title: Analysis of policy towards improvement of perinatal mortality in the Netherlands (2004-2011).
abstract: Relatively high perinatal mortality and morbidity rates(2) in the Netherlands resulted in a process which induced policy changes regarding the Dutch perinatal healthcare system. Aims of this policy analysis are (1) to identify actors, context and process factors that promoted or impeded agenda setting and formulation of policy regarding perinatal health care reform and (2) to present an overview of the renewed perinatal health policy. The policy triangle framework for policy analysis by Walt and Gilson was applied(3). Contents of policy, actors, context factors and process factors were identified by triangulation of data from three sources: a document analysis, stakeholder analysis and semi-structured interviews with key stakeholders. Analysis enabled us to chronologically reconstruct the policy process in response to the perinatal mortality rates. The quantification of the perinatal mortality problem, the openness of the debate and the nature of the topic were important process factors. Main theme of policy was that change was required in the entire spectrum of perinatal healthcare. This ranged from care in the preconception phase through to the puerperium. Furthermore emphasis was placed on the importance of preventive measures and socio-environmental determinants of health. This required involvement of the preventive setting, including municipalities. The Dutch tiered perinatal healthcare system and divergent views amongst curative perinatal health care providers were important context factors. This study provides lessons which are applicable to health care professionals and policy makers in perinatal care or other multidisciplinary fields.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Amber A
authors.initials: AA
authors.lastname: Vos
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: s.vanvoorst@erasmusmc.nl.
authors.forename: Sabine F
authors.initials: SF
authors.lastname: van Voorst
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.affiliation: Erasmus University College/Erasmus University Rotterdam, Department of Social & Behavioural Sciences, Nieuwemarkt 1A, 3011 HP Rotterdam, The Netherlands.
authors.forename: Semiha
authors.initials: S
authors.lastname: Denktaş
mesh_terms: D000328:Adult; D005260:Female; D018166:Health Care Reform / Q000379:methods*; D006291:Health Policy / Q000639:trends*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D009426:Netherlands; D018743:Perinatal Care / Q000379:methods / Q000592:standards*; D054238:Perinatal Mortality / Q000639:trends*; D011050:Policy Making; D011247:Pregnancy
keywords: Antenatal healthcare; Health policy; Perinatal; Policy analysis; Policy triangle; Pregnancy