Social Obstetrics as Niche-Development in Addressing Health Inequities

Abstract

We apply a transition research perspective to the Dutch obstetric care system to analyze historic, current, and future shifts and find ways to overcome persistent health inequities. We present social obstetrics as an emerging niche that addresses perinatal health inequities by acknowledging their multifaceted origins and fostering collaborations across the medical, social, and public health sectors. We conducted desk research, in-depth semi-structured expert interviews, and interactive group sessions with change-inclined professionals that are relevant for the implementation of social obstetrics in six Dutch municipalities. The outcomes are synthesized in a historical narrative and perspectives on current obstacles and future systemic shifts. We argue that social obstetrics can be considered a sustainable addition to what is already present, instead of a disruptive transformation of the current system. Social obstetrics is innovative as it connects various societal systems and offers a framework for cross-sectoral collaboration. These collaborations, in turn, can be the starting point for the transformation of the obstetric care system as well as other relevant societal systems.

The Dutch Solid Start program: describing the implementation and experiences of the program's first thousand days

“…Nevertheless, it seems that Solid Start has created a nationwide movement to integrate medical and social services for early life within a relative short time (mid-2018 till 2021), with modest funding (€41 million allocated throughout the program’s duration) [ 15 , 44 ] and without a system reform or refiguration. According to Barsties et al’s transition research in Dutch obstetric care [ 8 ], social obstetrics is a new way of thinking, doing and organizing that challenges the incumbent regime that may provide a sustainable addition to the current system, instead of a disruptive transformation. The authors note that social obstetrics can be a starting point for further transformations in obstetrics and other societal systems.…”

“…Although these previous studies have furthered our understanding on collaboration, to date, there is limited knowledge into the development of cross-sectoral collaboration between the medical and social sector during the complete trajectory of the first thousand days as only few studies have devoted attention to this topic as a whole [ 7 , 8 ]. This knowledge is particularly relevant as we do not know if collaboration between sectors presents different challenges compared to collaboration within a sector, due to for example the larger differences in cultures and structures.…”

“…Factors such as poverty, housing difficulties, stress and unemployment also highly influence health and wellbeing and cannot be addressed in the medical sector alone. Therefore, as stressed in several recent studies and reports, cross-sectoral collaboration between actors from the medical, social and public health sectors is considered essential to provide every child the best start in life [2,[7][8][9][10].…”

“…Other studies that reported on integrated youth (health)care [27][28][29] found similar facilitators and challenges and also mentioned the need for further collaboration. Collaboration in 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 [8,22,30]. More integrated care requires changes at different interrelated levels (micro, meso and macro), as outlined by Valentijn and colleagues [31].…”