Joyce Molenaar

A SOLID START FOR THE DUTCH FIRST THOUSAND DAYS-APPROACH Insights into program adoption, monitoring and cross-sectoral collaboration Joyce Marianne Molenaar

A solid start for the Dutch first thousand days-approach Insights into program adoption, monitoring and cross-sectoral collaboration Joyce Marianne Molenaar

COLOPHON A solid start for the Dutch first thousand days-approach. Insights into program adoption, monitoring and cross-sectoral collaboration. Joyce Marianne Molenaar, 2024 The research for this dissertation was conducted at the National Institute for Public Health and the Environment (RIVM), and the Health Campus The Hague, department of Public Health and Primary Care, Leiden University Medical Centre. The studies presented in this thesis were part of the monitor of the Dutch action program Solid Start. The Ministry of Health, Welfare and Sport commissioned the RIVM to monitor the program. ISBN: 978-94-6506-174-0 Cover and illustrations: Roy Hendrikx | www.royhendrikx.nl/visuals Lay-out and design: Dagmar van Schaik | www.persoonlijkproefschrift.nl Printing: Ridderprint | www.ridderprint.nl Copyright © 2024 Joyce M. Molenaar, Utrecht, the Netherlands. This thesis is protected by international copyright law. All rights reserved. No part of this thesis may be reproduced, stored, or transmitted in any form or by any means without the prior permission from the author of this thesis or, when appropriate, of the publishers of the scientific papers.

A solid start for the Dutch first thousand days-approach Insights into program adoption, monitoring and cross-sectoral collaboration Joyce Marianne Molenaar Proefschrift ter verkrijging van de graad van doctor aan de Universiteit Leiden, op gezag van rector magnificus prof.dr.ir. H. Bijl, volgens besluit van het college voor promoties te verdedigen op woensdag 4 september 2024 klokke 14:30 uur door Joyce Marianne Molenaar geboren te Schagen in 1993

Promotor: Prof. dr. J.C. Kiefte-de Jong Copromotor: Dr. J.N. Struijs Leden van de promotiecommissie: Prof. dr. M. Bussemaker Prof. dr. T.H. van den Akker Prof. dr. T.J. Roseboom, Amsterdam UMC Prof. dr. C.A. Baan, Tilburg University

TABLE OF CONTENTS Chapter 1 General introduction 7 Chapter 2 Defining vulnerability subgroups among pregnant women using pre-pregnancy information: a latent class analysis European Journal of Public Health, 2023 25 Chapter 3 Predicting population-level vulnerability among pregnant women using routinely collected data and the added relevance of self-reported data Submitted 55 Chapter 4 Monitoring the Dutch Solid Start program: developing an indicator set for municipalities to monitor their first thousand days-approach International Journal of Integrated Care, 2022 85 Chapter 5 The Dutch Solid Start program: describing the implementation and experiences of the program’s first thousand days BMC Health Services Research, 2023 115 Chapter 6 General discussion 155 Summary Nederlandse samenvatting List of publications Portfolio Curriculum vitae Dankwoord 181 185 188 190 192 193

1

General introduction

8 CHAPTER 1 Importance of the first thousand days of life The period from conception to a child’s second birthday (i.e. the first thousand days of life) is crucial to children’s further physical, mental and social development (1-3). During these first thousand days, the foundations for optimal later health and wellbeing are established (3, 4). The body grows, the immune system develops and all vital organs are formed. The pace of development far exceeds that of any other phase in life. Moreover, it is the period in which our developmental plasticity, the ability to adapt to environmental factors and exposures, is highest (5, 6). Although our experiences across the lifespan can still influence our development to some extent, the first thousand days form the basis for who we are and have lifelong effects (7, 8). The well-studied Developmental Origins of Health and Disease concept (originally the ‘Barker hypothesis’) explains how early life experiences and exposures - both positive and negative - can influence later health and wellbeing (9, 10). There is an abundance of studies that show that many (chronic) health conditions such as diabetes, asthma, obesity, cardiovascular diseases, cancer and depression can trace their origins to early life (e.g. 11-18). This was demonstrated for instance by the findings of the Dutch Famine Birth Cohort study in which also timing of exposure appeared important (12, 19, 20). One of the described mechanisms of how early life exposures influence later health and wellbeing is through epigenetic programming. Epigenetic programming states that during critical times of development several factors can ‘program’ the bodily structures and functions to anticipate the environment it will face in the future (9, 10). Negative factors such as smoking during pregnancy, stress, pollutants and malnutrition can thereby lead to more susceptibility to diseases (21). For example, if a foetus is exposed to poor nutrition, it may adapt its metabolic system by storing more fat, which would be beneficial in case of food scarcity in adulthood, but can lead to obesity and other chronic diseases in an environment with abundant food (9, 10). These epigenetic changes can also be passed down from parents or grandparents to their offspring (8, 10). A better physical, mental, and social development during early life can lead to various positive outcomes in the future for both the individual as well as society, and thus should be at the centre of investments (22, 23). Some of those positive outcomes include improved learning and behaviour, enhanced educational opportunities, better job prospects, more productivity and greater participation in the workforce or society later in life (8). The Nobel prize-winning economist James Heckman showed that the best return on investment that society can achieve is by focusing its efforts on these first few years (24, 25). Investing early means that the benefits can be enjoyed for longer, and have a compounding effect. These benefits result from both higher revenues as well as savings in costs related to social welfare, poverty, crime and negative health outcomes. Moreover, early interventions are generally less costly compared to later remedial programs (24). Hence, early life investments are the most efficient and effective public investments.

