An analysis of INSEE civil status data between 2001 and 2019, conducted by researchers from Inserm, AP-HP and University Hospital Nantes in collaboration with teams from the University of California, found that the infant mortality rate in France has been steadily increasing since 2012.
However, according to Jennifer Zeitlin, epidemiologist at INSERM, who took part in this analysis, there is no reason to worry about future mothers planning to give birth in France. On the other hand, now that the developed countries have reached a relatively low infant mortality rate and the rate is falling more slowly, it is not normal for this mortality rate to stagnate or even slightly increase for several years in a row.
Without being able to clearly identify the factors responsible for this trend, the INSERM researcher answered questions from 66 million impatient patients to contextualize this data and propose possible explanations.
66 Millions d’Impatients: How has the infant mortality rate in France evolved in recent decades and do we have good results compared to countries with which this rate is comparable?
Jennifer Zeitlin: In France, with a rate of 3.56 deaths per 1000 live births in 2019, we are close to neighboring countries such as the United Kingdom (3.7/1000 births), the Netherlands (3.6/1000) or even Germany, where the rate high is slightly lower (3.2/1000).
As a reminder, child mortality in France has been halved every 15 years for the past 60 years. In 1960 it was 28/1000, in 1975 14/1000 and in 1990 7.3/1000 births. Of course, the lower the numbers are, as is the case in most developed countries, the less progress we make on child mortality. However, there are European countries, particularly the Nordic countries, whose infant mortality rate has continued to decrease in recent years and is now around 2/1000 births, such as Norway and Iceland. This gives us hope to further improve our results significantly.
66 million impatient: far from improving our results, on the contrary, child mortality in France has increased a little every year since 2012?
Jennifer Zeitlin: Absolutely, as we see a slight increase between 2012 when the infant mortality rate was 3.32/1000 and 2019 when it was 3.56 deaths per 1000 live births. At the moment we have not carried out any analyzes that allow us to say that this is related to this and that phenomenon or factor.
However, there is nothing to make the mothers panic; There remains a great chance to give birth in Europe because the infant mortality rate is much higher in some developed countries than here. In the United States, for example, it was 5.7 per 1,000 in 2018.
66 million impatient: what are the factors that are difficult to act on?
Jennifer Zeitlin: There are indeed certain components of infant mortality that will be difficult for any country to take action on once it reaches very low levels. This is the case with very great prematurity or fatal congenital anomalies. With these congenital abnormalities, there is an opportunity to screen during pregnancy and perform medical abortion. On this point, France has a very active policy of screening for congenital anomalies and proposing medical abortion. It is therefore probably not a lever on which, based on current knowledge, we could intervene strongly to reduce the infant mortality rate in our country. Some analysts point out that for several years there has been a tendency among the couples concerned to want to continue the pregnancy to the end, despite the extremely low chances of the child surviving. In my opinion, this is a marginal trend that cannot really explain the increase in infant mortality since 2012.
66 Millions d’Impatients: And what’s your analysis on extreme prematurity?
Jennifer Zeitlin: This is an interesting point because it highlights the fact that the death rate is related to the way births are counted. In this case, prior to 2015 in France, compared to other European countries, there was little intervention to revive premature extremes and this is beginning to change. Therefore, since these years, more children are likely to be counted among live-born babies, which could partially explain the increase in infant mortality rate since their survival rate is very low.
66 Millions d’Impatients: What other factors could explain this increase in our infant mortality rates and how could this trend be reversed?
Jennifer Zeitlin: There is probably no single factor that explains the increase in infant mortality in France, but most likely a combination of factors. Several assumptions are made. The first relates to the development of the characteristics of pregnant women. For example, mothers are getting older today. With increasing age, not only do the chances of pregnancy decrease, but the complications during pregnancy also increase significantly. Obesity could also be a factor hampering the improvement of infant mortality rate as it has increased a lot in our country in recent years, but also overweight and obesity can lead to complications during pregnancy. Finally, the percentage of women in France who continue to smoke during their pregnancy is high. This is a factor that distinguishes us from, for example, the Nordic countries where smoking among young women is declining.
Regarding the last two factors, preventive measures could be implemented and would undoubtedly improve infant mortality rates. Maternal age seems more difficult to act on, even though in Finland, for example, the state has for some time been pursuing policies aimed at encouraging women to have slightly younger children.
There is another important factor to respond to, and it relates to the fact that around the world, and France is no exception, infant mortality rates are higher among socially disadvantaged women, particularly because they are more likely to give birth prematurely. This seems logical as we already know that the health of the most disadvantaged women, and even more so migrant or refugee women, is worse off, partly because they are less familiar with the healthcare system and have difficulty accessing it. By improving our understanding of the factors that explain this situation, or by reducing social inequalities, there is a chance that infant mortality can be reduced as a result.
66 million impatient: will we soon know why the infant mortality rate has increased in France?
Jennifer Zeitlin: No analysis has yet been performed to explain this upward trend in infant mortality rates in France. This type of analysis also relies on numerous data, which are still too scattered, since they are collected by different institutions in France (hospital data, INSEE, INSERM, CNAM, etc.). However, we are making progress with the establishment of the National Health Data System (SNDS) and we will soon be able to more easily correlate this data to identify the factors influencing the evolution of infant mortality. Understanding the factors involved in infant mortality will also improve overall perinatal health. I therefore propose a meeting in 5 years to explain the reasons that have led to the increase in mortality and to identify options for action.