Infographics. Maternity wards: small structures, the first targets of closures

On Thursday evening, MPs approved by a large majority a three-year moratorium on maternity ward closures . The measure, proposed by the centrist Liot group, aims to combat infant mortality, which continues to rise according to figures published by the French National Institute of Statistics and Economic Studies (INSEE) in mid-April.

Since 2000, France has lost 264 maternity units, according to data published by the Directorate for Research, Studies, Evaluation and Statistics (Drees). In 2023, there were 457 maternity units, compared to 721 in 2000. "Every time a maternity unit closes, it is not because of political will, but because of a lack of caregivers," declared the Minister of Health and Access to Healthcare, Yannick Neuder , during a question to the government in mid-March.

Over the last decade , the rate of maternity ward closures (-14.5% between 2013 and 2023) has, however, been lower than the decline in deliveries (-17.6%). But these closures also lead to a decline in obstetric beds, the number of which fell from 20,172 to 14,051 between 2000 and 2023. Over the last decade, the rate of obstetric bed closures (-19.3%) has been higher than the decline in deliveries. It should be noted, however, that the data published by the Drees does not allow for the identification of cases where beds have been taken over by neighboring maternity wards.

During this three-year moratorium, an "inventory" must be carried out on maternity units performing fewer than 1,000 deliveries per year. In 2023, there were 205 such units (45% of the total). Until now, small facilities have been the first targets of closures. Of the seven facilities whose closure was announced by December 31, 2022, only the Les Lilas maternity unit in Seine-Saint-Denis had performed more than 1,000 deliveries per year. Six out of seven were type 1 maternity units (i.e., those with only an obstetrics department).

In recent years, there has been a concentration towards more technical establishments, classified 2a (combining obstetrics and neonatology departments), 2b (also having a neonatal intensive care unit) and 3 (when the maternity unit has all these services as well as a neonatal intensive care unit). In 2023, maternity units of types 2a, 2b and 3 thus represented 65% of maternity units in France, and concentrated 79% of beds and 84% of deliveries. In ten years, 80 type 1 maternity units have disappeared, while three type 2 maternity units have been opened, while the number of type 3 maternity units has stagnated.

Private clinics are the other victims of the maternity closures of recent years. In 2023, France had 102 private, for-profit maternity hospitals, 26 private, non-profit maternity hospitals, and 327 public maternity hospitals. The number of private maternity hospitals has halved since 2000. Over the same period, the number of public maternity hospitals also declined, but less significantly (-20%).

In 2023, only a quarter of births took place in a private clinic, compared to 41% 20 years ago.