Low uptake of prenatal screening for Down syndrome in minority ethnic groups and socially deprived groups: a reflection of women's attitudes or a failure to facilitate informed choices?

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Abstract
Background It is not known if lower uptake of prenatal screening for Down syndrome in women from minority ethnic groups and socioeconomically disadvantaged women reflects more negative attitudes towards undergoing the test or women not acting in line with their attitudes i.e. not making an informed choice. Methods Uptake of prenatal screening, attitudes towards undergoing the test, uptake-attitude consistency, and informed choice were assessed in a prospective study of 1499 pregnant women attending two UK hospitals. Results Uptake was higher in white and socioeconomically advantaged women than in other women. There were no differences in attitudes towards undergoing the test; all women expressed relatively positive attitudes. Uptake-attitude consistency was higher in white and socioeconomically advantaged women than others, particularly in those with positive attitudes towards undergoing the test (76% white women with positive attitudes had the test compared with 45% South Asian women [difference 31%, 95% confidence interval (95% CI) 18–43] and 78% socioeconomically advantaged women compared with 63% more disadvantaged women (difference 15%, 95% CI 7–24)). Controlling for demographic variables, South Asian and socioeconomically disadvantaged women with positive attitudes were less likely to make an informed choice than other women [odds ratio (OR) 0.22, 95% CI 0.10–0.45 and OR 0.62, 95% CI 0.41–0.93, respectively]. Conclusion Lower uptake of screening for Down syndrome in women from minority ethnic groups and socioeconomically disadvantaged women does not reflect more negative attitudes towards screening but rather lower rates of informed choice, as assessed in this study. Healthcare systems appear to facilitate informed choices in the context of prenatal screening for Down syndrome screening less well for women from minority ethnic groups and those who are socioeconomically disadvantaged than for other women.