Key Points

Continuing Demographic Transition: Fewer Births, Older Mothers

• In 2024, France recorded nearly 660,000 live births (160,000 fewer than in 2012), with an average age at childbirth of 31.1 years (across all parities, ranking 12th out of 27 European countries from lowest to highest). More than a quarter of mothers were 35 or older at the time of delivery in 2024 (25.8% vs. 19.1% in 2012).

Increased risks before and during pregnancy, but progress in tobacco control

• Later pregnancies and poorer preconception health among women—with rates of overweight and obesity rising to 37.9% (2021), pre-existing diabetes at 0.92% (2024), and chronic hypertension at 1.63% (2024)—are contributing to an increase in pregnancy-related conditions: gestational diabetes reached 15.0% in 2024 (vs. 7.5% in 2012) and hypertensive disorders of pregnancy reached 5.5% in 2024 (vs. 5.1% in 2019). These adverse trends call for heightened vigilance. On the other hand, smoking rates are declining: only 11.8% of women were smoking during the third trimester of pregnancy in 2021 (compared to 17.1% in 2010 in mainland France).

Childbirth: Between a Return to Physiology and Increased Medicalization

• Episiotomies have dropped (2.8% in 2024 for unassisted vaginal deliveries vs. 16.2% in 2012), reflecting a shift toward more physiological practices. However, this trend is accompanied by an increase in severe perineal tears (1.36% in 2024 vs. 0.68% in 2012) and severe postpartum hemorrhage (0.92% in 2024 vs. 0.67% in 2012), the rise in which could reflect both the consequences of the reduction in episiotomies and those of the parallel increase in cesarean sections (22.0% in 2024 vs. 20.4% in 2012), as well as changes in women’s health status before and during pregnancy or improved detection of these complications. These opposing trends raise questions about the balance between physiology and medical intervention, and about their respective impacts—both medical and on women’s well-being and satisfaction.

Preterm births are declining, but extremely preterm births are on the rise

• Despite the increase in several risk factors for preterm birth (obesity, diabetes, hypertension, advanced maternal age, etc.), the preterm birth rate has declined to 6.7% in 2024 (vs. 7.3% in 2012), with a significant drop between 2019 and 2020. This positive trend is driven by a decrease in moderate preterm births (32–36 weeks’ gestation). In contrast, extremely preterm births (22–27 weeks’ gestation), although rare, are on the rise (0.43% in 2024 vs. 0.31% in 2012).

Infant Mortality: A Worrying Trend

• In France, infant mortality (deaths between 0 and 364 days) continues to rise, now ranking the country 21st out of 27 European countries in 2024 (from lowest to highest) with 4.08 deaths per 1,000 live births. This increase is driven by rising neonatal mortality—both early (0–6 days) and late (7–27 days)—while post-neonatal mortality (28–364 days) remains stable. In 2023, approximately half of all infant deaths were attributed to perinatal conditions, for which the death rate increased significantly between 2014 and 2017, partly due to deaths from pregnancy-related complications. However, the analysis of causes of death among infants under one year of age is limited by the growing proportion of incomplete death certificates since 2020, with a more pronounced lack of information in cases of early death.

Prevention and Prenatal/Postnatal Care: Room for Improvement

• In 2021, only 27.2% of women took folic acid before pregnancy (recommended to prevent neural tube defects), and 15.7% received counseling on preventing cytomegalovirus (CMV) infection. Early prenatal care (62.1% in 2024—introduced in 2007 and made mandatory in 2020) and early postnatal care (24.9% in 2024 —introduced and made mandatory in 2022) are struggling to achieve universal coverage.