measures. For example, studies indicate that a representative MNC workforce that enables provider-woman concordance,[202] and education on implicit bias contribute to equitable MNC.[231] Final conclusions Risk selection in MNC is necessary to ensure women and their children receive the right care, from the right professional, at the right place, and at the right time. Although risk selection has contributed to the lowest maternal and perinatal death rates in history, studies indicate a misalignment between the care that is necessary and the care that is delivered. The findings of the studies included in this dissertation offer a more comprehensive understanding of risk selection and the ways to optimize it. Our scoping review into the concept of risk selection showed that risk selection in MNC is professional-centred and focused on avoiding the underuse of care. It is an organizational measure, a practice, and a tool. Our historical study showed the political nature of risk selection, with decisions being determined not only by professionals’ understanding of risk but also by concerns with protecting their interests. Our exploration of MRS identified three models, which differed in the role of midwives and obstetricians. Our studies into the practice of risk selection showed that the probability of perinatal mortality depends on the number of maternal characteristics taken into account and found substantial variation in recommendations for care in hospital protocols for neonatal referral. Taken together, these findings show how the subjectivity of, and blind spots in, risk selection limit its effectiveness. Risk selection is a subjective process and is understood predominantly in terms of pathology. The subjectivity of risk can lead to ineffective risk selection, resulting in both the underuse and overuse of care, disparities in care, and disrespectful care. From this perspective, risk emerges not from the pregnant and birthing body, but from the MNC framing and managing of pregnancy and birth as risky, largely in response to pressures to account for MNC failure. Optimising risk selection requires rethinking of our understanding of risk selection in a way that appreciates its subjective and complex character. A broader conception of risk selection will centre its focus on women and will foreground prevention by taking into account the need to support physiology, to address societally-generated risks, and to prevent risks generated by MNC itself. 175 7 GENERAL DISCUSSION