According to a recent report by UNICEF, the rates of stillbirths in the Netherlands have declined drastically in recent years. While this is good news, it is necessary to know whether such improvements are actually present in all groups of society.
In a recent study, our research team from Erasmus MC [1, 2, 3, 4] and the Erasmus School of Economics , investigated how trends in birth outcomes looked different for distinct levels of neighbourhood poverty. We found that poor neighbourhoods experienced the largest improvements in absolute terms.
Health inequalities refer to differences in health that exist between more and less advantaged groups in the population. They are an increasing concern as many countries have observed a growing gap between the rich and the poor. We can observe health inequalities throughout the entire life-course, even since the first moments of life. For example, babies from mothers living in poor neighbourhoods have a higher risk of being premature or stillborn compared to those from rich areas.
Less stillbirths in the Netherlands
A recent report by UNICEF found that the number of stillbirths in the Netherlands decreased drastically in the last 20 years. Stillbirth refers to the loss of a baby before birth. In the year 2000, there were 5.2 stillbirths per thousand births in the Netherlands. In 2019 there were 2.3 per thousand births, corresponding to a decrease of 55%. While this is seemingly good news, the results from this report leave some important questions unanswered: was this decrease similar for all groups in society? In other words: did the decrease in stillbirths also result in a reduction in health inequalities? And what happened to other important adverse pregnancy outcomes, such as premature birth and being too small?
In our study (published in 2020), we looked at trends in birth outcomes in the Netherlands and how these differed across levels of neighbourhood poverty. We studied over two million births in the Netherlands between 2003 and 2017 using the Dutch Perinatal Registry. To assess neighbourhood poverty we used the Deprivation Index, which summarizes information on different neighbourhood socioeconomic characteristics. Based on this index, we assigned the births to one of five neighbourhood poverty categories (low to high poverty) according to the mother’s residential address. The birth outcomes we examined were premature births (births that occurred before 37 weeks of pregnancy), perinatal death (loss of the baby after 24 weeks of pregnancy or up to 7 days after birth), and small-for-gestational-age (SGA, birth weight below the 10th centile adjusted for gestational age and sex of the baby).
Findings: Largest improvement in poor neighbourhoods
We found that overall, babies from mothers living in the poorest neighbourhoods were much more likely to experience adverse birth outcomes. For example, 14% of births from the poorest neighbourhoods were SGA, while this was 9% in the richest areas. On a more positive note, we saw that the rates for all adverse outcomes declined for all groups. Notably, the decrease in adverse outcomes was the largest in the poorest neighbourhoods. This large improvement resulted in a reduction in the (absolute) differences between groups, a sign of smaller health inequalities.
Actions to reduce health inequalities
It is good news that the poorest neighbourhoods are the ones benefiting the most from the health improvements. Nevertheless, the gap between rich and poor areas is still present and we need to continue investing in public health actions to reduce it. For example, we must keep the support to initiatives that provide care for the most vulnerable, such as Kansrijke Start, Moeders van Rotterdam and Healthy Pregnancy 4 All. Furthermore, we need to pay more attention to how neighbourhoods influence our health, what can be done to improve them, and whether this can help reduce health inequalities. Health inequalities in birth outcomes in the Netherlands seem to be narrowing, however, there is still work to be done to close the gap between the most and least advantaged groups.
About the author
Lizbeth Burgos Ochoa is a PhD student at the department of Obstetrics and Gynecology at Erasmus Medical Centre. Her main focus is on the study of early-life health inequalities. You can contact her via email: firstname.lastname@example.org