Esmee from Tilburg is homeless, drug addicted and works as a prostitute. Twice she became pregnant and twice her baby was taken from her. Seven institutions were involved. But one of her supervisors, Connie Rijlaarsdam, was able to prevent Esmee from getting pregnant again. She turned it into a project and it is now so successful that the whole country is working on it.
In 2014, ‘Not pregnant now’ started in Tilburg. 175 municipalities are now working with it. That is half of all municipalities in our country. The rest will follow, because the program is now nationally on the map. The project entails that care providers discuss a possible desire to have children and contraception with people who have complex problems. For example, addicts or people with serious psychological problems.
It all started with nurse Connie Rijlaarsdam, who was working at the GGD in Tilburg at the time: “If someone who has complicated problems becomes pregnant, we as a care provider think something of it. But why don’t we think of it before then? Because none of us had ever asked Esmee if she wanted to have children.”
“How is that possible? You are taking my child away!”
But Esmee was not waiting for that question at all, Connie discovered: “You bitch! How is that possible?! You are taking my children away!” she was told.
But Connie didn’t give up. She started the conversation, over and over. Through those conversations, Esmee came to realize that if she doesn’t want to have children now, a contraceptive is better: “At one point I met her in the city. “I want that IUD now,” she said. I thought: then I have to arrange it now. I called her gynecologist and she said: come on. So she had an IUD within two hours.”
Esmee is still protected against new pregnancies. And the relationship with her care providers has gone to a ‘good enough’, according to Connie.
Connie’s action attracted the attention of Tilburg alderman Marcelle Hendrickx. She became ambassador of the project and donated money for the trial. Then the ball started rolling.
“We want vulnerable people to make a conscious choice.”
Marcelle wants to clear up a misunderstanding. Because it is certainly not the intention of the program to take away a wish to have children: “That’s not what this is about at all. We also want people in a vulnerable position to be able to make an informed choice. That they consciously decide on a wish to have children. Because if you accidentally get pregnant in that situation, it causes an incredible amount of misery in the lives of themselves and the children.”
Connie: “I spoke to a woman who had unintentionally become pregnant five times, and a child was removed from her home five times. She said, ‘That conversation was never with me.’”
“A man was afraid he would become impotent with sterilization.”
And another misunderstanding: “We also talk to men”, says Connie. “I spoke to a man who was afraid that sterilization would render him impotent. I sent him to the doctor. When he came back, he said, ‘Do you know that that doctor was sterilized himself? No problem at all!’”
More than 15,000 such conversations have now been held, with people who are homeless or addicted, have an intellectual disability, psychological problems or debts. Three quarters of them have taken measures to prevent them from becoming pregnant.
This prevented a lot of suffering, say Marcelle and Connie. But an enormous amount of money has also been saved: no out-of-home placement, care for parents or the baby that comes into the world with an addiction.
Connie has now noticed that postponement is not an option: “I got in touch again with a woman who said: ‘I have my life on track now, I do want a baby now.’ And she has a child. And I could say with confidence: how nice for you. And honestly give her that too.”