Participation in prenatal screening tests and intentions concerning selective termination in Finnish maternity care

Aims: The study examined how prenatal screening tests are presented to wome n, factors associated with women's participation in screening, their experi ence of decision-making and intentions concerning pregnancy termination, an d hospital data on rates of selective terminations. Methods: Questionnaires were given to pregnant women visiting maternity centres in two Finnish tow ns in which serum screening was offered (n = 1,035) and in one town where m idtrimester ultrasound screening was offered (n = 497). Response rates to t he questionnaires were 88 and 85%, respectively. Other questionnaires askin g about selective terminations following detected fetal disorders were sent in 1993 to all public hospitals with obstetrics or gynaecology departments (response rate 100%). Results: The serum screening test had usually been o ffered to women as a free choice, but for 22% of them it was presented as a routine procedure. Most women (92%) underwent serum screening and most (86 %) found the decision to participate or not easy. In almost every aspect of presentation and participation studied, serum and ultrasound screening dif fered from each other. 85% of respondents to ultrasound screening answered that it was offered as a routine procedure. Close acquaintance with a perso n with congenital disability was negatively associated with participation i n serum screening and with the intention to terminate pregnancy in case of a detected disability. 27% of women in the serum screening survey and 22% i n the ultrasound survey declared that they would have declined pregnancy te rmination if a fetal disorder had been detected. However, according to the hospitals' data, only 13% of pregnancies with a serious fetal disorder dete cted were continued. Conclusions: All prenatal screening tests, including u ltrasound examinations, require an adequate process of informed consent. Be cause the aim of such tests is to detect fetal malformations and syndromes, health care professionals should discuss the implications with women befor e they decide. Because acquaintance with a disabled person was found to ass ociate with participation in screening and with intentions about selective termination, women's perceptions of lives of the disabled should receive mo re attention in future studies.