Maternal mortality in France: the decline in deaths from haemorrhage is confirmed but social and territorial inequalities remain

These results are made public through the Triennial Report of the Confidential Enquiry into Maternal Deaths (ENCMM) coordinated by the Inserm EPOPé team, “Maternal deaths in France: better understanding for better prevention”.

For the period 2010-2012, 256 maternal deaths were identified, representing 85 women who died a year in France from a cause related to pregnancy, childbirth or their consequences. This figure corresponds to a maternal mortality ratio (MMR) of 10.3 per 100,000 live births, stable compared to the previous period 2007-2009, and in the average of European countries. However, 56% of these deaths are considered “avoidable” or “possibly avoidable” and in 60% of cases the care provided was not optimal, indicating room for improvement.

A major result of this report is the 1/3 decrease in direct maternal mortality over the last 10 years, mainly due to the statistically significant decrease in mortality from obstetric haemorrhage, the frequency of which was divided by 2 in 10 years, indicating improved care around childbirth. However, almost all of the remaining deaths from hemorrhage are considered avoidable and it is still the leading cause of maternal mortality in France (11% of deaths).

Some inequalities in maternal mortality remain unchanged and are a source of great concern. These are territorial disparities: 1 out of 7 maternal deaths occurs in the French overseas departments and the maternal mortality ratio in those departments is 4 times that in metropolitan France; and social disparities: the mortality of migrant women remains 2.5 times higher than that of women born in France, the excess mortality is particularly pronounced for women born in sub-Saharan Africa, whose RMM is 3.5 times that of native women.

Beyond the numbers, the authors have identified 22 key messages from the analysis of all maternal deaths in France in 2010-2012. According to the general principle of the survey, “better understanding for better prevention”, they target elements of the content or of the organization of care which are involved in the avoidability of these deaths and can be improved, and that have been repeatedly identified in this series of stories both unique and exemplary.

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