9 General introduction From a biomedical perspective to a focus on the social determinants of health A wealth of research has indicated that our health and opportunities are not solely determined by our genetic, biological or medical characteristics, but rather depend on the direct and indirect impacts of social, economic, cultural and environmental conditions. These conditions in which people are born, grow, live, work, and age are called the Social Determinants of Health (SDOH) (26). Several studies have also proved the importance of (clustered) SDOH for outcomes during pregnancy or childbirth, being focused on factors such as area deprivation or socio-economic status with underlying concepts such as income, occupation and education (27-37). The SDOH framework provides an overview of the structural elements that shape the SDOH, their interrelatedness and the mechanisms by which social determinants generate health inequities (26). Although the medical sector also faces the consequences of unfavourable SDOH, many of the underlying elements and possible solutions fall outside their scope, posing a challenge to reduce health inequities within the medical sector alone (8). The SDOH can have an impact at various stages of our lives: during the first thousand days, childhood, adolescence and adulthood. According to models of life course health development, our health development is a dynamic, complex and non-linear process that results from different exposures over the life course (7, 38, 39). Both negative (e.g. food or housing insecurity) and positive (e.g. positive school environment) contexts and experiences can lead to different health trajectories (8, 38). The life course theory emphasizes that health differences mainly result from exposures during critical periods in early development, which subsequently accumulate throughout the course of one’s life. The National Academies of Sciences, Engineering, and Medicine (NASEM) used the above insights in their report ‘Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity’ (8). Their conceptual model shows various elements that shape children’s health and development during the life course, from conception into adulthood (Figure 1). The development and health of children is presented in the inner purple circle. In the direct environment of children are the factors that directly influence their daily experiences and patterns, such as family cohesion, caregiver well-being and nurturing (dark pink circle). These factors are shaped by the SDOH (pink circle). These SDOH, in turn, are influenced by the outer level: the socioeconomic and political drivers such as policies and laws that distribute resources and opportunities among the population (grey circle). The distribution of resources and opportunities is often disproportionate, based on characteristics such as race, gender or social class. The model provides opportunities for interventions to enhance individual and population health, as well as health equity, from micro to macro levels. Moreover, the model provides a powerful call for practice and policy to prioritize investments in improving preconception and perinatal health, since early life experiences can shape health and well-being across an entire lifetime for parents themselves, but these risks and protective factors can also be transmitted to their children. As these children grow into adulthood and potentially become parents themselves, this can lead to new cycles of inequity or resilience. Because of the intergenerational aspect, 1

10 CHAPTER 1 (future) parents or caregivers are a central focus in optimizing children’s health and wellbeing and reducing health inequities (8, 40). Early life health inequities are known as unjust, unnecessary and preventable differences in health between different (social) groups (41). This can be related to, for example, income, ethnicity, immigration status, education, living circumstances, gender or sexual orientation. The concept of health inequities is frequently used interchangeably with health disparities. Moreover, it is at times mixed-up with health inequalities, which refers more broadly to measurable differences in health between groups, without a moral judgement (41). One example of health inequities is seen in life expectancy (2019 – 2022): individuals with a higher educational level in the Netherlands live 5 years longer, and 14 years longer in good health, compared to individuals with a low educational level (42). Also for perinatal health outcomes during pregnancy and childbirth, inequities exist between and within high-income countries (43). For example, across Dutch municipalities, preterm birth rates ranged from 2.4% to 11.7% in 2021 (mean: 6.6%) (44). There are also large differences in perinatal outcomes between neighbourhoods with varying levels of socioeconomic status, as demonstrated well by the work of researchers from Rotterdam (28, 45-47). Figure 1. Conceptual framework ‘Leveraging early opportunities to advance health equity across the life course’ by the National Academies of Sciences, Engineering, and Medicine (2019) (8).

