Strengths and limitations A major strength of this dissertation is that risk selection was studied comprehensively, from different points of view and using different methods. To our knowledge all our studies contributed novel insights into risk selection in MNC. We were the first to study the concept of risk selection; to analyse the SGKL’s role in the existing system of risk selection in the Netherlands; to explore the organization of tasks and responsibilities of primary care midwives and obstetricians in risk selection across the Netherlands; to examine the association between multiple maternal characteristics and fetal and neonatal mortality in different gestational weeks at term in a healthy population; and to explore variation in local hospital protocols in the Netherlands for neonatal referral to the paediatrician. A broad and systematic search strategy and the inductive thematic data synthesis approach enabled us to obtain a broad and deep view of the operationalization of risk selection across the full scope of MNC. Grounded theory enabled us to not only understand how, but also why the existing system of risk selection in the Netherlands came to be. The use of a survey provided insight into the complexity of the organization of risk selection in theNetherlands. The intersectional analyses allowed us to capture the complexity of risk selection. All studies were conducted by a multidisciplinary research team and all studies included in this dissertation are open access, reducing the likelihood of publication bias.[222] Our studies do have limitations. We would have liked to include the perspectives of women on risk selection, but due to the constraints of time and funding this work fell outside the scope of this dissertation. The studies included in the scoping reviews were limited to high-income countries. Thus, not all our results are universally applicable.[223] The use of ethnicity and SES in our study of the association between maternal characteristics and foetal and neonatal mortality does not reflect the diverse and dynamic nature of ethnic and SES categories, and may contribute to the (re)production of the notion of ethnicity and SES as biological markers.[224,225] Although the variation found in MRS and protocols seem unwarranted, this will require further study. Implications for practice Our studies show that the contemporary understanding of risk selection is based on the presumption that risk is objective and is centred around risks generated from within the body, with no reference to the external conditions that can harm women and their children. This is the base used to align women’s needs and MNC. The efficacy of this base for risk selection is belied by unwarranted variation in care, the underuse and overuse of care, care disparities, and disrespectful care; it is a notion that impedes the inclusion of institutional risks and the implementation of women-centred care and prevention, all of which are necessary to optimize risk selection. To better align women and children’s needs, MNC requires a rethinking of our understanding of risk selection that appreciates 172 7 CHAPTER 7