Strategies to Reduce Perinatal Health Inequalities

Abstract

Promotion of healthy pregnancies has gained high priority in the Netherlands because of the relatively unfavorable perinatal outcomes compared to surrounding countries which was confirmed by two consecutive European reports on perinatal health. Additionally, large inequalities were observed within the Netherlands. Poor perinatal outcomes seemed to be more prevalent in deprived areas and were often associated with socio-economic and ethnic minority related risk factors such as low-income or less integration into society. Research revealed that in 85% of all cases mortality was preceded by perinatal morbidity (e.g. preterm birth, small-for-gestational age, suboptimal start or congenital anomalies), also known as Big 4 morbidities. In addition, it was demonstrated that non-medical risk factors (social and lifestyle risk factors) had an equally high impact of perinatal outcomes when compared to medical and obstetrical risk factors, and that the accumulation of these risk factors could even further harm the chances of a good pregnancy outcome. Non-medical risk factors and risk accumulation were especially observed in deprived areas. This information made perinatal mortality an important political and social issue, which led to many national and local initiatives in the Dutch antenatal healthcare field.

In this thesis, the aim was threefold: 1) to evaluate initiatives that were implemented to improve perinatal morbidity and mortality rates in the Netherlands, 2) to investigate the influence of neighbourhood deprivation on perinatal outcomes, and 3) to investigate the contribution of (the assessment of ) non-medical risk factors. Our results were therefore presented and summarized in three parts.