11 General introduction Despite accumulating evidence regarding the determinants of poor health, health inequities in birth outcomes seem to have persisted (48) and may even be widening in certain populations and for specific health outcomes (49, 50). These considerations of equity are also very important in investing in early life. The concept of vulnerability in early life Thousands of parents and children in high-income countries are exposed to adverse conditions such as poverty, violence, inadequate nutrition, substance abuse, and stress. This means that many face an increased risk or susceptibility to adverse health outcomes or decreased well-being, or they experience a lower access to care. Recent literature often uses the concept of ‘vulnerability’ when referring to these (future) parents and their newborn or unborn children (51-54), but terms such as ‘disadvantaged’, ‘deprivation’ or ‘frailty’ are also common in the scientific literature. There are diverse and heterogeneous definitions and understanding of the concept of vulnerability around pregnancy. For example, de Groot and colleagues (2019) defined vulnerability as “a dynamic state that reflects converging effects of a set of interacting and amplifying personal and environmental factors” (p. 12), which increases a person’s susceptibility to ill health and hamper their recovery (53). Scheele and colleagues (2020) referred to pregnant vulnerable women as being “threatened by physical, psychological, cognitive and/or social risk factors in combination with lack of adequate support and/ or adequate coping skills” (p. 4) (54). Various stakeholders in the city of Rotterdam (2020) explained how “vulnerability arises from an imbalance between risk factors and protective factors” (55). Their definition of vulnerability includes a distinction between highly vulnerable women for whom the risk factors require immediate action (e.g. domestic violence) and vulnerable women who have one or more risk factors (e.g. unhealthy lifestyle factors, unemployment) and insufficient protective factors (e.g. supportive social network, stable home situation). The Dutch national organization for midwives (Dutch abbreviation: KNOV) described how vulnerable pregnant women face several challenging circumstances, emphasizing different risk factors (56). Briscoe, Lavender and McGowan (57) described vulnerability in three main attributes: threat, barrier and repair. Whether potential biological, psychosocial or sociological threats lead to vulnerability, depends on both the existing recovery systems available (e.g. warm supporting relationships), as well as barriers that may impede access to healthcare (e.g. stigmatization, lack of compassion). Taken together, most definitions of vulnerability acknowledge that vulnerability encompasses a dynamic, contextualized and complex process involving the interplay of risk and protective factors at different levels or life domains (51, 53-55, 58). In simplified terms, several stressors at either the individual or contextual level can function as risk factors contributing to vulnerability, whereas protective factors have the potential to diminish or prevent vulnerability. Whether risk factors increase vulnerability and hinder people from achieving their full potential, depends on the co-occurrence and balance of risk factors and protective factors (53, 55). 1

12 CHAPTER 1 When reviewing the previous literature about the influence of social factors and vulnerability on birth outcomes, it appears that most studies focus on a limited number of predetermined, single risk factors. Few authors have studied the clustering or interactions between risk factors (29, 30, 59-61). Moreover, protective factors are rarely considered in the studies. Hence, the influence of the co-existence of both protective and risk factors requires further study. Need for improved collaboration across the social and medical sector to address vulnerability and inequity Increased awareness of the influence of social factors has prompted further exploration of preventive strategies and interventions to address vulnerability and inequity during the first thousand days. While healthcare has a pivotal role in advancing health equity, it cannot effectively address health inequities on its own. Since many of the underlying determinants for health and well-being lie beyond the medical domain, addressing them requires collaboration with other domains as well. Recent literature widely acknowledges that cross-sectoral collaboration between the medical and social sector is necessary to provide children the best possible start in life (8, 62-64). The urge for increased collaboration aligns with a wider movement in Western countries to maintain an accessible, affordable, safe and effective healthcare system. Our healthcare systems face increased pressure due to rising costs, ageing populations, changing disease patterns and care needs, and an alarming shortage of personnel (65-68). These challenges and the need to respond also applies to the maternity care population and system, with increasing maternal age, more co- and multimorbidity and unhealthier lifestyle among women of childbearing age, technological developments, and more diversity in cultural and ethnic groups (69, 70). These pressing issues also underscore the importance of implementing preventive measures and integrating medical and social care and support. Previous research on collaboration during the first thousand days has predominantly focused on specific temporal windows within either the medical or social sector. For example, studies within the Netherlands (71-76) and other countries (77-81) explored collaboration between professionals and organizations during either pregnancy, childbirth or child service delivery. Collaboration in Dutch maternity care is often described as complex and not self-evident, as healthcare providers historically have worked relatively autonomous with separated organizational structures, education programs, protocols, cultures and practices (63, 74, 82). Few studies have devoted attention to the full period of the first thousand days within both the social and medical sectors (62, 63). Collaboration between sectors may present different challenges compared to collaboration within one sector, potentially due to larger differences in cultures and structures. A nationwide first thousand days-approach: Dutch action program Solid Start Yearly, approximately 170.000 children are born in the Netherlands (70). These children and their parents, especially those in vulnerable situations, could benefit from a more integrated and population health-based care and support system. In 2018, the nationwide

