Reproductive health care in The Netherlands: would integration improve it?

Since the 1994 ICPD, relatively little attention has been given to constraints in improving reproductive health programmes in industrialised countries. The Netherlands is known for its low rates of unwanted pregnancy, safe and accessible abortion services, low perinatal and maternal mortality and well-developed programmes for adolescent sexual health, but recent studies show a rising incidence of abortions and STDs, particularly among young people and immigrants. This article describes reproductive health services in the Netherlands, their historical roots and current constellation, including services for family planning, abortion, STDs, infertility, information, education and counselling on sexuality, and antenatal and delivery care, in the context of cost containment and other recent reforms. It shows that although these core components are well covered and the system of reimbursement for costs has greatly helped to increase accessibility, they are not all well integrated into the primary health care system. In some cases, they are well covered by other providers, such as midwives. Prevention and management of STDs and infertility, however, are particularly split between different providers and in some cases the extent and quality of service provision is lacking. What emerges is a still fragmented landscape--with many successes but also some significant shortcomings.