A recent study conducted by Inserm, Université Paris Cité, Inrae, Université Paris Nord, and AP-HP, published on September 16, 2025 in BMJ Medicine, suggests that part of the increase in neonatal mortality in France could be linked to socio-economic inequalities.
Among the lead researchers, Jennifer Zeitlin, epidemiologist and research director at Inserm (OPPaLE team, CRESS), coordinated the study. A specialist in perinatal health and social inequalities, she emphasizes the need to better understand how socio-economic conditions impact the very first days of life.
Measuring community-level disadvantage in perinatal health
The research team developed a perinatal social disadvantage index for every municipality in mainland France. This index takes into account several factors previously associated with newborn health outcomes: local unemployment rate, proportion of immigrants, share of tenants, percentage of single-parent families, and median household income.
The researchers then linked this index with neonatal mortality data (defined as deaths occurring between birth and the 28th day of life) across two periods: 2001–2008 and 2015–2020, using France’s National Health Data System (SNDS).
Key findings: sharp disparities by socio-economic context
The results reveal striking inequalities:
- In 2015–2020, infants born to mothers living in the most disadvantaged municipalities (the bottom 20%) had a neonatal mortality rate of 3.34 per 1,000 live births, compared with 1.95 per 1,000 in the most advantaged areas — meaning a 1.7 times higher risk in the poorest communities.
- If all newborns in France had faced the same risk as those in the most advantaged quintile, nearly one-quarter of neonatal deaths (about 2,496 between 2015 and 2020) could potentially have been avoided.
- The increase in neonatal mortality over time was concentrated solely in the most disadvantaged municipalities, while rates in better-off areas remained stable.
Possible explanations and policy recommendations
According to Jennifer Zeitlin and her colleagues, several mechanisms may contribute to this link between social disadvantage and neonatal mortality:
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Maternal health factors such as obesity, smoking, and exposure to pollution, more prevalent in disadvantaged groups, which increase risks of preterm birth and low birthweight.
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Access to and organization of healthcare, which can be more limited in deprived areas, with neonatal intensive care units facing staffing shortages and service pressures.
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Prenatal care decisions, including medical terminations or management of fetal conditions, which may vary depending on access to specialized services and available information for parents.
To address these disparities, the team recommends conducting territory-level audits of perinatal care services, especially in high-risk areas, to ensure adequate staffing, training, and infrastructure.
Conclusion
This study, led by Jennifer Zeitlin, highlights that neonatal health outcomes in France remain deeply tied to social and territorial inequalities. The recent rise in neonatal mortality disproportionately affects the most disadvantaged populations, underscoring the urgent need for targeted public health measures to reduce inequalities from the very start of life.
