Health. Infant mortality: Will the vote for a moratorium on maternity ward closures reverse the trend?

"One in 250 children dies before their first birthday," warned the INSEE in April . The institute then revealed France's infant mortality rate, which rose from 3.5 deaths per 1,000 live births in 2011 to 4.1 per thousand in 2024. This rising figure ranks France ^23rd out of 27 in the European Union.

A moratorium on maternity closures

To curb this "alarming" trend, Paul-André Colombani, MP for South Corsica, defended a bill on Thursday during the parliamentary recess of the Liot group (Liberties, Independents, Overseas Territories). The bill plans to create a "national birth register" to gather previously scattered statistical information and better understand the reasons for the current trend. Ongoing training for professionals in emergency obstetric procedures must also be implemented.

But the text's flagship measure is the creation of a three-year moratorium on maternity ward closures. "Behind this figure are human tragedies. It is unacceptable to push women even further away from their place of birth," the Corsican MP, a doctor by training, protested. In 1975, there were 1,369 maternity wards in France, compared to only 457 today.

Less security in small maternity wards?

The rise in infant mortality involves "complex realities and multiple factors that we must analyze with hindsight," said Health Minister Yannick Neuder , pointing in particular to "demographic factors such as the later age of the first child and the increase in multiple pregnancies, as well as the extreme age of mothers."

"A maternity ward that performs few deliveries may offer less safety due to a lack of regular obstetric procedures," argued Renaissance MP Jean-François Rousset.

The adoption of this moratorium was not a given since the measure had been withdrawn from the text by the Social Affairs Committee to replace it with the obligation of "a prior assessment of possible alternatives" before the closure of a maternity unit.

The moratorium was finally reinstated in the bill, which was then approved on first reading by a large majority of MPs, with 97 votes in favor and 4 against. "This moratorium is not a systematic sanctuary. We must move away from dogmatic logic," said Paul-André Colombani, who wants the opportunity to maintain a maternity ward to be assessed on a case-by-case basis, according to the specific characteristics of the territory. An "inventory" will be carried out on maternity wards that perform fewer than a thousand births per year.

Yet some professionals see this as a smokescreen. "That's not the problem. Focusing attention on small maternity units distracts from the real issue: the chain of care following birth, that is, neonatal critical care," dismisses Elsa Kermorvant, vice-president of the French Society of Neonatology (SFN). The neonatology specialist highlights the fact that newborns who die as a result of out-of-hospital births are not very numerous compared to the total number of infant deaths.

"The leading cause of neonatal mortality is prematurity and its complications, the second is congenital malformations, and third is complications of childbirth," explains the professor, who works at AP-HP Hôpital Necker. "75% of newborns who die are premature. All these children cannot simply go to a maternity room; they need machines to help them breathe and feed, and sometimes require surgery and constant care. They are hospitalized in specialized units, in neonatal intensive care and intensive care for newborns, neonatal critical care."

Lack of nurses

According to her, the French dropout is therefore due more to the state of these services. "The number of beds is insufficient and their distribution is uneven across the country. Neonatal critical care services are saturated, 23% of them report regularly refusing admissions," says Elsa Kermorvant, who deplores the fact that her specialty is still governed by decrees dating from 1998 that have become inadequate.

"The second problem that has been demonstrated is that nursing staffing levels are very insufficient." According to a Quebec study, understaffed nurses combined with overcrowded services increases the mortality rate of premature babies.

"For extremely premature and critically ill newborns, countries like Switzerland, the United Kingdom, and Sweden have one nurse per patient, but in France, we struggle to have one nurse for every two patients," she points out.