Summary In this dissertation, we studied risk selection in maternal and newborn care (MNC). Chapter 1, the general introduction to this dissertation, begins by pointing to an interesting phenomenon: while contemporary risk selection has contributed to the lowest maternal and perinatal death rates in history, a misalignment between the care that is necessary and the care that is delivered remains, leading to unwarranted variation in care, the underuse and overuse of medical interventions, care disparities, and disrespectful care. To better understand this misalignment, I explore the genealogy of contemporary risk selection in MNC, starting with the origins of the term ‘risk’ and moving on to describe how changes in societal understandings of risk in high-income countries have shaped contemporary risk selection in MNC. The chapter concludes with the central research question of this dissertation: what is the nature of, and variation in, risk selection? To answer this research question, we conducted five studies, analysing (1) the concept of risk selection in MNC, and (2) the history, (3) the organisation, and (4 and 5) the practice of risk selection in MNC in the Netherlands. In chapter 2, we report the results of a scoping review of the concept of risk selection in MNC. We systematically searched the scientific literature to study how is risk selection conceptualized internationally. We included 210 papers, published over the past four decades, originating from 24 countries. We used inductive thematic analysis to identify key dimensions of risk selection. This study lays the groundwork for a shared conceptualisation of risk selection. We found that while different definitions of risk were used in the papers included in our review those definitions had at least two common elements: first, risk is often used as a proxy for establishing the needs of women and children, and second, risk is generally associated with pathology. Our analysis identified three main dimensions of risk selection: (1) risk selection as an organisational measure to optimally align women’s and children’s needs and resources, (2) risk selection as a practice to detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as a tool to ensure safe care. We found that these three dimensions have three themes in common: risk selection (1) is viewed as both requiring and providing regulation, (2) has a provider centred focus and (3) aims to avoid underuse of care. The literature lacks a comprehensive understanding of risk selection that includes consideration of disparities in access to care, the needs of women in terms other than pathology, and the problem of the overuse of care. In chapter 3, we examine the systemof risk selection used in the Netherlands in its historical context, studying why and how midwives in the Netherlands gained their position as gatekeepers to specialist care. The existing system of risk selection in the Netherlands was based on the work of the 1983-1987 Study Group for the Revision of the Kloosterman List 10 SUMMARY
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