and the more effectively resources and needs can be aligned. Furthermore, the premise is that the needs identified will require medical interventions. This is evident in the rising intervention rates in high-income countries,[5–7] including the Netherlands.[8] Although the increased use of medical interventions has been associated with a reduction in maternal and perinatal mortality and morbidity, the studies by Renfrew and colleagues (2014) point out, rather paradoxically, that a selection system informed by a pathology focused understanding of risk serves a minority of women instead of providing effective care for all, and may induce harm.[9] Medical interventions can have adverse side effects. [3,10] Over an optimum threshold, the disadvantages of medical interventions outweigh the advantages.[11–14] Nevertheless, the problem of overuse of care and unnecessary medical interventions receives little attention in contemporary risk selection. Due to the pathology-centred conception of need, resources will be predominantly allocated towards screening, diagnosis, interventions, and hospital based, high-level, specialized, and acute services.[4,14] However, this approach draws resources away from practices focused on promotion of physiological reproductive processes that have been shown to strengthen women’s capabilities, prevent complications, and support and maintain health, like continuity of care,[15] and group prenatal care.[16,17] Furthermore, not all women have access to these services because they are not yet standard care. As such, these services are used less by marginalized women.[18–21] Also, the focus on pathology in risk selection may increase anxiety amongst women. Risk consciousness as a major aspect of everyday contemporary life,[22] and perceptions of risk during pregnancy have not significantly declined over time.[23] Labelling women to be ‘at risk’ may negatively affect their psychosocial state and maternal/fetal attachment.[24–27] It has been argued that in a pathology discourse, women may come to perceive the condition of pregnancy itself as a risky event.[26] The relativity of risk selection The interpretation of risk by women and professionals is influenced by the way information is framed and presented. Risks can be expressed in several ways. Consider, for example, the case of a non–Dutch, 35-39 year old woman in our study into the association between maternal characteristics and perinatal mortality. Here, risk can be explained in four different ways (table 1), each based on the same underlying data. But, as illustrated, each conveys a different perspective. 163 7 GENERAL DISCUSSION
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