Maternal Deaths in France: Better Understanding for Better Prevention. 7th Report of the National Confidential Survey on Maternal Deaths (ENCMM), 2016–2018

For the period 2016–2018, 272 maternal deaths were recorded, representing one death every four days in France due to a cause related to pregnancy, childbirth, or their aftermath. This figure corresponds to a maternal mortality ratio (MMR) of 11.8 deaths up to one year after the end of pregnancy, and an MMR limited to forty-two days of 8.5 deaths per 100,000 live births, which is in line with the average for European countries. Compared to women aged 20–24, the risk of mortality is 2.6 times higher for women aged 35–39, and 5 times higher for those aged 40 and older. Obese women account for twice as many maternal deaths as in the general population of pregnant women. There are regional disparities—women residing in the French overseas departments and regions (DROM) have a maternal mortality risk twice that of women in mainland France, a significant difference, though smaller in magnitude than in 2013–2015—and social disparities—mortality among migrant women is higher than among women born in France, with excess mortality particularly pronounced among women born in sub-Saharan Africa, whose risk is three times that of women born in France. One in three women (34%) met at least one criterion for socioeconomic vulnerability, compared to 22% in the overall population of women giving birth. A striking finding is the predominant role of suicides and psychiatric causes of death, which is confirmed for the 2016–2018 period as the leading cause of maternal mortality within one year (17%), with an MMR of 1.9 per 100,000 live births, representing approximately one maternal death from psychiatric causes every three weeks in France. Cardiovascular diseases are the second leading cause of maternal mortality (MM) within one year (14%) and the leading cause of MM within forty-two days (16%), with 1.3 deaths per 100,000 live births. After a dramatic halving over fifteen years, maternal mortality due to obstetric hemorrhage has remained stable compared to the previous three-year period (2013–2015), MMR of 0.9 per 100,000 live births, making it the fifth leading cause of MM within one year (7%) and the fourth leading cause of MM within 42 days (10%), placing it in the upper range among European countries. However, 60% of maternal deaths are considered “probably” (17%) or “possibly” (43%) preventable. This proportion—more than half of potentially preventable maternal deaths—shows that a reduction in maternal mortality is possible and must be achieved, with the goal of preventing all avoidable deaths. The most frequently cited factor is inadequate care; preventability linked to this factor is identified in 53% of deaths, all causes combined. A lack of organizational coordination in care is identified as a preventable factor in 24% of deaths; and a lack of interaction between the woman and the healthcare system in 22% of deaths. Beyond the numbers, the authors identified 30 key messages from the analysis of all maternal deaths occurring in France between 2016 and 2018. In line with the survey’s overarching principle of “better understanding to better prevent,” they focus on areas for improvement in care or its organization that contributed to the preventability of these deaths and were repeatedly identified in this series of stories that are both unique and exemplary.

Author(s): Deneux-Tharaux Catherine, Saucedo Monica

Publishing year: 2024

Pages: 232 p.

Collection: Studies and Surveys

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