Socio-cultural inequities in access to prenatal diagnosis: the role of insurance coverage and regulatory policies.
The article presents the results of a 4-month-period survey by questionnaire among all women attending the Marseille Centre for Prenatal Diagnosis for amniocentesis. Socio-cultural status of women getting access to amniocentesis is significantly higher than in the general population of pregnant women in the same geographic area of south-eastern France. Socio-cultural status is also higher among women who have to cover costs of procedure to get access to amniocentesis than among those who benefit from it free-of-charge according to French Social Security regulations. In contrast, risk perception and attitudes toward termination of pregnancy are similar in these two groups. A total of 24.4 per cent of respondents declared that they got access to amniocentesis 'on their own initiative', the remaining 75.6 per cent declaring that they 'were following medical advice'. Multidimensional analysis shows that the women who do not benefit from free-of-charge amniocentesis, and who have a high level of education and no antecedents of fetal and perinatal deaths, are more likely to perceive themselves as 'self-referring'. The study indicates that institutional coverage may be effective in reducing socio-cultural inequities in access to prenatal diagnosis. But such a policy may conflict with the respect of women's individual autonomy in the amniocentesis decision.
Moatti
J P
JP
INSERM Research Unit 240 on Risk Assessment and Evaluation of Prevention, Fontenay aux Roses, France.
Le Gales
C
C
Julian
C
C
Durbec
J P
JP
Mattei
J F
JF
Ayme
S
S
D000328:Adult; D000649:Amniocentesis / Q000191:economics*; D002869:Chromosome Aberrations / Q000175:diagnosis; D025063:Chromosome Disorders; D003469:Culture; D004522:Educational Status; D005260:Female; D005602:France; D005865:Gestational Age; D006801:Humans; D007348:Insurance, Health; D009790:Occupations; D010298:Parity; D010342:Patient Acceptance of Health Care; D018579:Patient Selection; D026684:Personal Autonomy; D011247:Pregnancy; D037841:Pregnant People; D012044:Regression Analysis; D012067:Religion; D040841:Resource Allocation; D012306:Risk; D012923:Social Class; D012945:Social Values; D011795:Surveys and Questionnaires