live, learn, work, and grow that have effects on their health risks and outcomes. Key areas include healthcare access and quality, education access and quality, social and community conditions, economic stability, and neighbourhood and built environment. Data suggest that these social determinants attribute up to half of poor health outcomes.[190–192] Our study into the association between maternal characteristics and foetal and neonatal mortality highlights disparities based on ethnicity and SES in the Netherlands. The intersectional analysis demonstrates the interaction between these social determinants and maternal age and parity. The association between these social and biological determinants is complicated. Our analyses show that high-SES does not mitigate risk for poor health outcomes among women with a non-Dutch migration background.[192–194] Also, high parity, non-Dutch migration background and low-SES are associated with higher risk of fetal and neonatal mortality. However, high parity is also associated with non-Dutch migration background and low-SES. These interactions make it difficult to determine the root cause of mortality.[186,189] Our study resonates with other Dutch and international studies showing ethnic, racial, and socioeconomic disparities to be present in maternal and newborn outcomes during the Covid-19 pandemic,[84,195] and in the severity and persistence of obstetric racism. [135,153,196] Research indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population.[197] When it comes to skin colour, for example, most health care professionals have implicit biases against non-white-skinned individuals. Studies suggest that black professionals are less likely to demonstrate implicit bias.[198] Women of colour describe perceptions of stereotyping by professionals, such as the assumption that black pregnant women are single, poor, and uneducated,[199] which may lead them to avoid care.[95,199–201] Furthermore, studies suggest that professional-neonatal racial category concordance is associated with a significantly lower neonatal mortality.[202] Nevertheless, discrimination and racism are often not named as contributors to health inequities.[203–205] The two main risk factors for perinatal mortality associated with ethnicity and SES are preterm birth and intrauterine growth restriction.[206–208] These conditions are hard to predict and there are no effective treatments for them in pregnancy, making them difficult to prevent after women have entered MNC services. This problem is compounded by the effect of inequity in the health of women at the molecular level, which results in intergenerational risk transmission.[209–213] In the contemporary conception of risk selection these and other risks of perinatal mortality rooted in society are reduced to individual problems and treated from a biomedical perspective. This individualization of risk can be found in the many measures taken to 170 7 CHAPTER 7
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