title: Low uptake of the combined test in The Netherlands--which factors contribute?
abstract: OBJECTIVE
  The aim of this study was to evaluate which of the following factors affect the uptake of the combined test (CT) in The Netherlands: women's socio-demographic background, attitude towards Down syndrome, attitude towards termination of pregnancy, counseling process, reimbursement policy, and knowledge on the aim of the CT.
  
  
  METHODS
  Cross-sectional survey in the Northwest (NW) and the Northeast (NE) region of The Netherlands.
  
  
  RESULTS
  Analyses were based on 820 questionnaires (73% response rate). Women from the NW region opted more often for the CT than women from the NE region (52.1% and 16.5%, respectively, p < 0.001). Women of 36 years and older opted more often for the CT than younger women (59.4% and 28.2%, respectively, p < 0.001). Women's socio-demographic background and their attitude towards Down syndrome and termination of pregnancy (TOP) had contributed independently on CT choice.
  
  
  CONCLUSIONS
  The uptake of the CT in this study is low. The main reason for the low uptake is the relatively positive attitude towards Down syndrome and a negative attitude towards TOP. Moreover, the perception of maternal age as strong predictor of Down syndrome risk and the inequality of access to care, due to the financial threshold for younger women, are likely to affect participation in screening.
authors.affiliation: Department of Obstetrics and Gynecology, Fetal Medicine Unit, University Medical Centre, Groningen, The Netherlands. merelbakker@gmail.com
authors.forename: Merel
authors.initials: M
authors.lastname: Bakker
authors.forename: Erwin
authors.initials: E
authors.lastname: Birnie
authors.forename: Eva
authors.initials: E
authors.lastname: Pajkrt
authors.forename: Caterina Maddalena
authors.initials: CM
authors.lastname: Bilardo
authors.forename: Rosalinde Johanna Maria
authors.initials: RJ
authors.lastname: Snijders
mesh_terms: D000028:Abortion, Induced / Q000523:psychology*; D000328:Adult; D003430:Cross-Sectional Studies; D004314:Down Syndrome / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D062145:Maternal Serum Screening Tests / Q000523:psychology / Q000706:statistics & numerical data*; D009426:Netherlands; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy