[Organization of Perinatal Care in Mainland France 2016-2021: Overview, trends, and regional comparisons]

The increase in infant mortality in France, driven by the rise in neonatal mortality, raises concerns about the quality of perinatal care. While better organization is identified as a key improvement strategy, data are sparse on the organizational characteristics of maternity units in France.

This study describes the organization of perinatal care in mainland France in 2016 and 2021, at both national and regional levels, based on data from the National Perinatal Surveys and Annual Hospital Statistics. Six indicators were analysed: maternity unit volume (annual number of births), authorization type, triple on-call coverage (continuous presence of an obstetrician, anaesthesiologist, and paediatrician), understaffed obstetric teams (fewer than 7 full-time equivalents), midwives' workload (ratio of midwives-to-births), and use of temporary staff.

Between 2016 and 2021, the number of maternity units decreased by 8%, and the number of births by 9%. In 2021, 42.5% of maternity units performed fewer than 1000 deliveries per year, 55.4% did not provide triple on-call coverage, 65.9% of obstetric teams were understaffed, 21.1% of midwifery teams had a very high workload, and 68.0% of units used temporary staff at least once a month. These issues varied significantly depending on the region and the unit's level of care.

A large part of the maternity care system was affected by organizational challenges. Their impact on perinatal health needs to be assessed to propose effective solutions for the upcoming revision of the 1998 perinatal care regulations. Significant regional disparities also call for responses tailored to local specificities.