 5, p. 15-16).

3. Integrate the identification of perinatal psychological distress into pathways, by mobilising identified high-use services — home visits by midwives, meetings with a social worker, birth preparation sessions — to reduce non-use by 73% (p. 11).

4. Deploy or relay evidence-based home interventions like Panjo for families in at-risk psychosocial contexts (6 to 12 visits from pregnancy to the child's 12 months), in connection with PMI (p. 14).

5. Target the most exposed areas (DROM, Grand Est for mortality; Hauts-de-France for smoking at 17.1%; Guadeloupe for postpartum depression) for a differentiated allocation of prevention actions (p. 5, p. 8, p. 10).

6. Mobilise free multilingual and remote resources for vulnerable populations: bilingual health booklets (17 languages, chapter dedicated to the first 1000 days), Comede guide, Tobacco/Alcohol/Drugs info service (p. 16). Unmet need reported : the flu vaccination coverage remains very low (29% received against 56.4% offered), to be specifically addressed (p. 9).

4. ADDITIONAL REFERENCES

🔍➕ For more information, see the articles referenced by "Health Practices" on the topic of perinatality ➡️🔗https://pratiquesensante.odoo.com/5-1-perinatalite

1. Court of Auditors, The perinatality policy (May 2024) — evaluation of health outcomes and the organisation of care; complements the file with a political and organisational angle on the same indicators (neonatal mortality, inequalities, overseas).
   https://www.ccomptes.fr/fr/publications/la-politique-de-perinatalite
2. Instruction DGOS/P3/2025/118 of 4 August 2025 — experimentation of a care pathway for post-partum depression — recent operational framework for detection, referral and graduated care; extends the mental health section of the file.
   https://bulletins-officiels.social.gouv.fr/instruction-ndeg-dgosp32025118-du-4-aout-2025-relative-lexperimentation-visant-mettre-en-place-un-parcours-de-prise-en-charge-de-la-depression-post-partum
3. BEH No. 14/2025 — The early postnatal interview conducted by the midwives of PMI in Hérault (screening for PPD, data 2024) — concrete field feedback on the implementation of the EPNP, useful for local action.
   https://beh.santepubliquefrance.fr/beh/2025/14/2025_14_2.html

5. FREQUENTLY ASKED QUESTIONS (FAQ)

1. Why is infant mortality increasing despite medical advances?

It reaches 4.08 ‰ in 2024 (+1%/year between 2014 and 2024), mainly driven by neonatal mortality. Perinatal conditions (more than half of infant deaths in 2023) and the deterioration of maternal health upstream are to blame. The exact causes remain to be explored (p. 4-5).

2. What risk factors have worsened in ten years?

Advanced maternal age (>1 in 4 women ≥ 35 years), overweight/obesity (≈ 38 %), gestational diabetes (doubled to 15 %), and hypertensive disorders (5.5 %). They increase complications (p. 4).

3. Is prematurity really decreasing?

Yes for moderate prematurity (32-36 weeks), which lowers the overall rate to 6.7 %. But extreme prematurity (< 28 weeks) is increasing, from 0.31 % to 0.43 % of live births (p. 4).

4. What do congenital anomalies reveal?

A prevalence of major forms of 3.5 % (2019-2021), higher than the European average (2.7 %). Cardiac malformations are the most common; the risk of genetic anomalies increases up to ×8 after 40 years; 24 % of cases have led to a termination of pregnancy (p. 5).

5. What is the extent of perinatal mental suffering?

Nearly 200,000 women/year affected at 2 months postpartum: ≈ 17 % with depressive symptoms, > 27 % with anxiety, ≈ 5.5 % with suicidal thoughts. Suicide has been among the top two causes of maternal mortality since 2013 (≈ 15/year) (p. 10).

6. Why do so many women not seek mental health care during pregnancy?

73 % of women reporting antenatal psychological difficulties did not seek care. Women with pregnancy-related conditions (gestational diabetes, hypertension, anaemia) are more affected by this lack of care (p. 11).

7. What free tools can be mobilised right now?

The website 1000-premiers-jours.fr, the guide "From pregnancy to the arrival of baby, with peace of mind", the Panjo intervention (PMI), Vaccination-info-service.fr, the Tobacco/Alcohol/Drugs info service, and bilingual health booklets (17 languages) (p. 12-16).

6. REWRITING IN EASY TO READ LANGUAGE

What the document says

The health of babies and mothers is a problem in France.

There are fewer births than before.

Mothers are often older.

Worrying figures

• More babies die before 1 year old than before.
• Many women are ill before pregnancy. For example, they have diabetes or are overweight.
• Some babies are born with a malformation. It is a health problem present at birth.

The mental health of mothers

After birth, many women feel unwell in their minds.

About 1 in 6 women are sad for a very long time. This is called depression.

About 1 in 4 women are very scared or very stressed.

Many women do not dare to ask for help.

What needs to be done

• Help women early, before and during pregnancy.
• Talk with them during a special appointment. This appointment is called the early interview.
• Give advice on food and exercise.
• Offer home visits for families in difficulty.

Free tools exist. They help parents. They can be found online, by phone, or in several languages.

7. CROSS-SECTIONAL ANALYSIS — VALUES OF HEALTH PRACTICES

Literacy: Yes — the file refers to graded tools (illustrated guides, leaflets, postcard format, public websites, bilingual versions), and indicates that low health literacy is a risk factor for post-partum depression.

Empowerment: Partial — a qualitative study tested and optimised the pregnancy guide with pregnant women, but the involvement of beneficiaries remains sporadic and not systematised.

Participation : Low — a few participatory devices (preparation for birth, Evane study on parental experience), without a formalised co-construction mechanism described.

Community health : Moderate — collective dimension present via the PMI, home visits and territorial targeting, but the approach remains centred on the mother-child individual.

Ethics : Partially addressed — social and territorial biases are clearly identified (precarity, DROM, literacy), without in-depth discussion of cultural biases.

Human rights : Yes — equity and inclusion are at the heart of the discourse (reduction of social and territorial inequalities, access for migrant individuals via bilingual booklets and Comede guide).

Intersectorality : Yes — explicit health/social partnerships (CNAF for Evane, PMI, social workers, Comede), and cross-referenced data Inserm/DREES/DGS/DGOS.

Partnership : Yes — formalised models cited (Panjo supported by the PMI, coordinated monitoring system, future SNOOPI warehouse).

Combating discrimination : Partial — access inequalities are documented and a specific response exists for migrant individuals; non-judgment and diversity are not explicitly developed.

8. EVALUATION OF THE RELIABILITY OF THE RESOURCE

Scientific relevance : High. Reference institutional source (Public Health France), recent and cross-referenced data 2012-2024 (ENP, ENCMM, SNDS, EUROCAT registers, Epifane, neonatal screening). Caveat: format “press release” without detailed methodology — refer to source reports for the complete apparatus and confidence intervals.

Operational relevance: High for orientation and argumentation. The document clearly identifies priorities, target areas, and mobilisable free resources. Limitation: it indicates what to prioritise more than how to implement — it is a framing document, not a step-by-step intervention guide.

Internal coherence: no major contradictions noted. It should be noted that the displayed European ranking (21st/27 on infant mortality) differs from that of the Court of Auditors (22nd/34 on neonatal mortality) — two indicators and two distinct, non-contradictory scopes.

10. STRATEGIC HASHTAGS

#PerinatalHealth #Prevention #1000FirstDays #PerinatalMentalHealth #HealthInequalities #HealthPromotion #PostPartumDepression #healthpractices