Perinatal mortality in the Netherlands. Backgrounds of a worsening international ranking

Perinatal mortality rates have dropped sharply in the past few decades, in the Netherlands as well as in all other European countries. However, as the decrease has generally slowed down since the 1980s, the Netherlands has lost its prominent position in the international ranking of countries with favourable perinatal mortality rates. This lower ranking is not only the result of the dialectics of progress, but also the consequence of a relatively restrained use of antenatal diagnostics. In addition, the Netherlands is among the European countries scoring highest on a number of important risk factors. This article examines the effect on perinatal mortality rates of known risk factors, in particular the presence of non-western foreigners, multiple births and older mothers. With respect to the latter factor, it is concluded that children of older mothers run a significantly higher risk of foetal mortality, whereas babies of young mothers (including women in their early twenties) run a higher risk of infant mortality. For babies of non-western mothers, infant mortality rates are higher, although there are substantial differences between ethnic backgrounds. First week mortality is most unfavourable for Surinamese and Antillean/Aruban children, and post-neonatal mortality is highest among Turkish and Moroccan babies. The fact that relatively many non-western foreigners from countries with relatively high risks of perinatal mortality have settled in the Netherlands, is one of the reasons for the fall in the international ranking. Lastly, the increase in the number of multiple births has been stronger in the Netherlands than in most other countries. The higher incidence of assisted reproduction explains most of this increase.