Perinatality: French cost-benefit studies and decisions on handicap and prevention.

The Perinatal Care Programme (or 'Périnatalité') was implemented between 1970 and 1975 by the French Ministry of Health, with the aim of reducing the number of birth-related accidents, i.e. the number of deaths and injuries occurring during the perinatal period. It aimed to reduce the perinatal mortality rate from 26/10(3) in 1970 to 18/10(3) in 1980. To give an order of priorities to the actions, a cost-effectiveness evaluation was made. The ratio (Cost over 15 years)/(Number of deaths + number of handicap cases avoided during the same period) indicated that first place should go to resuscitation in the labour room, which cost only 200 francs to save a life while avoiding after-effects. The other measures concerned the training of medical personnel, the development of statistics and research, inoculation against German measles, intensification of antenatal supervision, improvement of supervision during confinement, and the creation of intensive resuscitation units. Evaluation of the programme is still going on. The perinatal mortality rate has considerably decreased, with the objective foreseen for 1980 already reached in 1975. The handicaps will be traced through the results of obligatory screenings at birth, nine months and two years.