14 mars 2023
Maternal mortality has been stable in France for several years. But that does not mean that it does not undergo any evolution. The latest national monitoring data reveals that cardiovascular disease and suicide are now more common causes than bleeding. Another observation: the inequalities that lead to delays in care remain profound.
What are pregnant women and young mothers dying of in France? This is the question answered by the enhanced maternal mortality surveillance system called Confidential National Inquiry into Maternal Deaths (ENCMM). Its latest barometer – which identified every death occurring during pregnancy, labor and delivery and up to a year following childbirth between 2013 to 2015 – reports a total of 262 deaths, which translates to 10.8 per 100,000 live births.
First observation: unlike previous years, “Obstetric hemorrhage is no longer the leading cause of maternal mortality”, note the editors of the Weekly Epidemiology Bulletin (BEH) which echoes it. It is now “indirect” causes that take precedence: specifically cardiovascular diseases and suicide.
How to explain this change? With regard to cardiovascular diseases, the figures “probably reflect the demographic evolution of pregnant women in France”, suggest the authors. Indeed, women have children later in life, which exposes them more to these pathologies favored by aging. Moreover, now “cardiovascular disease and suicide are the leading causes of death in many high-income countries,” generally.
Disadvantaged women from the DROMs and women born in Africa
Another observation: regional and social disparities in maternal mortality persist. The former clearly disadvantage women in the overseas departments and regions (DROM). Indeed, maternal mortality is three times higher in Martinique, Guadeloupe, Guyana, Reunion and Mayotte, compared to metropolitan France.
Social inequalities put women born in sub-Saharan Africa at greater risk than those born in France or in other countries. More specifically, these women experience greater delays in care than others. This may be a delay in the decision to consult, a delay in arrival at a health facility or a delay in the delivery of an appropriate offer of care, depending on the quality criteria of the care defined by the World Health Organization (WHO).
How to prevent preventable maternal deaths?
Most deaths linked to delayed care “would probably have been avoided by modifying prevention strategies, the organization of care or the care itself”, say the authors. This is why it is important to concentrate prevention actions both “on reducing inequalities in pregnancy-related care”, they specify. While acting “on cardiovascular health and mental health during and following pregnancy. » With for “ultimate goal of preventing all preventable maternal deaths. »
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Source : BEH, 14 mars 2023
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Written by : Dominique Salomon – Edited by: Emmanuel Ducreuzet
