[Perinatal mortality in the Netherlands: everyone's problem and yet no one's problem].

In 1986, this journal published a paper showing that the rate of decline of perinatal mortality in the Netherlands was lower than in several other European countries. As a result, the Netherlands had lost its position as a country with one of the lowest perinatal mortality rates in the world. Since then, relatively little has happened to redress the situation, despite the fact that several studies have shown that the higher perinatal mortality rates are not due to registration artefacts, and that the quality of perinatal care in the Netherlands is lower than that in countries with lower perinatal mortality rates. In a recent analysis by the Rijksinstituut voor Volksgezondheid en Milieu (State Institute for Public Health and the Environment) it was estimated that between 20 and 25% of the difference between the perinatal mortality rates of the Netherlands and those of Sweden and Finland is due to the higher frequency in the Netherlands of five factors: multiple pregnancies (probably as a result of in-vitro fertilisation), smoking during pregnancy, pregnancies among non-western immigrants, no screening for congenital disorders, and (other) 'substandard' factors in perinatal care. Unfortunately, there are still no signs of a determined policy response. It seems that twenty years of working on the basis of the voluntary participation of many different organisations, and without clear leadership, have not produced the gain in perinatal mortality that would theoretically have been possible.