provider requires an understanding of the arguments underlying the design of a system of risk selection. The existing system of risk selection in the Netherlands was based on the work of the 1987 Study Group for the Revision of the Kloosterman List (SGKL), a committee comprised of representatives from all professions and organisations involved in Dutch MNC. This committee formally granted community-based primary care midwives the authority to autonomously conduct risk selection. Until now, there was no thorough explanation of how and why the SGKL granted midwives this authority. In Chapter 2, we examine the system of risk selection used in the Netherlands in its historical context. We analysed the minutes of the SGKL’s meetings and conducted interviews with eight key-informants who were involved in the SGKL’s decision process. We used theories of professional jurisdiction and cultural theories of risk to analyse the factors that played a role in redefining the division of tasks and responsibilities in risk selection. The results of this study offer insight into how the authority to undertake risk selection is negotiated at the political and regulatory level. Chapter 3: The organization of risk selection The lack of knowledge about the best way to organize risk selection has opened the door to experiments with different MRS in the Netherlands. As a result of experiments with MRS, obstetricians in some regions became routinely involved in the assessment and decision making process, although their tasks, responsibilities, and authority varied considerably. In other regions, primary care midwives’ tasks, responsibilities and authority were extended to women with a high-risk profile. Little is known about these MRS. In chapter 3, we studied the MRS using a nationwide survey amongst all primary midwifery care practices and obstetric departments. The results of this study offer an in-depth understanding of MRS that is necessary to compare and evaluate risk-based selection systems. Chapter 4 and 5: The effectiveness of the practice risk selection Lack of knowledge about the effectiveness of the practice of risk selection hinders efforts to optimize the practice of risk selection. We studied the effectiveness of the practice of risk selection by researching the risk factors that inform the selection process and the protocols that are used to support that process. The results of our studies offer insight into the ways the accuracy of risk selection can be improved. Parity and age are increasingly used as single indicators for induction of labour of otherwise healthy women. In chapter 4, we studied the effectiveness of this risk selection practice by analysing whether consideration of additional maternal characteristics associated with perinatal mortality in addition to gestational age in the selection process would more accurately identify births that would benefit from induction of labour. We examined perinatal mortality rates for each gestational week at term, by maternal ethnicity, age, parity, and socioeconomic status, investigating the interaction between these 28 1 CHAPTER 1