Inequalities in the reported offer and uptake of antenatal screening

Summary 

Objective

The objective of this study was to identify whether there is a different pattern of reported offer and uptake of antenatal screening tests across social groups.

Design

Prospective cohort study.

Setting

Two large maternity hospitals in Northern Ireland.

Sample

Women booking for antenatal care were recruited consecutively over a 3-month period commencing 1 September 2003. In total, 711 women were recruited at booking: 359 at Hospital 1 and 352 at Hospital 2. Six hundred and sixty-six women completed both interviews.

Methods

Two semi-structured interviews were arranged with consenting participants. The first interview was conducted at the booking appointment, and the second interview took place after 23 weeks of gestation after all screening, including anomaly ultrasound, would have been offered.

Main outcome measures

Reported offer and uptake of all screening tests were explored in relation to key sociodemographic indicators: level of education; mother's occupation; partner's occupation; single parent status; car ownership; religious denomination; and Townsend Deprivation Index.

Results

With the exception of screening for Down's syndrome and neural tube defects, virtually all of the women were offered and underwent screening tests. Further analysis of data from Hospital 1 showed that, after controlling for other sociodemographic factors, women with a lower level of education had a lower odds of reporting Down's syndrome screening being offered Down's syndrome screening. Women having private antenatal care had a higher odds of accepting the offer of a test for Down's syndrome.

Conclusions

While the majority of antenatal screening tests are offered to all pregnant women in Northern Ireland, screening for Down's syndrome and NTD reflects a different pattern of offer and uptake. This paper provides evidence of variations in offer and uptake that exist even when it is hospital policy to offer screening to all women.

Keywords: Inequality, Test offer, Test uptake, Antenatal screening