Factors Affecting the Use of Prenatal Testing for Fetal Anomalities in a Traditional Society

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Abstract
The Bedouin Arabs of the southern part of Israel are a community at increased risk for genetic diseases and congenital anomalies as a result of frequent consanguineous marriages and underutilization of prenatal tests to detect fetal anomalies. Objective: To investigate factors affecting the use of prenatal tests to detect fetal anomalies in a traditional non-western minority who is offered modern western-type prenatal care services. Method: Demographic and obstetric data, medical family history and information about utilization of mother and child health (MCH) clinics and of prenatal tests to detect fetal anomalies was obtained for all Bedouin women living in 4 towns who gave birth in the regional hospital between September 1994 and February 1995. Univariate and multivariate analyses were used to find which factors may be contributing to increased utilization of these services. Results: Multivariate analysis among multigravidae showed that the main factors associated with undergoing at least one prenatal test to detect fetal anomalies were: having no children following pregnancy loss(es) (OR = 5.47, 95% confidence interval [2.00; 15.00]) or having only one previous child (OR = 1.67 [1.16; 2.42]), raising a child with a congenital anomaly, genetic or chronic disease (OR = 3.38 [1.81; 6.33]), chronic diseases among close relatives (OR = 1.83 [1.17; 2.87]), and holding a job (OR = 2.86 [1.00; 8.20]). Perinatal mortality in previous pregnancies or a later child loss as well as reported congenital diseases in close relatives were not significantly associated with increased uptake of prenatal tests. After controlling for age, no difference in utilization indices was found between primigravidae and multigravidae. Conclusions: Failures of previous pregnancies, personal experience of coping with a child affected by a chronic condition, exposure to western culture in general, and continued positive contact with modern health services are proposed as possible underlying factors affecting uptake of prenatal tests to detect fetal anomalies.