The Netherlands consistently scores high among countries with the happiest children and mothers. What is the Dutch secret? The Northern Times looked into the history – and current state – of maternal care in the Netherlands to try and find out.
Maternal health starts with sexual education, which is provided with characteristic Dutch candour. Since 2012, Dutch elementary, secondary and special education schools have been required to include information about sexual orientation during sex education. Elementary schools can teach students one of two curricula: a standard version developed by the Rutgers resource centre for sexual education or an orthodox Christian version. Rutgers recommends starting discussing themes related to sexuality and physical autonomy with children as young as 4 or 5 years old.
That may seem pretty early, but the health outcomes are a pretty strong testament to that approach: teenage pregnancy and abortion rates in the Netherlands are consistently low and have been in decline over the past decade. As of 2016, fewer than 1,500 women under the age of 21 had given birth.
One of the most influential medical professionals in Dutch history is Aletta Jacobs, the first female university student and graduate in the Netherlands. Jacobs was born and raised in the Groningen village of Sappemeer and achieved her doctorate from the University of Groningen in 1879.
Jacobs was a pioneer for women’s sexual rights, ranging from improving forms of contraception to ensuring adequate health care and legal protections for prostitutes at a free clinic for vulnerable women. Her activism extended to securing better working conditions for women: she campaigned against women being forced to stand in factories for many hours without a break on the grounds that it could cause gynaecological problems. Jacobs saw unequal health outcomes as inextricably related to greater social inequality and was also active in the women’s suffrage movement. Jacobs wrote a book about her life and activism, titled “Memories: My Life as an International Leader in Health, Suffrage, and Peace”.
Modern Dutch health care in general is characterised in many foreigner’s minds by a reluctance to prescribe a pill for what ails you. This seems to be apparent when it comes to labour, too. Epidurals are relatively uncommon: 19 percent of women had an epidural in 2013 when giving birth for the first time, and 10 percent had one during their second childbirth. Caesarean sections are relatively rare, too: in 2013, only 16.4 percent of deliveries were C-sections.
One fact that comes as a surprise to some newcomers in the Netherlands is that many women still give birth at home. Across the globe, giving birth in a hospital setting became the norm over the course of the 20th century, and although more women around the world are opting for alternative settings outside the hospital, the Dutch numbers remain higher than most other European countries: in 2015, 13% of Dutch women chose to give birth at home. Interestingly, the majority of first and second generation women – around 75 percent– choose to deliver in hospital.
Even though it remains a popular option in the Netherlands, homebirth is only admissible if the mother and baby are low risk and show no signs of complications, and medical professionals – typically midwives – are on hand to make sure that childbirth goes safely. The Dutch health system regards midwifery as a full-fledged component of prenatal care and delivery.
Infant and maternal mortality
There does not appear to be a clear correlation between a higher rate of home births and increased risk to mothers or babies, but the Netherlands had something of a wake-up call about a decade ago: in 2010, the national infant mortality rate in the Netherlands was 9 births out of every 1,000. That was one of the highest rates in Europe at the time, but that is relative, since Europe is one of the safest regions on the planet in terms of infant health. As of 2015, the Dutch infant mortality rate was down to 3.3 out of 1,000.
As for maternal health, since 1970, there have been fewer than 20 women who died either during or shortly follow giving birth out of 100,000 live births. Even though the rate is inarguably low, the mortality rate among women with a migrant background (first, second or third generation) was more than twice as high as the general Dutch population as of 2012. Fewer first and second generation women have post-natal care, which is typically attributed to language barriers, but participation numbers are slowly rising.
You may be familiar with some of the basic Dutch traditions surrounding the birth of a child: after receiving a birth announcement within a few weeks after delivery, guests are expected to send one of seemingly thousands of different designs for “it’s a boy” or “it’s a girl” cards, then schedule a time to come by and congratulate the new parents, who will serve visitors beschuit met muisjes, biscuits covered in butter and topped with anise-flavoured sprinkles. Depending on your opinion of things that taste like liquorice, you may love or hate this little snack.
There are various theories about how this treat became synonymous with birth: anise has been used as an herbal medication in Europe at least as far back as the 16thcentury, and once upon a time, it was believed that anise would help new mothers produce more milk and restore the uterus to its normal size (which, for the record, happens naturally on its own). It is also unclear how the sprinkles came to be called “muisjes” (“tiny mice”), but it could be based on the stem of the seed sticking out of the blue or pink candy shell resembling a tiny tail.
In Friesland, some family and friends still celebrate a birth with a “poppeslok”: a glass of strong spirits in honour of the baby’s arrival. Back in the day, the beverage of choice, which was served in a communal vessel, was called “kandeel”: a mix of wine, cinnamon, cloves and raw eggs. This particular recipe was thought to strengthen anyone who took a sip, but it may only have strengthened their stomachs. Depending on the sex of the child, certain Frisian households still serve a “boffert”, a ring-shaped cake: for a baby girl, guests are served a “suikerboffert” and for a baby boy, visitors get a slice of a “krentenboffert”.
Whether a woman gives birth at home or in hospital, post-delivery in-home assistance – kraamzorg – is a defining feature of Dutch and Belgian maternal care, and likely goes a long way toward explaining why Dutch mothers report being some of the happiest in the world. For ten days after giving birth, these professionals provide new mothers with guidance on breastfeeding, help to take care of the mother and the baby, and answer new parents’ questions. “Kraamzorgers” used to be known as “bakers” (“birthers” – before it meant questioning where an American president was born) prior to 1900, and in 1923, a formal training programme was created for the profession. Child healthcare professionals (consultatiebureau) also pay home visits to families with babies throughout the first months of their life.
Once babies are born, Dutch moms and kids alike consistently report a high sense of well-being and happiness in the Netherlands. In 2013, UNICEF reported that Dutch children had the highest sense of well-being among rich countries, a status which is attributed to a wide range of factors: freedom to roam, less of a link between academic performance and self-worth, a structured upbringing, a decidedly un-hovering approach to parenting and the normalcy of working part time. The latter point is especially important to Dutch and foreign parents alike. The Dutch approach to providing support and resources for mothers and babies before, during and well after pregnancy seems to be a testament to making parenthood at least a little bit more relaxed.
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