13 General introduction action program ‘Solid Start’ was launched by the Dutch Ministry of Health, Welfare, and Sport (Dutch abbreviation: VWS) to ensure that every child receives the best possible start during the first thousand days of life (83). It promotes collaborative efforts across the medical and social sector and focuses particularly on (future) parents and young children in vulnerable situations. The action program’s strategic framework is built upon previous endeavours aimed at integrating medical and social services, such as the local ‘Ready for a baby’ program in Rotterdam (2008–2012) (84) and subsequent ‘Healthy Pregnancy 4-All’ programs implemented in various municipalities since 2011 (28, 62, 85). It is part of a wider movement in Dutch maternity care, which developed from a narrow focus to the mother’s health during childbirth, to a more social and cross-sectoral approach for (future) parents and children in which pregnancy and early childhood is considered a window of opportunity to address health inequities and enhance overall well-being (63). Several key moments catalysed this movement. For example, the European Peristat reports showed relatively high perinatal mortality rates in 2004 and 2008 (86, 87) which created momentum for a cascade of activities (88). Activities including the establishments of maternity care networks in which midwives, gynaecologists and other maternity care providers collaborate (89), experiments with bundled payment (90) and the initiation of the Standard for Integrated Maternity Care (91). The action program Solid Start employs a comprehensive and population-based strategy (83). It is conceptualized and implemented across three pillars: before pregnancy, during pregnancy, and after birth. At the start of the action program Solid Start, several aims were set, summarized as follows: prevent unintended pregnancies, prepare parents better for pregnancy, identify medical and non-medical issues earlier, and offer tailored support for (future) parents in vulnerable situations. The preventive and supportive measures aim to address the underlying determinants of health and well-being from an early stage, to prevent or mitigate health-related issues that may arise later in life. The program’s backbone is the stimulation of cross-sectoral collaboration through local coalitions Solid Start. Municipalities are vital in creating local coalitions Solid Start, consisting of organizations and service providers spanning the medical, social and public health domain. Involved stakeholders can include midwives, obstetricians, maternity care assistants, youth healthcare providers, social workers, debt counsellors, municipal officials, experts-by-experience. Municipalities are stimulated to create their own approach that fits their local context, challenges and existing networks. Since the decentralization in 2015, municipalities were already given new responsibilities in youth care, long-term care and income-support that fuelled differences in their approach and services (92). Municipalities received financial support from the Ministry of Health, Welfare and Sport, and they were provided assistance in building or strengthening their coalition from Pharos, the Dutch Centre of Expertise on Health Disparities (93). Pharos’ advisors have one-on-one meetings with municipalities, but the organization also provides shared training, webinars and informative webpages. Other support for local coalitions Solid Start included the availability of an analysis tool, data, a list of effective interventions and care pathways. Moreover, the Ministry of Health, Welfare and Sport facilitates and stimulates the action program Solid Start by striving for legal changes. Part of the action program also 1

14 CHAPTER 1 includes the implementation of interventions, including ‘Not Pregnant Now’ that supports professionals in sustaining the autonomy of vulnerable groups in making informed choices regarding pregnancy and contraception (94). Starting from 2019, the Ministry of Health, Welfare and Sport commissioned the National Institute for Public Health and the Environment (Dutch abbreviation: RIVM) to monitor the action program Solid Start. There are several reasons to monitor policy programs like the action program Solid Start. These reasons, for example, relate to accountability, learning and engagement (95, 96). Firstly, monitoring can be a tool to document actions and assess their alignment with predetermined plans or objectives. Secondly, monitoring for learning aims to provide insight into the approach (e.g. progress, facilitators, barriers) to allow reflection and make improvements. Thirdly, monitoring can facilitate the sharing of successes and small-wins, thereby keeping people engaged and enthusiastic. The monitoring efforts in relation to the action program Solid Start initially focus on gaining insight into how certain processes and outcomes develop over time, without determining causal effects. In order to start monitoring the action program Solid Start, decisions had to be made on how to operationalize certain concepts (e.g. vulnerability) and which data and indicators are useful. Considering the cross-sectoral approach, a cross-sectoral data infrastructure was considered beneficial in the monitoring endeavours. OBJECTIVE OF THIS THESIS The main objective of this thesis is to provide insight into the adoption of the action program Solid Start, thereby focusing on monitoring and cross-sectoral collaboration. In this thesis, the monitoring aspect relates to both the what and how to monitor, as well as the developments and experiences with the action program Solid Start. THESIS CONTEXT This thesis constitutes the scientific basis for the monitoring of the Dutch action program Solid Start that is conducted by the National Institute for Public Health and the Environment. The National Institute for Public Health and the Environment is a knowledge institute that conducts independent scientific research for commissioning partners. In the case of the action program Solid Start, this is the Dutch Ministry of Health, Welfare and Sport (97). The acquired knowledge is shared with the government, professionals and the general public to support a healthy population and environment. The organization is an agency of the Dutch Ministry of Health, Welfare and Sport. In 2019, the National Institute for Public Health and the Environment started to monitor the Dutch action program Solid Start at national level. This national monitor has quantitative

