The results show that indicators are generally less favorable than in mainland France and highlight the need to better understand the factors driving these trends in order to tailor prevention and care initiatives. The ENP-DROM is being conducted for the first time, simultaneously, across all the DROMs. It provides a description of the key indicators of the health status of women and children at birth and two months postpartum, and allows for a more detailed analysis of the situation in each of the overseas departments, regions, and communities covered by the study.

Essential information for a better understanding of perinatal health in the overseas territories

The ENP-DROM, conducted for the first time in 2021, is a study co-led by Santé publique France and the relevant regional health agencies (ARS). The study enabled the collection of samples of 800 to 1,000 births per DROM in the overseas departments and regions that wished to participate. Women were interviewed in the maternity ward and then two months after delivery. The ENP-DROM thus makes it possible, for the first time, to produce robust indicators and conduct a detailed analysis of the situation in each territory. These data can then be compared with those from the 2021 National Perinatal Survey, which uses the same methodology in mainland France and is coordinated by INSERM. These initial results pertain to Martinique, Guadeloupe, and Réunion. Reports on Mayotte and French Guiana will be published at a later date.

Higher risk factors during pregnancy and childbirth than in mainland France

The results of the 2021 ENP-DROM in Guadeloupe, Martinique, and Réunion show, across the board, less favorable health indicators and risk factors than in mainland France, within a context of greater precariousness. In fact, the proportion of households reporting a monthly net income of less than 1,000 euros ranged from 25.1% to 33.4%, compared to 7.5% in mainland France.

The proportion of women who were obese before pregnancy was higher (between 22.1% and 24.9%, compared to 14.4% in mainland France). This prevalence, which increases the risk of chronic diseases for women as well as obstetric and neonatal complications, is a cause for concern.

The data also show less controlled fertility in the territories studied, notably with a proportion of pregnancies that occurred too early or were unwanted of 23.7% in Réunion, 28.6% in Guadeloupe, and 32.8% in Martinique, compared to 16.6% in mainland France.

Certain indicators related to children were more unfavorable in these territories. This is the case for the proportion of children with low birth weight (less than 2,500g), which was generally higher in these DROMs (between 10.5% and 12.4%, compared to 7.1% in mainland France).

Another notable point is that at two months of age, more than one in three children slept in their parents’ bed in these DROMs, compared to about one in ten in mainland France. Recommendations (HAS, 2020) advise that infants sleep in their parents’ room during the first 6 months of life, but in a separate bed and on their backs. These figures underscore the importance of more widely disseminating prevention messages regarding sudden infant death.

Breastfeeding and tobacco use: more favorable indicators in these regions

Other indicators show that behaviors more conducive to maternal and child health are more common in these territories than in mainland France. Lower rates than those in mainland France were recorded regarding the proportion of women reporting tobacco use during the third trimester of pregnancy, ranging from 3.9% to 8.7% in the DROMs, compared to 12.2% in mainland France.

Furthermore, breastfeeding was more widely practiced, both in the maternity ward and two months after birth. In Guadeloupe, Martinique, and Réunion, 82.6% to 93.6% of children were exclusively or partially breastfed in the maternity ward (compared to 69.7% in mainland France). At two months, these rates ranged from 66.0% to 76.1%, compared to 54.2% in mainland France.

The wealth of data collected in the ENP-DROM study will enable numerous complementary studies to be conducted in order to better understand risk factors and protective factors, and thus identify potential levers that take into account not only the individual characteristics of women but also the local context in which they live.
As part of the “First 1,000 Days” strategy, the ENP-DROM study thus enables the production of perinatal indicators that will help drive changes in public policies and clinical practices across the overseas departments, regions, and local authorities. They will also enable the analysis of the dissemination of best practice recommendations issued by representative bodies of healthcare professionals, the estimation of prevention needs, and the guidance and evaluation of public policies related to perinatal care.