Improving perinatal care for migrants: A case study of Bulgarian women in the Netherlands

A guest post by Sterre Naaktgeboren, alumna of last year’s 2021-22 MPP cohort


Curious to learn more about the “wicked problem” of migration, I chose the Migration Studies Specialization of UNU-MERIT’s Master of Science in Public Policy and Human Development programme, where I decided to focus on the interconnections between migration and health. Since April 2023, I have been working as a PhD candidate and project management assistant at Radboud University in Nijmegen. During the upcoming years, I aim to contribute to the improvement of irregular migrants’ working conditions and access to basic rights and services.

In this blog post, I share some insights from my master’s thesis research.

Bulgarian Migrant Women’s Access to, Utilization of and Quality of Perinatal Care in the Netherlands

About a year ago, Marjolein Keij (Senior Project Leader and Advisor Youth at Pharos, the Dutch Centre of Expertise on Health Disparities) received signals from some healthcare professionals about the unusual healthcare utilization behavior of pregnant Bulgarian migrants. When delving into scientific literature about migrants’ pregnancies in the Netherlands, I discovered that most studies focus on asylum seekers, refugees and migrants from countries like Morocco, Turkey and Suriname. Few studies, however, examine the perinatal (i.e., pregnancy-related) care provided to migrants from central and eastern European countries.

Therefore, I decided to write my master’s thesis on Bulgarian migrants’ access to, utilization of, and quality of perinatal care in the Netherlands. This project was supervised by both Dr. Michaella Vanore (UNU-MERIT/Maastricht University) and Marjolein Keij (Pharos). I conducted individual and group interviews with 12 perinatal healthcare professionals and 11 (formerly) pregnant Bulgarian migrant women in the Netherlands.


Key findings

  • A thematic analysis with Atlas.ti revealed that the Bulgarian population is highly diverse. That is why I concluded that Bulgarian women’ access to, utilization of and quality of care results from a complex interplay between Bulgarian women themselves, their social network, the healthcare professionals, and the health system at large.
  • From the care providers’ perspective, the findings suggest that women’s utilization behavior regularly deviates from Dutch standards. Some of the main causes for this utilization behavior related to language barriers, affordability issues and the lack of awareness of the Dutch (perinatal) healthcare system.
  • Many professionals went through great lengths to adapt their care to Bulgarian migrant women. Nevertheless, because of various reasons, a considerable number of healthcare professionals concluded that they cannot provide the quality of perinatal care that they would like to provide.
  • Contrary to healthcare professionals, the experiences of the Bulgarian women were largely positive. The Bulgarian frame of reference seemed to contribute to this positive evaluation.
  • One main point of improvement mentioned by Bulgarian women concerned the amount of information they received about the pregnancy and Dutch pregnancy-related services. Especially Bulgarian women’s lack of awareness of typically Dutch services like kraamzorg was a topic mentioned by many women.
  • Based on this study’s insights into the needs of healthcare professionals and Bulgarian migrant women, policy options related to further research, information provision and language barriers were proposed.



Besides the academic thesis, Pharos created a factsheet (in Dutch) about the pregnancies of Bulgarian migrants. I am thankful for this research experience and the incredible supervision by Dr Michaella Vanore (who brought out the best in me on both a personal and academic level) and Marjolein Keij (who helped me make this scientific project more inclusive and policy-relevant). If you have any questions or comments, feel free to reach out to me on LinkedIn!

My thesis can be found here.