15 General introduction and qualitative components. For the quantitative component, a Delphi study with experts from policy, practice and research was conducted to develop a set of fifteen indicators (98). Indicators reflect both processes (e.g. percentage of municipalities with a local coalition Solid Start) and outcomes (e.g. percentage of children born prematurely and/or with a low birth weight for gestational age). Together, these indicators provide insight in both the progress of program implementation, as well as developments or trends in health and its underlying factors for parents and children (98). Several data sources are used to quantify the indicators, including questionnaires among municipalities, inquiries among national or regional organizations (e.g. among those implementing interventions), and the nationwide population-based data infrastructure DIAPER (99). DIAPER (acronym for Data-InfrAstructure for ParEnts and childRen) combines routinely collected data from three major Dutch nationwide sources: 1) Perined - the Dutch perinatal registry that collects routine care data during pregnancy and childbirth on care use and health outcomes (100), 2) Vektis – the healthcare information centre that compiles data on medical spending under the Healthcare Insurance Act (101), and 3) Statistics Netherlands (Dutch abbreviation: CBS), which collects and publishes linkable data on societal aspects, including health, welfare, income, education, and employment (102, 103). DIAPER provides a suitable source to study the action program Solid Start and its related elements, because cross-sector data is considered essential in order to gain a comprehensive understanding of cross-sector collaboration. The qualitative component includes yearly focus group discussions and interviews with those involved in the action program Solid Start, including representatives from care and support organizations (e.g. managers and care providers), Solid Start project leaders and advisors, municipal officials, representatives of national knowledge institutes and professional associations, researchers, and experts-by-experience and clients. All results of the monitor are publicly available and presented in yearly factsheets or notes addressed to the Ministry of Health, Welfare and Sport (104-107). A scientific advisory committee oversees the monitoring activities. In 2021, the National Institute for Public Health and the Environment was also commissioned to support municipalities in monitoring their local approach within the ‘learning local monitor Solid Start’. The support program centralizes learning and knowledge sharing between and within local coalitions Solid Start. It aims to encourage both starting and more developed local coalitions Solid Start to use monitoring as a tool to reflect on and design their local Solid Start approach. To do so, the National Institute for Public Health and the Environment organizes regular learning sessions with eleven local coalitions Solid Start in which participants share best practices, challenges and needs for monitoring. Those needs are addressed in thematic sessions for a wider audience, open to all who are involved or interested in monitoring or implementing the action program Solid Start at the local level. 1

16 CHAPTER 1 OUTLINE OF THIS THESIS Chapter 2 and 3: monitoring vulnerability The first two studies addressed the monitoring of vulnerability during pregnancy. The action program Solid Start specifically focuses on (future) parents and children in a vulnerable situation. Monitoring vulnerability at population-level requires more insight into the operationalization of vulnerability. We used various data-science techniques to gain insight into different vulnerability-classes with varying combinations of risk and protective factors (Chapter 2), and to identify if we could predict vulnerability at population-level using nationwide routinely collected data (Chapter 3). This led to the following overall research question: What is vulnerability during pregnancy, and how to operationalize vulnerability for monitoring? Chapter 4: indicators for local monitoring The action program Solid Start was quantitatively monitored at a national level right from the start of the program. Monitoring Solid Start for municipalities or coalitions at the local level may require different indicators, given the different context, informational needs and intended use. Therefore, Chapter 4 of this thesis describes how we used a Delphi approach in developing an indicator set to monitor the action program Solid Start on a local level. The research question was: Which indicators can be used to monitor the action program Solid Start on a local level? Chapter 5: developments and experiences with Solid Start and cross-sectoral collaboration The action program Solid Start was implemented at the end of 2018 with the aim to provide every child the best possible start in life. A key program element is to improve the collaboration between the medical and social sector by creating local coalitions Solid Start. Therefore, we aimed to describe the implementation of the action program Solid Start during the program’s own first thousand days (2019, 2020 and 2021) with a specific focus on cross-sectoral collaboration. We used both quantitative and qualitative research methods to answer the following research question in Chapter 5: What are the developments and experiences with the action program Solid Start, specifically regarding crosssectoral collaboration? Chapter 6: general discussion The separate and combined findings from the studies offer deeper insights into 1) the adoption of the action program Solid Start, 2) monitoring and 3) cross-sectoral collaboration. Chapter 6 discusses the main findings in light of these three elements, providing key lessons learned. The chapter proceeds with methodological considerations along with recommendations for research, a future outlook with recommendations for policy, practice and education, and concluding remarks.

