A report by France's national public health agency, Santé Publique France, and the National Institute for Health and Medical Research (Inserm), found that 272 maternal deaths were reported from 2016-2018, the equivalent of one woman dying from childbirth every four days in France, and 11.8 deaths per 100,000 births.

"Maternal mortality remains rare, but we must stay vigilant," said Catherine Deneux-Tharaux, director of research at Inserm and scientific leader of the report, "because a certain number of risk factors, such as age or obesity among pregnant women, are becoming increasingly frequent. It also says something about our healthcare system."

Compared to Italy and the United Kingdom, France's maternal mortality rate is doing better, but it's not yet at the levels seen in Norway and Denmark. According to the report's experts, which included epidemiologists, obstetric gynecologists, midwives, intensive care anesthetists, psychiatrists and internists, who analyzed these deaths, 60% of the deaths are considered "likely" (17%) or "possibly" (43%) avoidable.

To measure maternal mortality, all deaths occurring during pregnancy – at 42 days (an ancient reference which historically corresponded to the return of menstruation) and up to one year after its end, as recommended by the World Health Organization (WHO) – were taken into account, whatever the cause of death, linked to pregnancy, childbirth and their aftermath. "This period of up to a year is all the more important given the WHO's emphasis on the importance of women's mental health and the fact that most suicides occur beyond these 42 days," explained Deneux-Tharaux.

Accounting for 45 deaths, suicide was the leading cause of death up to one year after giving birth, peaking around four to five months after childbirth. These were often first-time mothers with a proven psychiatric history or eating disorders. According to the director of Inserm, one of the ways to prevent these deaths is for those involved to be more aware of the signs of poor mental health.

"And for women who already have a history of mental health issues and are planning a pregnancy, we need to create a coordinated care pathway between outpatient care and maternity doctors. When the child arrives, all too often we act as if the story is over, whereas we know that the postpartum months are a period of great fragility for women," said Deneux-Tharaux. Among the other indirect causes of maternal mortality, deaths linked to cardiovascular disease (39 cases) came in second place. But these conditions represented the leading cause of mortality at 42 days. Experts are calling for better training of all perinatal professionals.

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