Internationally regarded as a reflection of the overall quality of a country’s healthcare system, the maternal mortality rate is a key public health indicator. Coordinated by the Inserm EPOPé team since 1996 and led by Catherine Deneux-Tharaux, the Confidential Survey on Maternal Deaths (ENCMM) enables the comprehensive identification of the causes of death among women occurring before, during, or following childbirth. This makes it possible to gather all the information needed to understand the sequence of events leading to the death and to draw lessons for the future. This analysis, conducted by the National Committee of Experts on Maternal Mortality (operating under the auspices of Santé Publique France since 2014), helps identify potential shortcomings in the healthcare system, which are also responsible for non-fatal complications—more numerous but harder to study.

For the period studied, from 2010 to 2012, 256 maternal deaths were identified, representing 85 women who died per year in France. This figure corresponds to approximately 10 maternal deaths per 100,000 live births. This rate remains stable compared to the previous period (2007–2009) and is in line with the average for European countries. However, 56% of these deaths are considered “preventable” or “possibly preventable,” and in 59% of cases, the care provided was not optimal, indicating room for improvement.

Decline in direct mortality (during childbirth)

A major finding of this report is the one-third decrease over the past 10 years in mortality directly related to obstetric complications, hemorrhage, eclampsia, etc. For the first time, there has been a statistically significant decline in mortality from obstetric hemorrhage, with the rate halving over 10 years. These results reflect an overall improvement in the quality of obstetric care during the study period. However, nearly all remaining deaths from hemorrhage are considered preventable, and this remains the leading cause of maternal mortality in France (11% of deaths), whereas such deaths have become rare in other countries. Thus, "efforts must not wane, and the findings of this report allow us to identify new areas of focus to further reduce mortality from hemorrhage," the researchers state.

Persistent regional and social inequalities

Certain inequalities in maternal mortality persist and are cause for concern. These include regional disparities: 1 in 7 maternal deaths occurs in the Overseas Departments (DOMs), and the number of maternal deaths per live births in the DOMs is four times higher than in mainland France (40 versus 9 deaths per 100,000 live births).And social disparities: mortality among migrant women remains 2.5 times higher than that of women born in France. This excess mortality is particularly pronounced among women born in sub-Saharan Africa, whose risk is 3.5 times higher than that of women born in France. Analysis of these women’s life trajectories suggests, among other factors, that the language barrier may sometimes be involved in the chain of events leading to death.

Overall stability masking other trends

The overall stability in maternal mortality since 2007 can be explained by two phenomena:

• changes in the characteristics of the pregnant population, which place them at increased risk of maternal death (maternal age continues to rise, as do the rates of overweight and obesity);

• the increase in causes of death not directly related to childbirth complications: maternal deaths due to infection (9%), particularly those linked to influenza among unvaccinated women; sudden maternal deaths (9%); or maternal suicides (4%).

"Beyond the numbers, members of the National Expert Committee on Maternal Mortality (CNEMM) identified 22 key messages from this analysis intended for clinicians and public authorities (editor’s note: full report). "In line with the survey’s guiding principle, ‘better understanding for better prevention,’ we are targeting specific areas for improvement in care or its organization to prevent patient deaths, but also likely to prevent serious maternal complications that do not result in death but stem from the same systemic failures," concludes Catherine Deneux-Tharaux, the survey’s coordinator.

Learn more:

Maternal Deaths in France: Better Understanding for Better Prevention. 5th Report of the Confidential National Survey on Maternal Deaths (ENCMM), 2010–2012. Saint-Maurice: Santé publique France, 2017. 230 p.