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19 General introduction 40. Hossin MZ. Early Life Determinants of Socioeconomic and Health Inequalities Life Course Studies Within and Across Generations: Karolinska Institutet (Sweden); 2021. 41. Arcaya MC, Arcaya AL, Subramanian SV. Inequalities in health: definitions, concepts, and theories. Global health action. 2015;8(1):27106. 42. Statistics Netherlands (CBS) Statline. Gezonde levensverwachting; geslacht, leeftijd en onderwijsniveau [Healthy life expectancy; gender, age, and level of education] n.d. [Date cited: 10/17/2023]. Available from: https://opendata.cbs.nl/statline/?ts=1605183219229#/ CBS/nl/dataset/84842NED/table 43. Euro-Peristat. European perinatal health report. Core indicators of the health and care of pregnant women and babies in Europe from 2015 to 2019. 2022. Available from: https:// www.europeristat.com/images/Euro-Peristat_Fact_sheets_2022_for_upload.pdf 44. RIVM. Indicatorenset Lokale Monitoring Kansrijke Start [Indicator set local monitoring Solid Start] n.d. [Date cited: 02/01/2024]. Available from: https://www.regiobeeld.nl/ kansrijkestart 45. Ochoa LB, Bertens LC, Garcia-Gomez P, Van Ourti T, Steegers EA, Been JV. Association of neighbourhood socioeconomic trajectories with preterm birth and small-for-gestational-age in the Netherlands: a nationwide population-based study. The Lancet Regional Health–Europe. 2021;10. 46. Vos AA, Denktaş S, Borsboom GJ, Bonsel GJ, Steegers EA. Differences in perinatal morbidity and mortality on the neighbourhood level in Dutch municipalities: a population based cohort study. BMC Pregnancy Childbirth. 2015;15(1):1-9. 47. Poeran J, Denktas S, Birnie E, Bonsel GJ, Steegers EA. Urban perinatal health inequalities. The Journal of Maternal-Fetal & Neonatal Medicine. 2011;24(4):643-6. 48. Bertens LC, Ochoa LB, Van Ourti T, Steegers EA, Been JV. Persisting inequalities in birth outcomes related to neighbourhood deprivation. J Epidemiol Community Health. 2020;74(3):232-9. 49. Mackenbach JP, Kulhánová I, Artnik B, Bopp M, Borrell C, Clemens T, et al. Changes in mortality inequalities over two decades: register based study of European countries. BMJ. 2016;353. 50. Mackenbach JP. The persistence of health inequalities in modern welfare states: the explanation of a paradox. Soc Sci Med. 2012;75(4):761-9. 51. Colciago E, Merazzi B, Panzeri M, Fumagalli S, Nespoli A. Women’s vulnerability within the childbearing continuum: A scoping review. European Journal of Midwifery. 2020;4. 52. Grabovschi C, Loignon C, Fortin M. Mapping the concept of vulnerability related to health care disparities: a scoping review. BMC Health Serv Res. 2013;13(1):94. 53. de Groot N, Bonsel GJ, Birnie E, Valentine NB. Towards a universal concept of vulnerability: broadening the evidence from the elderly to perinatal health using a Delphi approach. PLoS One. 2019;14(2):e0212633. 54. Scheele J, van der Vliet–Torij HH, Wingelaar-Loomans E, Goumans M. Defining vulnerability in European pregnant women, a Delphi study. Midwifery. 2020;86:102708. 55. van der Meer L, Ernst H, Blanchette L, Steegers E. Een kwetsbare zwangere, wat is dat eigenlijk? [A vulnerable pregnant woman, what is that actually?]. Medisch Contact. 2020. 56. KNOV. Kwetsbare zwangere vrouwen [vulnerable pregnant women] n.d. [Date cited: 02/01/2024]. Available from: https://www.knov.nl/kennis-en-scholing/ vakkennis-en-wetenschap/vakkennis/kwetsbare-zwangere-vrouwen 57. Briscoe L, Lavender T, McGowan L. A concept analysis of women’s vulnerability during pregnancy, birth and the postnatal period. J Adv Nurs. 2016;72(10):2330-45. 58. Spini D, Bernardi L, Oris M. Toward a life course framework for studying vulnerability. Research in Human Development. 2017;14(1):5-25. 1

