It is a sad report of regression. Over the past ten years, infant mortality has increased in France, and particularly in Ile-de-France. This is increasing everywhere but “the increase in this rate seems more marked in Île-de-France than at the national level”, writes the Regional Health Observatory, the ORS, in a study published in June. In concrete terms, the average infant mortality rate (IMR) is estimated at 3.95 deaths per 1,000 live births over the past 19 years in Île-de-France compared to 3.63 per thousand in metropolitan France.
The situation is certainly not the same according to the territories, which have their own history. Seine-Saint-Denis has a much higher infant mortality (around 5 per thousand) than all the other departments, while Hauts-de-Seine and Seine-et-Marne have not experienced any increase.
France fell from 5th to 18th place
In total, in Île-de-France, between 2000 and 2020, more than 13,400 deaths were recorded among children under one year old, of which almost half (47.8%) in the first week of life. . And it is particularly in this age group, which is called early neonatal mortality, that the sharpest increase is recorded (on average, by 2.52% per year). “Ile-de-France has the highest 0-6 day mortality in the country since 2012,” writes the ORS. Children aged 7 to 27 days also die very slightly more, but less significantly, while so-called post-neonatal mortality (28-365 days) is declining.
This alarm signal is all the more worrying as infant mortality continues to fall in most other European countries, according to data from the Organization for Economic Co-operation and Development (OECD). While France was in 5th position among OECD countries in this area, it has gradually fallen back, to now be in 18th place.
Poverty and junk food are increasing
The explanations for this increase are multiple. First of all, there are economic and societal factors, such as the increase in diabetes, maternal obesity, linked to junk food. But also the increase in poverty, which leads more people to take less care of themselves and their pregnancy. “The least we can say is that it is not improving in the field of precariousness” cowardly Maylis Telle-Lamberton, epidemiologist at the ORS, at 20 Minutes. Its observatory published a vast regional diagnosis of the health of Ile-de-France residentswhich shows an increasing trend in massive obesity.
Women also give birth to their first child later and later, particularly in Ile-de-France. “Perinatal health is marked by an increase in the age of women at first childbirth, pregnancy-related morbidity (gestational diabetes and hypertension) as well as the percentage of people covered by state medical aid. These increases are probably partly responsible for more unfavorable perinatal health indicators in Île-de-France than elsewhere,” writes the ORS in its diagnosis.
Hypotheses that deserve to be dug
Finally, other factors more related to the evolution of the pressurized health system or medicine come into account, such as progress in neonatal resuscitation, which could “encourage resuscitation of very fragile and unviable newborns”. , “which can artificially increase early neonatal mortality,” says the ORS. “At one point we wondered if we wouldn’t let the children who had a congenital malformation be born, so that they could have a funeral, which is not possible if they are declared dead before,” explains the Professor Martin Chalumeau, pediatrician at Necker Hospital, researcher at Inserm and co-author of a remarkable study on the subject of infant mortality last yearwhich is the starting point of the ORS study.
But all these explanations are only hypotheses, which deserve to be dug in depth, believes the professor, who judges that “France does not give itself the means to explore the origin of this mortality”. He pleads for more data on death certificates: “We have the sex, the date of birth and the date of death but we do not know the geographical origin, if the mother is a migrant, if she has pathologies during the pregnancy, the level of income, the level of education, if there was a serious congenital malformation…” An evolution of the neonatal death certificate must soon be the subject of an order.