School of Human and Social Sciences, University of West London, Paragon House, Boston Manor Road, Brentford, TW8 9GA, UK.
Sciences Po, Observatoire Sociologique du Changement, 27 rue Saint-Guillaume, 75007 Paris, France.
Midwifery. 2022 Jul;110:103351. doi: 10.1016/j.midw.2022.103351. Epub 2022 Apr 21.
The study aims to analyse the reasons underpinning women's refusal to undertake Down's syndrome screening (DSS) by maternal serum testing (MST).
A retrospective, mixed methods sequential approach was used. An online survey on women's experience of prenatal testing followed by in-depth interviews were conducted, with women over 18 years old, who had been pregnant within five years prior to the study. Altogether, 1726 responses were gathered, of which 217 related to women who had refused MST. The study compares the women who refused MST with women who accepted it on sociodemographic characteristics, the evolution and experience of the pregnancy, their knowledge about Down's syndrome (DS). It also utilises survey comments and five in-depth interviews to explore, using Thematic Analysis, the reasons for refusing MST.
To refuse MST is cognitively demanding. Indeed, women who refused MST were better educated, knew more about prenatal diagnosis sequences and DS than women who accepted it. This position is also emotionally challenging as women's interactions with practitioners can put them in difficult situations, where they have to defend their point of view. Reasons for refusing MST go beyond religious beliefs, negative attitudes towards abortion and/or medicalisation of pregnancy. Rather, women's position appears to be driven by a holistic conception of care-based monitoring, values of inclusivity and a desire to remain in control of their pregnancy.
It is essential that women feel accepted and supported in their choice to refuse MST. Consequently, it is important for professionals to remain cognisant of the diversity of factors underpinning women's decision, the pressure this position generates and the challenges that come with it.
本研究旨在分析导致女性拒绝接受母体血清筛查（MST）以进行唐氏综合征筛查（DSS）的原因。
采用回顾性混合方法序贯方法。对 18 岁以上、在研究前五年内怀孕的妇女进行了一项关于产前检测体验的在线调查，随后进行了深入访谈。共收集了 1726 份回复，其中 217 份与拒绝 MST 的女性有关。该研究比较了拒绝 MST 的女性与接受 MST 的女性在社会人口统计学特征、妊娠的演变和经历、对唐氏综合征（DS）的了解方面的差异。它还利用调查评论和五名深入访谈，使用主题分析，探讨拒绝 MST 的原因。
拒绝 MST 需要认知上的努力。事实上，拒绝 MST 的女性受教育程度更高，对产前诊断序列和 DS 的了解也多于接受 MST 的女性。这种立场在情感上也具有挑战性，因为女性与从业者的互动可能使她们处于困难的境地，她们必须为自己的观点辩护。拒绝 MST 的原因不仅限于宗教信仰、对堕胎的消极态度和/或怀孕的医学化。相反，女性的立场似乎是由基于关怀的监测的整体概念、包容性价值观以及对妊娠控制的渴望所驱动的。
重要的是，专业人员要接受和支持女性拒绝 MST 的选择。因此，专业人员必须始终意识到影响女性决策的因素的多样性、这种立场带来的压力以及随之而来的挑战。