20 CHAPTER 1 59. Crone M, Luurssen-Masurel N, Bruinsma-van Zwicht B, van Lith J, Rijnders M. Pregnant women at increased risk of adverse perinatal outcomes: A combination of less healthy behaviors and adverse psychosocial and socio-economic circumstances. Prev Med. 2019;127:105817. 60. Hendryx M, Chojenta C, Byles JE. Latent class analysis of low birth weight and preterm delivery among Australian women. The Journal of pediatrics. 2020;218:42-8. e1. 61. Daalderop LA, de Groot MW, van der Meer L, Steegers EAP, Bertens LCM. Non-medical determinants of perinatal health: protocol for a systematic review with meta-analysis. BMJ Open. 2019;9(9):e031437. 62. Barsties LS, Daalderop LA, Lagendijk J, van Steenbergen F, Been JV, Bertens LCM, et al. Addressing perinatal health inequities in Dutch municipalities: Protocol for the Healthy Pregnancy 4 All-3 programme. Health Policy. 2021;125(3):385-92. 63. Barsties LS, Steenbergen FSv, Loorbach D. Social Obstetrics as Niche-Development in Addressing Health Inequities. Sustainability. 2021;13(22):12814. 64. National Academies of Sciences, Engineering and Medicine. Integrating social care into the delivery of health care: Moving upstream to improve the nation’s health. Washington, DC: The National Academies Press; 2019. 65. World Health Organization. Global strategy on human resources for health: workforce 2030. 2016. Report No.: 9241511133. Available from: https://www.who.int/publications/i/ item/9789241511131 66. World Health Organization. Global expenditure on health: public spending on the rise? 2021. Report No.: 9240041214. Available from: https://iris.who.int/bitstream/handle/1066 5/350560/9789240041219-eng.pdf 67. RIVM. Volksgezondheid Toekomst Verkenning 2018: Een gezond vooruitzicht. [Public Health Foresight Report 2018 - A healthy prospect] Bilthoven; 2018. Report No.: 2018-0030. Available from: https://www.rivm.nl/publicaties/volksgezondheid-toekomst-verkenning- 2018-gezond-vooruitzicht-synthese 68. Wetenschappelijke Raad voor het Regeringsbeleid. Kiezen voor houdbare zorg. Mensen, middelen en maatschappelijk draagvlak [Choosing sustainable healthcare. People, resources and societal support]. 2021. Available from: https://www.wrr.nl/publicaties/ rapporten/2021/09/15/kiezen-voor-houdbare-zorg 69. RIVM. Beter weten: Een beter begin: Samen sneller naar een betere zorg rond de zwangerschap [Knowing better: A better start: Faster towards better pregnancy care together] 2020. Available from: https://www.rivm.nl/publicaties/beter-weten-beter-begin- samen-sneller-naar-betere-zorg-rond-zwangerschap 70. Statistics Netherlands (CBS) Statline. Geboorte; kerncijfers [birth; key figures] n.d. [Date cited: 10/17/2023]. Available from: https://opendata.cbs.nl/statline/#/CBS/nl/dataset/37422ned/ table?dl=6FBF7 71. Cronie D, Rijnders M, Jans S, Verhoeven CJ, de Vries R. How good is collaboration between maternity service providers in the Netherlands? Journal of multidisciplinary healthcare. 2019;12:21. 72. Perdok H, Jans S, Verhoeven C, Henneman L, Wiegers T, Mol BW, et al. Opinions of maternity care professionals and other stakeholders about integration of maternity care: a qualitative study in the Netherlands. BMC Pregnancy Childbirth. 2016;16(1):1-12. 73. Molenaar JM, Lips SR, Teunissen PW, Vermeulen G, Schuitmaker-Warnaar TJ. Creating togetherness in a historically divided maternity care system. International Journal of Health Professions. 2020;7(1):33-44. 74. van der Lee N, Driessen EW, Scheele F. How the past influences interprofessional collaboration between obstetricians and midwives in the Netherlands: Findings from a secondary analysis. Journal of interprofessional care. 2016;30(1):71-6.

21 General introduction 75. Schölmerich VL, Posthumus AG, Ghorashi H, Waelput AJ, Groenewegen P, Denktaş S. Improving interprofessional coordination in Dutch midwifery and obstetrics: a qualitative study. BMC Pregnancy Childbirth. 2014;14(1):1-8. 76. Blanken M, Mathijssen J, van Nieuwenhuizen C, Raab J, van Oers H. Cross-sectoral collaboration: comparing complex child service delivery systems. Journal of Health Organization and Management. 2022;36(9):79-94. 77. Reiger KM, Lane KL. Working together: collaboration between midwives and doctors in public hospitals. Aust Health Rev. 2009;33(2):315-24. 78. Macdonald D, Snelgrove-Clarke E, Campbell-Yeo M, Aston M, Helwig M, Baker KA. The experiences of midwives and nurses collaborating to provide birthing care: a systematic review. JBI Evidence Synthesis. 2015;13(11):74-127. 79. Peterson WE, Medves JM, Davies BL, Graham ID. Multidisciplinary collaborative maternity care in Canada: easier said than done. Journal of Obstetrics and Gynaecology Canada. 2007;29(11):880-6. 80. Nooteboom LA, Mulder EA, Kuiper CH, Colins OF, Vermeiren RR. Towards integrated youth care: A systematic review of facilitators and barriers for professionals. Administration and Policy in Mental Health and Mental Health Services Research. 2021;48(1):88-105. 81. Rumping S, Boendermaker L, de Ruyter DJ. Stimulating interdisciplinary collaboration among youth social workers: A scoping review. Health & Social Care in the Community. 2019;27(2):293-305. 82. Lips S, Molenaar J, Schuitmaker-Warnaar TJ. Transforming maternity care: obstetric partnerships as a policy instrument for integration. Health Policy. 2020;124(11):1245-53. 83. Ministry of Health Welfare and Sport. Solid Start - the action programme. The Hague; 2020. Available from: https://www.government.nl/documents/publications/2020/08/24/ solid-start-the-action-programme 84. Denktas S, Bonsel GJ, Van der Weg EJ, Voorham AJ, Torij HW, De Graaf JP, et al. An urban perinatal health programme of strategies to improve perinatal health. Matern Child Health J. 2012;16(8):1553-8. 85. Denktaş S, Poeran J, van Voorst SF, Vos AA, de Jong-Potjer LC, Waelput AJ, et al. Design and outline of the healthy pregnancy 4 all study. BMC Pregnancy Childbirth. 2014;14(1):1-11. 86. Mohangoo AD, Buitendijk SE, Hukkelhouen C, Ravelli AC, Rijninks-van Driel GC, Tamminga P, Nijhuis JG. Hoge perinatale sterfte in Nederland vergeleken met andere Europese landen: de Peristat-II-studie [Higher perinatal mortality in The Netherlands compared to other European countries: the Peristat-II study]. Ned Tijdschr Geneeskd. 2008;152(50):2718. 87. Euro-Peristat. European perinatal health report. 2008. Available from: https://www.europeristat.com/images/doc/EPHR/european-perinatal-health-report.pdf 88. Vos AA, van Voorst SF, Steegers EA, Denktaş S. Analysis of policy towards improvement of perinatal mortality in the Netherlands (2004–2011). Soc Sci Med. 2016;157:156-64. 89. Stuurgroep Zwangerschap en Geboorte. Een goed begin. Veilige zorg rond zwangerschap en geboorte. [A good start. Safe care for pregnancy and childbirth]. Utrecht, the Netherlands; 2009. Available from: https://www.kennisnetgeboortezorg.nl/?- file=9324&m=1493021653&action=file.download 90. Struijs JN, Hargreaves DS. Turning a crisis into a policy opportunity: lessons learned so far and next steps in the Dutch early years strategy. The Lancet Child & Adolescent Health. 2019;3(2):66-8. 91. Zorginstituut Nederland. Zorgstandaard Integrale Geboortezorg [Standard for Integrated Birth Care]. 2016. Available from: https://www.zorginzicht.nl/kwaliteitsinstrumenten/ integrale-geboortezorg-zorgstandaard 92. Wouter Vermeulen. Decentralisation of social policy in the Netherlands. 2015:127. 1

