In a randomized control trial, the authors tested whether short-and long-term effects of an early literacy intervention are moderated by mild perinatal adversities in accordance with differential susceptibility theory. One-hundred 5-year-old children (58% male) who scored at or below the 30th percentile on early literacy measures were randomized to a Web-based remedial early literacy program Living Letters or a treated control group. Parents gave written informed consent to access the perinatal data of their children at the Perinatal Register in the Netherlands. Twenty-one children were, at birth, small for gestational age (between the 2.5th and 10th percentiles) or late preterm (between 34 and 37 weeks, 6 days). In this group with mild perinatal adversities, intervention children outperformed the control group immediately after the intervention and after 8 months of formal reading instruction, but a similar effect of the computerized literacy program in children without mild perinatal adversities was absent. In line with the theory of differential susceptibility, children with mild perinatal adversities seem to be more open to environmental input, for better and for worse.

Home birth, under routine conditions, is generally not associated with increased intrapartum and early neonatal death, yet in subgroups, additional risk cannot be excluded.

BackgroundThe concept of responsiveness was introduced by the World Health Organization (WHO) to address non-clinical aspects of service quality in an internationally comparable way. Responsiveness is defined as aspects of the way individuals are treated and the environment in which they are treated during health system interactions.The aim of this study is to assess responsiveness outcomes, their importance and factors influencing responsiveness outcomes during the antenatal and delivery phases of perinatal care.MethodThe Responsiveness in Perinatal and Obstetric Health Care Questionnaire was developed in 2009/10 based on the eight-domain WHO concept and the World Health Survey questionnaire. After ethical approval, a total of 171 women, who were 2 weeks postpartum, were recruited from three primary care midwifery practices in Rotterdam, the Netherlands, using face-to-face interviews. We dichotomized the original five ordinal response categories for responsiveness attainment as ‘poor’ and good responsiveness and analyzed the ranking of the domain performance and importance according to frequency scores. We used a series of independent variables related to health services and users’ personal background characteristics in multiple logistic regression analyses to explain responsiveness.ResultsPoor responsiveness outcomes ranged from 5.9% to 31.7% for the antenatal phase and from 9.7% to 27.1% for the delivery phase. Overall for both phases, ‘respect for persons’ (Autonomy, Dignity, Communication and Confidentiality) domains performed better and were judged to be more important than ‘client orientation’ domains (Choice and Continuity, Prompt Attention, Quality of Basic Amenities, Social Consideration). On the whole, responsiveness was explained more by health-care and health related issues than personal characteristics.ConclusionTo improve responsiveness outcomes caregivers should focus on domains in the category ‘client orientation’.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1464-8) contains supplementary material, which is available to authorized users.