Routinization of prenatal screening: Women's perspectives on decision making about screening uptake

Abstract

Background. Prenatal screening programs, in which screening is routinely offered to all pregnant women, have been implemented in a number of regions in Canada and other countries. Such programs are typically marketed as having the goal of providing women with the opportunity to make an informed choice about screening. Studies have suggested, however, that structural and cultural factors related to the rise of surveillance medicine have combined to effectively routinize the offer and uptake of prenatal screening, potentially hindering the capacity to ensure true autonomy and informed choice for women. Purpose. This study was conducted to explore the concept of the routinization of prenatal screening by examining women's accounts of their decision making about accepting or declining prenatal screening and what judgments they made about the value of prenatal screening for themselves and others. Methods. This was a descriptive, exploratory study using qualitative research methods for data collection and analysis. Data were collected from 18 women who had delivered healthy babies using semi-structured interviews. Both data collection and analysis were conducted using methods of Grounded Theory. Results. Routine uptake of prenatal screening was described by many women. Themes arising from interviews included: the recognition of choice and/or the need for deliberation; the ways in which prenatal screening is presented; the value placed on the information provided by screening; varying conceptions of risk; and the relationships between prenatal screening, abortion, disability, and responsibility. Conclusions. Factors contributing to the routinization of prenatal screening operate at a variety of levels: individual, structural, and cultural. Further research is needed to clarify and quantify the effects of routine acceptance of screening on women and their families, and to determine the most effective and appropriate ways of ensuring that women's choices are truly informed and deliberated.