How would you explain to a family member what your research is about?
“I would explain that, despite high-quality and subsidised health care, the Netherlands has high child morbidity and child mortality rates. Women living in disadvantaged neighbourhoods are four times more likely to see their children die than the average Dutchwoman, on a par with Albania. My research focused on what can be done about this, and who is responsible for doing it. In other words, who will look after the children-to-be?”
What is the main conclusion you drew?
“Most people seek to find solutions on the supply side, e.g. through doctors and other health professionals. But vulnerable pregnant women tend not to use the existing types of care, so they will have to be motivated to start doing so. The effects of poverty get under people’s skin. My research shows that people have adaptive preferences, meaning they lower their expectations and believe they have fewer needs. If they want less from life, they are less likely to be disappointed. In a way, they are giving up. It stops them from seeking health care and causes them to feel like they are not in charge of their own pregnancy. If you have no job, are poorly educated and have seen your previous children removed from your custody, you won’t give a toss about whether or not to take folic acid. This being the case, the solution lies in empowering women, which is a bit of a buzzword these days. It means removing social barriers so as to give them intrinsic motivation. My PhD supervisor calls it social obstetrics.”
How did you encounter this subject?
“After studying jazz guitar at a conservatory, I studied Philosophy in Leiden and got a master degree in Applied Ethics in Utrecht. I did not aspire to a PhD, but I did want to teach at a university. That requires a PhD, so a professor drew my attention to several research projects open to PhD students, one of which was this. Initially, the study was to be about ethics and preconception care, but I wanted to broaden the question by determining who is responsible for unborn children.”
Did you ever have a difficult time of it during your years as a PhD student?
“All in all, it took me five years to complete everything – three years’ worth of research and two years’ worth of teaching in Rotterdam and Utrecht. PhD students at the Faculty of Medicine are required to publish articles. This means that you will be awarded a doctorate for several articles, to which you add an introduction and a conclusion. Four of these articles must have been published by highly ranked journals. At first I had a hard time with this because I hadn’t clearly delineated the scope of my research, which meant everything was progressing very slowly. It takes up a lot of additional time and it’s frustrating. If you come up with a subject yourself, you must be in it for the long haul, because you will encounter plenty of setbacks along the way.”
Are you confident that your dissertation will be able to make a difference?
“The real solutions lie at the institutional level, because poverty is not a medical issue. Child mortality in disadvantaged neighbourhoods is just one of the many ways in which poverty manifests itself. Poverty is about how we organise our country, how we deal with vulnerable people. These days we are all about being able to do things independently and being responsible for our own decisions. Women are expected to stop smoking and drinking on their own while pregnant. It’s a great idea in theory, but in actual practice, it’s quite hard for these women.
“My theory is that the government should look after vulnerable people. You can’t tell them that it’s their own fault they are poor. There is no scientific evidence for that whatsoever. What has been proven is that they are exposed to great risks due to their socioeconomic position. As far as that’s concerned, there is nothing moralistic about my argument. It’s a fact that these women have to fight harder to succeed than people who do not grow up poor.”
What’s on the cover?
“It’s a baby who has not yet been born, but who can be seen. It symbolises our responsibilities to children, which begin before the children are even born.”