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Ethnic differences in informed decision-making about prenatal screening for Down syndrome
  1. Mirjam Fransen1,
  2. Marie-Louise Essink-Bot2,
  3. Ineke Vogel1,
  4. Johan P Mackenbach1,
  5. Eric Steegers1,
  6. Hajo Wildschut1
  1. 1 Erasmus MC, University Medical Center Rotterdam, Netherlands;
  2. 2 Academic Medical Centre, University of Amsterdam, Netherlands
  1. * Corresponding author; email: m.fransen{at}


Background: The aim of this study was to assess ethnic variations in informed decision-making about prenatal screening for Down syndrome and to examine the contribution of background and decision-making variables.

Methods: Pregnant women from Dutch, Turkish and Surinamese origin were recruited between 2006 and 2008 from community midwifery or obstetrical practices in the Netherlands. Each woman was personally interviewed 3 weeks (mean) after booking for prenatal care. Knowledge, attitude and participation in prenatal screening were assessed following the ‘Multidimensional Measure of Informed Choice’ that has been developed and applied in the UK.

Results: In total, 71% of the Dutch women were classified as informed decision-makers compared to 5% of the Turkish and 26% of the Surinamese women. Differences between Surinamese and Dutch women could to a large extent be attributed to differences in educational level and age. Differences between Dutch and Turkish women could mainly be attributed to differences in language skills and gender emancipation.

Conclusion: Women from ethnic minority groups less often made an informed decision whether or not to participate in prenatal screening. Interventions to decrease these ethnic differences should first of all be aimed at overcoming language barriers and increasing comprehension among women with a low education level. To further develop diversity-sensitive strategies for counseling it should be investigated how women from different ethnic backgrounds value informed decision-making in prenatal screening, what decision-relevant knowledge they need, and what they take into account when considering participation in prenatal screening.

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