22 CHAPTER 1 93. Pharos. Stimuleringsprogramma lokale coalities Kansrijke Start [stimulation program local coalitions Solid Start] n.d. [Date cited: 01/20/2023]. Available from: https://www.pharos.nl/ over-pharos/programmas-pharos/kansrijke-start/ 94. Waelput AJ, Rijlaarsdam CW, Steegers EA. Preconception health and choices: tailored solutions for prospective parents. International Journal of Birth and Parental Education. 2022;9(2). 95. Pasanen T, Barnett I. Supporting adaptive management: monitoring and evaluation tools and approaches. 2019. 96. Van Mierlo B, Regeer B, van Amstel M, Arkesteijn M, Beekman V, Bunders J, et al. Reflexive monitoring in action. A guide for monitoring system innovation projects. Communication and Innovation Studies, WUR; Athena Institute, VU; 2010. Available from: https://research. wur.nl/en/publications/reflexive-monitoring-in-action-a-guide-for-monitoring-system-inno 97. RIVM. About RIVM n.d. [Date cited: 01/20/2023]. Available from: https://www.rivm.nl/en/ about-rivm 98. RIVM. Indicatoren Kansrijke Start: Een Delphi-studie [Indicators Solid Start: a Delphi study]. Bilthoven, the Netherlands; 2019. Available from: https://www.rivm.nl/documenten/ indicatoren-kansrijke-start-delphi-studie 99. Scheefhals ZT, de Vries EF, Molenaar JM, Numans ME, Struijs JN. Observational Data for Integrated Maternity Care: Experiences with a Data-Infrastructure for Parents and Children in the Netherlands. International Journal of Integrated Care. 2023;23(4). 100. Perined. Over Perined [about Perined] n.d. [Date cited: 10/17/2023]. Available from: https:// www.perined.nl/over-perined 101. de Boo A. Vektis ‘Informatiecentrum voor de zorg’ [Vektis ‘Information center for healthcare’]. Tijdschrift voor gezondheidswetenschappen. 2011;89(7):358-9. 102. Bakker BF, Van Rooijen J, Van Toor L. The system of social statistical datasets of Statistics Netherlands: An integral approach to the production of register-based social statistics. Statistical Journal of the IAOS. 2014;30(4):411-24. 103. Statistics Netherlands (CBS). About CBS n.d. [Date cited: 10/17/2023]. Available from: https:// www.cbs.nl/en-gb/about-us 104. RIVM. Monitor Kansrijke Start 2019 [Monitor Solid Start 2019]. Bilthoven, the Netherlands; 2019. Available from: https://www.rivm.nl/documenten/factsheet-kansrijke-start 105. RIVM. Monitor Kansrijke Start 2020 [Monitor Solid Start 2020]. Bilthoven, the Netherlands; 2020. Available from: https://www.rivm.nl/documenten/monitor-kansrijke-start-2020 106. RIVM. Monitor Kansrijke Start 2021 [Monitor Solid Start 2021]. Bilthoven, the Netherlands; 2021. Available from: https://www.rivm.nl/documenten/monitor-kansrijke-start-2021 107. RIVM. Monitor Kansrijke Start 2022 [Monitor Solid Start 2022]. Bilthoven, the Netherlands; 2022. Available from: https://www.rivm.nl/documenten/monitor-kansrijke-start-2022

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