The reforms of Dutch obstetric healthcare and the introduction of an integral insurance tariff for pregnancies and parturition in 2017 cause dangers to the self-determination of women.

At the end of January, three organizations - the Clara Wichmann Institute, the Dutch Women´s Council and the Birth Movement - sent a letter to Dutch Minister of Health, Welfare and Sport Edith Schipper about the reform of obstetrical healthcare in the Netherlands. Women´s right to self-determination is at stake.

"Not long ago there were proposals to put Dutch obstetric healthcare on the UNESCO world heritage list and, only a short time later, after one negative comparative study in the context of perinatal deaths, the whole system is to be removed without clarity about the relationship between our obstetrical care system and the outcomes of this research," Anniek de Ruijter, chairman of the Clara Wichmann Institute, says.

Boss of my own belly

The organizations fear that while making new plans there was too little attention for women’s interests. According to them, it will be far more complicated for a pregnant woman to change from one midwife or hospital to another.

Protocols about how a woman "has to" give birth are becoming stricter and the flexibility for health professionals to give in to the desires of the pregnant person are increasingly narrowed.

Thus, women are at risk to walk into a trap of health carers, resulting in the possibility of losing their right to self-determination, according to the letter, which was delivered to Minister Schipper on January 27.

They also worry about the randomness that may be created, as the reforms will be largely left to the regions. According to the three organizations, a number of issues concerning the obstetric care in every region should be guaranteed, such as respecting women’s self-determination, alternatives for hospital care (e.g. home births, or in a birth center supervised by a midwife) and easy access to a broad range of pain relief medication.

Cold cuts

The old system concerning birth care can surely benefit from improvement, but there are no solid reasons to turn the present system completely upside down, the letter says:

“There is a cold reorganization going on of the first line care. The plans are rushed, insufficiently substantiated, and women’s rights are overlooked.”

The groups call on Minister Schippers to perform a review and conduct solid research before the whole system is reformed.