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
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