Determinants affecting pregnant women's utilization of prenatal screening for Down syndrome: a review of the literature

Objective: Uptake rates for Down syndrome screening (DSS) in the Netherlands are low compared with those in Northern European countries (27% versus 61% in the United Kingdom and 90% in Denmark). These differences are unexpected, especially since the countries have similar cultural and social values. Method: To analyse factors that underlie differences in uptake we reviewed current literature on individual characteristics and healthcare system factors, which determine potential influential factors on utilization of DSS. Results: Arguments "Against abortion'' and "Down syndrome (DS) not severe enough condition to terminate pregnancy'' correlated with declining DSS, whereas "Perceived guidance of healthcare professional,'' "Perceived negative attitude of society towards DS'' and "Preparation/Early termination'' correlated with accepting DSS. However, the majority of determinants were used both in favour of accepting or declining DSS. Conclusions: Decision making regarding DSS seems a process with influences on different levels and subtle interactions rather than a dichotomous process. Utilization may also be influenced by the implicit way it is being offered, as an extra option or as part of routine care and how this offer is perceived by the social environment. Finally, national healthcare system characteristics, although underrepresented in the examined studies, may also influence participation in DSS.