Born into Inequality : Organizational and Environmental Influences on Reproductive Health

There are high rates of inequality between birth outcomes across wealthy and impoverished neighborhoods in the Netherlands. The most pronounced inequalities can be found in Rotterdam, where the rate of perinatal mortality is 10 times higher in the poorest neighborhoods than in the richest neighborhoods. With such high rates of inequality, the Netherlands is home to one of the highest recorded disparities in birth outcomes across neighborhoods in any developed country. Substantial inequalities are not only found across neighborhoods, but also across different social groups. Women of low socio-economic status and/or with a non-Western ethnic minority background show the worst birth outcomes. Reducing inequalities in birth outcomes has become a primary concern for the Dutch government. In line with this concern, this thesis aims to increase our understanding of reproductive health inequalities (and birth outcomes, in particular) and to propose ways for addressing them. More specifically, this thesis focuses on two themes that have been identified by two recent scientific reports as key to reducing reproductive health inequalities: a) improving pregnancy-related health behaviors and b) strengthening coordination between midwives and obstetric caregivers.