Baby mortality 'even higher'

28 November 2003

AMSTERDAM — Research revealing the Netherlands has the highest baby mortality rate in the EU has sparked major political concern with one academic warning the true figure could be higher, while another claimed the ratings system was misleading.

The Peristat research, commissioned by the European Commission, found that in the Netherlands 7.4 foetuses out of every 1,000 die a month before birth. In Germany that figure is 3.5 out of 1,000, while in Belgium that figure was 4.5 and 3.9 in Sweden.

Also, a relatively large number of babies die in the Netherlands in the first month after birth, with figures indicating the death rate is four out of every 1,000. The European average is 3 out of 1,000.

The figures sparked immediate concern among MPs and green-left GroenLinks MP Evelien Tonkens raised the matter in Parliament. But Health State Secretary Clemence Ross refused to comment on Thursday, saying she first wanted to study the research, newspaper Trouw reported.

But Dr Tanja de Galan-Roo Snr — who obtained a doctoral degree in Nijmegen University last year with a thesis focused on baby mortality around the time of childbirth — claimed 10 percent of deaths are not registered within the Dutch gynaecologist system and that post-birth baby deaths are especially under-registered.

Gynaecologists are required to register a death from the 24th week of a pregnancy — when foetuses are considered old enough to live outside the womb — until the end of the first week after birth.

If a baby is stillborn, it must be registered with the municipal authority and there is also an obligation to bury or cremate the child, which is expensive. De Galan-Roo has claimed some people try to avoid the funeral costs by not reporting the stillbirth.

But another problem lies in the communication between medics in various departments, she said. Gynaecologists are often unaware what happens in the week after birth because the baby is transferred to the children’s ward of a hospital and there is a breakdown in communication.

De Galan-Roo called for the enforcement of an obligation to register deaths up until four weeks after birth. She said 30 percent of all babies that die within the first month after birth are not registered.

The chairman of gynaecologists association NVOG also admitted the registration system in the Netherlands was flawed.

The four professions involved in pregnancy or baby deaths — obstetricians or midwives, family doctors, gynaecologists and children’s doctors — have been co-operating in the past two years to develop one registration system with unequivocal definitions.

But questions have also been raised about the different methods of counting baby deaths. In most countries, the death of a foetus is included in statistics if it lived passed the 22nd week of a woman’s pregnancy, but in Denmark, Sweden and France, that only occurs after 28 weeks, newspaper De Volkskrant reported.

The Central Bureau of Statistics (CBS) said the death rate in the Netherlands by a pregnancy length of 28 weeks or more was 4.7 out of 1,000 in 2002. But the Dutch rate was still high because in Denmark the figure was 3.8.

A researcher with the Government Institute for Public Health RIVM, Peter Achterberg, said the figures were not new. In 2001, he studied death rates from 24 or 28 weeks and in the first week after birth and compared them against other EU countries. The results indicated the Netherlands had fallen from fourth place in 1960 to 11th in 1996.

But he also concluded that the initial large difference between European countries had lessened and rank numbers had lost some of their importance.

Academic Galan-Roo also admitted that an internationally-comparable registration system was difficult to develop, recognising that different countries had different definitions determining whether the loss of a foetus was a death or an abortion. She said Norway had a border of 16 weeks, Switzerland used length as its criterion and Belgium used a weight of 500g.

Meanwhile, the EU-commissioned researchers attributed the high death rate in the Netherlands to the fact that Dutch health authorities do not screen women for birth defects as much as other EU countries do. Therefore a lesser number of pregnancies are terminated and about 25 percent of Dutch baby deaths are attributed to birth defects.

The Dutch Government recently decided that only pregnant women aged 36 years or older — and who are therefore at higher risk of having a baby with Down Syndrome or spina bifida — will receive the standard tests.

The researchers also said the Netherlands has a relatively large number of older mothers, with one in five above the age of 35 at the time of the child’s birth, while the Dutch have the second highest percentage of multiple baby births and a large number of migrant mothers, a group more susceptible to baby deaths.

The Dutch tradition of homebirths — which account for one out of every three births — did not explain the higher baby death rates, researchers said. It is possible though that the death rate will decline now that breach birth babies are more often delivered by Caesarean, which has been common practice in other EU nations for some time.

Subject: Dutch news

Baby mortality ‘even higher’