WOMENS DECISION-MAKING IN PRENATAL SCREENING

With serum screening (MS-AFP and hCG testing for Down's syndrome) wome n have to make several decisions in a limited time: whether to partici pate in the screening in the first place; then, if increased risk for fetal abnormality is detected, whether to have a diagnostic test, and finally, what to do if fetal abnormality is detected. The aim of this study was to examine how women themselves in an unselected population describe their decision-making in the different phases of serum screen ing. Women receiving a positive result from serum screening in two Fin nish towns from September 1993 to March 1994 and a group of individual ly matched controls were invited to semistructured interviews; 45 inde x and 46 control women (79% of those invited) participated between the ir 29th and 37th weeks of gestation (mean 31 weeks). Although serum sc reening was most often presented as voluntary or as an option, half th e women described participation as a routine or self-evident act; only one-fourth of the women described actively deciding about participati on. After a positive screening result, women's reactions to diagnostic tests, and their intentions if disability would be detected, varied g reatly. Most of the women actively decided about having diagnostic tes ts, but for 23% participation in diagnostic testing was called a self- evident act. Women's intentions regarding abortion varied from a firm decision to abort to a firm decision not to abort, and many remained a mbivalent. Prenatal screening, which demands the making of several dec isions in a limited time and is offered to all pregnant women as part of established maternity care, is not based on every participant's act ive decision-making and thus creates an ethical problem. This problem should receive special attention from those who develop, introduce and decide on new health care practices. (C) 1998 Elsevier Science Ltd. A il rights reserved.