Where you are born has a major influence on your chances and your health for the rest of your life. Researchers from Erasmus MC saw a direct link between a poor living environment and negative health consequences for the baby during pregnancy. A study published on Thursday showed for the first time in the Netherlands that the risk of problems during pregnancy is higher in neighborhoods where incomes are relatively low, houses are poorly maintained, and the feeling of insecurity is high. Babies are stillborn there more often, die every week or are born too early and much too small.
Every day, Jasper Been, one of the authors and a pediatrician in the intensive care unit for babies at the Erasmus MC in Rotterdam, sees newborns with very serious complications, and yet he is shocked by these results. “In our department we see relatively more people from vulnerable situations, because they have a high risk of all these negative outcomes during pregnancy. We now see this reflected in the figures. This research clearly underlines that you are 2-0 behind if you are born in a neighborhood with poor quality of life and insecurity.”
The results do not surprise Eric Steegers, gynecologist and head of the Department of Obstetrics and Gynecology at Erasmus MC. An accumulation of problems produces “toxic stress,” he says, and “no one can sustain that.” “Toxic stress affects the brain development and organs of the child during pregnancy.”
“These are parents who already have a lot of problems,” says Steegers. “Then you hope that the child will do well, in a home with extra care.” Living in poorly insulated houses that become very hot in the summer, with crime in the neighborhood, and little money in the wallet: none of this helps the child’s chances, says Steegers.
Major backlogs
The twenty neighborhoods examined in the Rotterdam study have been covered by the national National Liveability and Safety Program (NPLV) since 2022. This concerns areas such as Utrecht Overvecht, Tilburg Noord West and Amsterdam Zuidoost and Nieuw-West. The central government has made 400 million euros available to strengthen the quality of life and equality of opportunity in these areas.
The last one figures from Statistics Netherlands (CBS) show that people in NPLV areas often have a more difficult time than people in non-NPLV areas. In 2025, approximately 1.2 million people lived there, of which 1 million were 12 years or older.
The researchers see a vicious circle. They advocate an approach that combines medical and social care. And that the physical environment is addressed.
NPLV neighborhoods have relatively high levels of poverty, high crime, and housing is cheap and poorly maintained. In 2025, residents of NPLV areas experienced almost twice as much nuisance and insecurity as the average in the Netherlands, writes Statistics Netherlands. They also say they feel less healthy. For example, in the twenty neighborhoods people take medication for psychological complaints more often than in other parts of the Netherlands.
In almost every NPLV district, the figures for complicated births are above the Dutch average. Especially in Heerlen-Noord, Lelystad Oost, and Rotterdam Zuid, considerably more babies are born with complications than the average in the Netherlands.
Babies from Amsterdam South East are born with the greatest health disadvantage compared to babies in the rest of the Netherlands. Death, low weight and premature birth are relatively most common there. About 8 in 1,000 babies from that neighborhood die during pregnancy or shortly after birth. That is about twice as much as in non-NPLV areas. About 7 percent of babies in Amsterdam South East are born prematurely (compared to about 5 percent in the rest of Amsterdam and the Netherlands). Nearly one in five babies has a low birth weight, compared to one in ten infants who do not come from vulnerable neighborhoods.
Sum of factors
Children who survive such a complicated birth are also more likely to have health problems later on. They quickly pile up. For example, children born prematurely are often too small, says ICU doctor Been. “The smallest children we treat are between 400 and 500 grams. That fits in your hand. All organs are not yet properly developed. The lungs cannot breathe properly, the intestines cannot tolerate food well. The brain is sometimes not properly constructed, which can cause bleeding.” Concerns about social security and living environment are important factors that will be added later, especially in NPLV neighborhoods. “It is a sum of factors,” says Been.
The researchers used data from about 1.1 million mothers in Perined, a national registry where about 97 percent of pregnancies (after 22 weeks) are registered. They compared figures between 2015 and 2021, before the NPLV program began. These figures serve as a ‘baseline measurement’, Been explains, so that researchers can see in a number of years what effect the government interventions have had. Factors that can predict risks at a personal level have been filtered out of the results. For example, an older mother is more likely to develop complications than a young mother. This has been taken into account.
When people think of vulnerable neighborhoods, they quickly think of adults, says Been. But the differences begin at birth, “or even before,” and continue later in life. It is one of the reasons why the Promising Start program was set up by the government in 2018, says Been. “To connect social care with medical care” and with the aim of laying a better foundation for a healthy life in a child’s first thousand days.
Gynecologist Steegers believes that ministries, municipalities, companies, banks and knowledge organizations should work together to increase the chances of babies from NPLV areas. “Care providers must start identifying poor living conditions” and call for help, he adds. Steegers: “Every doctor must pay attention to the social environment, not just the medical environment. You are responsible for the treatment of diseases and for their causes. That must become part of the quality of care.”
With the cooperation of Roos Liefting
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