reduce disparities in perinatal mortality. These measures are not focused on primary prevention by addressing the larger societal causes, but centred around treatment with medical interventions, approaches that are controlled by, and available to professionals. Consequently, when professionals are confronted with the consequences of societal and institutional risks that do not originate within the body of the pregnant woman, they will resort to medical interventions, responding to those risks as if they are induced by pregnancy and birth. Paradoxically, this may cause more harm to women and their children and perpetuate the institutional sources of risk.[188,189,214] The ineffectiveness of the short termand individualised focus of risk selection is insufficiently taken into account in the contemporary conception of risk selection. This introduces a pathologization process,[215] (re)creating and concealing the harmful side effects of MNC itself, institutional risk factors of maternal and perinatal morbidity and mortality.[3,114] Take, for instance, the controversial recommendation in the draft NICE guidelines to induce all healthy women from ‘ethnic’ and ‘racial’ marginalised background at 39 weeks to prevent perinatal mortality.[216] Although IOL may prevent late-term perinatal mortality, it does not tackle the root causes of the disparity. Moreover, this policy stereotypes these women, individualizes their risk, medicalizes their births, limits their choices, and exposes those, who are already in vulnerable positions, to the risks of IOL.[217] In the Netherlands, similar approaches are applied to tackle larger societal causes of perinatal mortality. A clear example is the national action program ‘Promising Start’. This program was rolled out in 2018 to improve the outcomes of children born to “vulnerable women”. To offer the children of these “vulnerable women” a more “promising start” of their life, this program includes several interventions during pregnancy and birth focused on prevention. However, although these women are predominantly in a “vulnerable” position as a result of structural inequalities, the identified risks are individualized and medicalized. Furthermore, these interventions are one-time or short term interventions, such as a consultation to prevent unwanted pregnancy, a house visit froma child healthcare nurse during pregnancy, and a stress-reducing intervention where “vulnerable women” are encouraged to talk to their care providers about stress inducing events, such as financial problems.[218] Concern has been expressed about the lack of a clear definition of “vulnerable women”, allowing individual and stereotypical interpretations of professionals. [219] A sustainable attempt to improve the perinatal outcomes requires expansion from interventions only after women enter MNC services, toward efforts to address the larger structural causes of their societally rooted risks, such as poverty, unhealthy nutrition and living conditions, insufficient access to medical care, and systematic discrimination and racism.[220,221] This approach would offer the children of these women not only a “promising start”, but an equal start.[186,187] 171 7 GENERAL DISCUSSION
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