Suicide is becoming the leading cause of death related to pregnancy or childbirth in France, according to a study.

Although they are rare, “maternal mortality” still exists in France, and suicide has become the leading cause, according to a study published on Wednesday by Inserm and Public Health France, not including the Covid pandemic.

Every year, about 90 women die from causes related to pregnancy or childbirth, on average once every four days, according to the 7th edition of this work, supported by the observation of gynecologists-obstetricians, anesthesiologists-resuscitators, wise women and epidemiologists.

“Increasing Confirmation of Suicide Weight”

Between 2016 and 2018, 272 maternal deaths were reported between conception and one year after the end of pregnancy. The European average maternal mortality ratio (11.8 deaths per 100,000 live births) was unchanged from previous studies. But this time, suicide, along with other psychiatric causes, is becoming the leading cause of maternal mortality (17%), ahead of cardiovascular diseases (14%).

“This was the second reason, it becomes the first: it is not a radical change in the trend, but an increase in the number of suicides,” Catherine-Denet Taro, director of research at Inserm.

In just 42 days after the end of pregnancy (the reference period for international comparisons), 197 deaths occurred between 2016 and 2018, predominantly caused by cardiovascular diseases.

Migrants and vulnerable women on the front line

“The two leading causes of maternal mortality—suicide and cardiovascular disease—are non-obstetric, and their absolute levels are increasing slightly,” notes the perinatal epidemiologist, inviting us to “take a global view of women’s health.”

For about a decade, obstetric hemorrhage is no longer prevalent, which is “good news,” she says. Having halved in 15 years, mortality due to excessive bleeding during childbirth or in the next 24 hours now remains at the high end of the range in European countries.

After 2018, Catherine-Dene Tarot said, “maternal mortality will increase due to the Covid pandemic, in particular because pregnant women are at greater risk of severe forms.” These deaths are caused by strong territorial and socio-demographic inequalities. The risk in overseas France is therefore double that in mainland France – previously the gap was higher.

Among migrant women, the mortality rate is on average twice as high as among native French women. And among maternal deaths, socially vulnerable women are 1.5 times more represented. Age also increases the risk, “noticeably” after age 35. And obesity: obese women have twice the maternal mortality rate.

Raising awareness among the general public and involving carers.

“Improvement is possible because more than half of maternal deaths are considered likely or possibly preventable, and in two thirds of cases the care provided was suboptimal,” the study highlights.

To avoid suicide, “personal and family risk factors for perinatal depression should be known to professionals (…) and taken into account throughout pregnancy and postpartum care,” experts emphasize. In addition to engaging all caregivers to identify mental health symptoms in the year following birth, they recommend educating pregnant women, others, and the general public about perinatal depression.

UN agencies estimate that by 2023, a woman will die every two minutes worldwide from complications related to pregnancy or childbirth (up to 42 days later).